Research Roundup - October 2017

California

New Law Challenges ‘Evils’ of Pharma Profits, California Governor Claims

By April Dembosky | Kaiser Health News | Oct. 9, 2017

The California Governor signed a sweeping drug price transparency bill that will force drugmakers to publicly justify big price hikes, according to Kaiser Health News. The new law will require drug companies to give 60 days’ notice to state agencies and health insurers anytime they plan to raise the price of a drug by 16 percent or more over two years on drugs with a wholesale cost of $40 or higher. They must also explain why the price increases are necessary. The bill drew support from a diverse coalition, including labor and consumer groups, the hospital industry and even health insurers. But some experts say that transparency alone is not enough to bring down drug prices, and that California’s law may lack the muscle being applied in other states to directly hold drug prices down.

Colorado

CO’s Pediatric Care Network Brings Value-Based Care to Children

By Jacqueline Belliveau | RevCycle Intelligence | Oct. 6, 2017

The quality measures used to reimburse Medicare providers for high-quality, cost-efficient care do not necessarily translate to a pediatric population. With collaboration in mind, the Pediatric Care Network, a clinically integrated network of more than 1,400 providers and the Children’s Hospital Colorado was established, according to a news article in RevCycle Intelligence. The network aimed to define value-based care in the pediatric space. To start the collaborative journey to value-based pediatrics, the network focused on increasing data sharing to gain a comprehensive view into the pediatric care continuum. The Pediatric Care Network intends to break down the data silos between private practices, hospitals, and other pediatric care centers.

NASHP Awards Grants to Colorado, Delaware, and Oklahoma to Tackle Rising Rx Drug Prices

By Jennifer Reck | National Academy for State Health Policy | Oct. 10, 2017

Colorado, Delaware and Oklahoma have received $300,000 in grants to help develop innovative policy solutions to tackle high prescription drug prices in their states, according to the National Academy for State Health Policy. The funds will help these states explore the following promising policy approaches: Colorado will develop a new payment system for physician-administered drugs; Delaware will develop a shared preferred drug list to maximize savings with agencies and hospitals; and Oklahoma will develop a value-based purchasing agreement.

Florida

Telehealth Final Report and Legislative Recommendations Approved

By Bill Bortzfield | WJCT | Oct. 17, 2017

The Florida state Telehealth Advisory Council unanimously approved a final report and legislative recommendations to remove barriers to the use of telehealth, according to a news article from WJCT. The report recommends that lawmakers require Florida health insurance plans, excluding Medicare plans, to provide reimbursement “parity” for health services provided through telehealth or in person. The report includes a limit on the recommendation to make clear that the legislature should “not require insurers to add additional service lines or specialties, mandate fee-for-service arrangements, inhibit value based payment programs, or limit healthcare insurers and practitioners from negotiating contractual coverage terms.”

New York

New York Borrows a Healthcare Idea from Africa   

By JoAnne Kenen | Politico | Oct. 25, 2017

In Africa and India, the idea of using non-traditional healthcare workers was born of necessity. They simply didn’t have the money or resources to do it any other way. Unlike sub-Saharan Africa, Upper Manhattan is rich in hospitals, medical schools and pricey specialists. But it’s poor in effective community-based primary care, particularly the kind of care that can reach into kitchens and living rooms of patients, according to a news article in Politico. City Health Works is a promising approach that differs from a lot of other health coaching or community groups. It was co-designed with clinicians in its community, from places like Mount Sinai Hospital, who are open to a team-based approach and who understand that peer workers can sometimes reach where a physician cannot.

Ohio

Microhospitals Could Add to the Mix of Healthcare Offerings in Central Ohio

By JoAnne Viviano | Columbus Dispatch | Oct. 10, 2017

Central Ohioans could soon see at least two new small hospitals as part of a nationwide trend. These so-called “microhospitals” typically have eight to 10 inpatient beds and such core services as emergency care, outpatient services, labs, imaging and pharmacies, according to a news article in The Columbus Dispatch. They target communities that might not need a full-blown facility. It’s a way to introduce a higher level of care to a community in a manner that is appropriate for the community size and healthcare needs. These facilities can be more cost-efficient than full-service hospitals for handling lower-acute needs.

Texas

Pfizer Loses Lawsuit Against Texas Agency that Provided Drug Cost Data to Senators

By Sabriya Rice | Dallas Morning News | Oct. 3, 2017

According to an article in Dallas Morning News, Texas legislators are entitled to details about how pharmaceutical giant Pfizer priced drugs offered through the state's Medicaid program after a judge’s ruling. State lawmakers have been seeking methods to offset soaring costs and generate hundreds of millions in savings from Medicaid programs.

For more state news and to get alerts for your state, visit the Hub website

Recent Reports

Low-Cost, High-Volume Health Services Contribute the Most to Unnecessary Health Spending

By John Mafi, et al. | Health Affairs | October 2017

An analysis of 44 low-value healthcare services in the Virginia all-payer claims database revealed more than $586 million in unnecessary costs in 2014. The study found that low-value, low-cost services drove the bulk of wasteful spending, accounting for nearly twice the spending as low-value, high0-cost services. Researchers assert that strategies to reduce waste should focus on low-value, low-cost services, as they are less controversial than low-value, high-cost services and can have a sizable impact on reducing unnecessary healthcare spending.

Coordination Program Reduced Acute Care Use and Increased Primary Care Visits among Frequent Emergency Care Users

By Roberta Capp, et al. | Health Affairs | October 2017

The Bridges to Care (B2C) program provides intensive medical, behavioral health and social care coordination services to emergency department (ED) “high-utilizers,” providing up to eight home visits within sixty days of an ED visit or hospital discharge from a primary care provider, care coordinator, health coach, behavioral health evaluator and community health worker. A study published in Health Affairs found that participation in B2C significantly reduced ED visits and significantly increased primary care visits among ED high-utilizers, including those with mental health comorbidities. Care coordination programs that incorporate behavioral health services and increase access to primary care show promise in reducing wasteful healthcare spending.

Persistent Frequent Emergency Department Use: Core Group Exhibits Extreme Levels of Use for More than a Decade

By Hemal Kanzaria, et al. | Health Affairs | October 2017

Frequent emergency department (ED) users represent 4-8 percent of ED patients, but they account for 21-28 percent of all ED visits, with significant associated costs. Many frequent users do not sustain high use over time, making it difficult to create targeted interventions to address their health needs. A report in Health Affairs studied nonelderly frequent ED users in California from 2005-2015, in attempt to identify characteristics of users who engage in intense ED use year after year. The study found that, compared to nonpersistent, frequent ED users, a higher proportion of persistent frequent users were female, non-Hispanic white or black, publicly insured and had a mental health diagnosis. Identifying and differentiating persistent frequent users is important, as they may be candidates for distinct interventions.

High-Deductible Health Plans Reduce Healthcare Cost and Utilization, Including Use of Needed Preventive Services

By Rajender Agarwal, Olena Mazurenko and Nir Menachemi | Health Affairs | October 2017

Current evidence suggests that high-deductible health plans (HDHPs) lower healthcare costs by reducing the use of health services, including those that are medically appropriate. A literature review in Health Affairs revealed that HDHPs were associated with a significant reduction in preventive care in seven of twelve studies and a significant reduction in office visits in six of eleven studies—leading to a reduction in both appropriate and inappropriate care. The studies also suggested that HDHPs may reduce appropriate preventive care and medication adherence. The majority of the studies did not consider important outcomes such as health status, morbidity, mortality or patient experience.

Out-of-Pocket Costs Often Keep Pricey New Cholesterol Drugs Out of Reach

By Michelle Andrews | Chicago Tribune | Oct. 4, 2017

Access to powerful new cholesterol-lowering drugs is so tightly controlled and patients' out-of-pocket costs are so high that less than a third of people whose doctors prescribe the drugs receive them, according to a report in the Chicago Tribune. While highly effective, the new drugs cost as much as $14,000 annually, leading some insurers and pharmacy benefit managers to require doctors to get preapproval for them. For example, only 47.2 percent of people who were prescribed the drugs Praluent and Repatha received that insurance green light, and just under two-thirds of those patients filled their prescriptions.

Doctors Feel Excluded from Health Care Value Effects

By Tim Van Biesen and Josh Weisbrod | Harvard Business Review | Oct. 6, 2017

A report in the Harvard Business Review looked at how U.S. hospitals and healthcare groups have experimented over the past decade with new management structures and alternative payment models to provide quality healthcare at lower cost. But physicians have been slow to embrace these for a host of reasons. Chief among them is that physicians feel excluded from the process. Authors recommend healthcare organizations bring physicians back into the decision-making process. After years of experimentation, doctors want evidence that new models for healthcare management, reimbursement and policy will actually improve clinical outcomes for their patients.

State Population Health Strategies that Make a Difference

By David Jones and Christopher Louis | Milbank Memorial Fund | Oct. 12, 2017

In an analysis of three state health scorecards, researchers identified states that had significant and sustained improvements in at least one key health outcome measure, according to a report from the Milbank Memorial Fund. Visits to these states to understand exactly how they achieved these improvements were the basis of companion reports. Georgia and Florida reduced infant mortality rates, while Delaware and Iowa reduced the burden of chronic disease. The researchers argue that the findings are generalizable and the roles and responsibilities identified for the public and private sectors can be used to address other healthcare issues in any state.

Visit these pages for background on strategies to address frequent ED utilizers, state roles in healthcare value and more!

Commentary/News

The Problem is the Prices: Opaque and Sky High Bills are Breaking Americans — and Our Healthcare System

By Sarah Kliff | Vox | Oct. 16, 2017

Nearly all hospitals charge emergency facility fees to patients seeking emergency room care, but the price varies enormously and is typically kept secret, reports Vox journalist Sarah Kliff. Beginning Oct. 16, Kliff and colleagues launched a campaign asking readers to submit hospital bills to assemble nationwide picture of emergency facility fees and expose exorbitant healthcare prices across the U.S. Kliff will report the findings on Vox’s website and in her new podcast, The Impact, a series exploring the big challenges in American healthcare through the lives of people who experience it. If you would like to participate, details can be found here.

Do Physicians Make Too Much Money?

By Peter Ubel | MedPage Today | October 3, 2017

 Healthcare spending in the U.S. is a major problem and soaring healthcare incomes are partly responsible argues Dr. Peter Ubel.  Having gone through the late nights, intense workloads and 80-hour work weeks to become a physician himself, Ubel argues that physicians deserve to be paid well, but questions just how much is too much. He does not just limit this notion to physicians, but includes executive administrators and others in the healthcare marketplace. With high healthcare spending burdening state and federal governments, as well as employers and patients, Ubel suggests several policies to combat the price of healthcare. For physician salaries he argues for malpractice reform and subsidized medical education so that healthcare professionals are not exposed to litigation debt and graduate with only modest debt, allowing them to take a job with modest pay.

Nudging Health: Health Law and Behavioral Economics

By Elizabeth Weeks Leonard | Health Law Jotwell | Sept. 5, 2017

This review of the book Nudging Health: Health Law and Behavioral Economics by Elizabeth Weeks Leonard offers insights to how the authors apply legal theory to health law and policy topics. The book is a compilation of forty-five essays that examine how behavioral science may be used to nudge health law and policy towards improved health and better healthcare spending. Weeks Leonard describes the book as an “essential reading for anyone interested in moving the health reform ball forward.”

MedPAC Targets Docs Who Sell – Physician-Owned Distributors Accused of Raising Costs and Promoting Unneeded Products

By Shannon Firth | MedPage Today | Oct. 6, 2017

MedPAC, a Medicare advisory panel, discussed how to stop physician-owned distributors from profiting excessively from medical device sales, according to MedPage Today. These physician-owned distributors are defined as “entities that derive revenue from selling or arranging for the sale of devices ordered by their physician owners for use in procedures the physician owners perform on their patients,” creating potentially large conflicts of interest and possible unnecessary Medicare billing. MedPac discussed the challenges and benefits to amending laws to close loopholes which allow for potential unethical behavior from physician-owned distributors.

U.S. Healthcare Reform Can’t Wait for Quality Measures to Be Perfect

By Brian Marcotte, et al. | Harvard Business Review | Oct. 4, 2017

Currently available quality measures are adequate to move forward with payment reform efforts, according to an article published in Harvard Business Review.  The authors argue: 1) even imperfect measurement and transparency will accelerate quality improvement; 2) only by using the measures can we improve the measurement; and 3) returning to a fee-for-service system is not an option because of the clear waste, cost and quality of care issues that are produced using this system. They argue that payment reform efforts must continue to move forward even with the risk of imperfect measurement.

Using Medicare Prices – Toward Equity and Affordability in the ACA Marketplace

By Zirui Song | New England Journal of Medicine | Oct. 18, 2017

A missing debate from the discussion on the future of the Affordable Care Act is reducing costs for participating insurers, for federal government and enrollees, according to this commentary the New England Journal of Medicine. The author suggests narrowing or closing the differences in prices paid for the same medical services that are billed to different federal programs. He argues that in order to have a well-functioning health insurance market competition is a requirement among both insurers and providers. By reducing the cost disparity between commercial and Medicare pricing it could increase competition in the marketplace, help improve equity and lead to a level of affordability.

CMS to Focus on Outcomes-Based Measures Going Forward

By Heather Landi | Healthcare Informatics | Oct. 30, 2017

A new approach to quality measurement by the Centers for Medicare & Medicaid Services called Meaning Measures was announced by CMS Administrator Seema Verma. The approach will assess only those measures that reflect the core issues that are vital to providing high quality care and improving patient outcomes. This approach will look to reduce the burden of reporting on all providers, increase efficiencies and improve the patient experience by going through each reporting requirement and asking the purpose of it, it is required, does it meaningfully impact patient outcomes, care or safety, and if it doesn’t why is it there.