Week of November 16-20, 2015


Strategy and the Health Care Marketplace
Everyone is calling for transparency in prices for health care services. If you could shop for health care services it is likely competition would improve quality and lower costs. But, as we all know too well, health care is not like shopping for computers, cars, or even electricians and contractors. There are almost no price information and limited quality data.  Why This California Hospital is a Model for Price and Quality Transparency, Forbes, 

As put forth in The McDonaldization of Society, “the principles of the fast-food restaurant are coming to dominate more and more sectors of American society,” including medicine. While designed to produce a rational system, the 4 basic principles of McDonaldization—efficiency, calculability, predictability, and control—often lead to adverse consequences. Without measures to counter McDonaldization, medicine’s most cherished and defining values including care for the individual and meaningful patient-physician relationships will be threatened.  JAMA Neurology, The McDonaldization of Medicine,

In a marked departure from healthcare’s current payment system, University of Vermont Medical Center CEO John R. Brumsted, MD, has revealed an ambitious goal to have 80 percent of all healthcare provided by the medical center tied to quality of care, instead of volume of services, by 2018.  UVMC has also partnered with Dartmouth Hitchcock Medical Center in leading a statewide accountable care organization in Vermont that over the last 3 years has saved millions of dollars and met or exceeded federal quality measures. Becker’s, UVMC CEO unveils goal for 80% value-based care by 2018,

Use of financial incentives to reduce low-density lipoprotein cholesterol (LDL-C) levels in primary care is effective only when patients and physicians share those incentives, suggests a cluster randomized trial published in this issue of JAMA, 

ACA Implementation
Senate Minority Leader Harry Reid on Thursday disputed GOP claims that the House-passed reconciliation bill can be rewritten in a way to repeal major portions of the 2010 health care law. Reid: Reconciliation Bill Can’t Repeal Health Care Law Mandates, CQ HealthBeat, 

Like the U.S. overall, Texas saw a decline in the number of children without health insurance in 2014. But supporters of the federal health care law say hostility to the Affordable Care Act is preventing the state—which still has the nation’s biggest population of uninsured kids—from making faster progress.
Slow Crawl to Insuring Kids in Texas, CQ HealthBeat,

The folks who run the health insurance marketplace, or exchange, in Massachusetts are using tax records to identify state residents who could benefit from, but haven’t yet signed up for, coverage under the federal health care law.  In California, exchange officials are touring the state in a bus to sign up uncovered Californians.
CQ HealthBeat, State Marketplaces Step Up Pursuit of Uninsured Groups, 

Starting in 2016, push comes to shove for small businesses under the Affordable Care Act, better known as Obamacare. As of January 1, small businesses, broadly defined as firms with 50 to 100 full-time employees, must comply with the ACA’s employer mandate and provide qualified health insurance to their workers or face stiff penalties. But this requirement poses a big threat to the financial stability of small employers—and not for the reasons you might think.
How Obamacare inadvertently threatens the financial health of small businesses, and what states should do about it, Brookings Institute,

Talk about targeted. Consumers scrolling through the health plan options on the insurance marketplaces in a few states this fall may come upon plans whose name — Leap Diabetes Plans — leaves no doubt about who should apply.  Offered by Aetna in four regions next year, the gold-level plans are tailored for the needs of people with diabetes.
New Health Plans Offer Discounts For Diabetes Care, Kaiser,

Administration Finalizes Regulations Implementing ACA Insurance Reforms, Health Affairs, 
Based on a survey of primary care clinicians in early 2015, this Visualizing Health Policy infographic examines the experiences and attitudes of primary care practitioners (PCPs) after the Affordable Care Act’s (ACA’s) major coverage provisions took effect in January 2014.
Experiences and Attitudes of Primary Care Practitioners After the ACA,

Millions of consumers who are enrolled this year could pay higher rates if they stay in the same health plan next year, according to a study released Wednesday by the Kaiser Family Foundation. Because the market can change rapidly in the first few years of its existence – particularly with new insurer entrants or exits, and swings in premiums as plans vie for market share – there is concern that those who passively renew may no longer be in the plan that is best suited for them.
Potential Savings from Actively Shopping for Marketplace Coverage in 2016, Kaiser, 

Health care costs are unaffordable for 25 percent of working-age adults with private insurance coverage, according to the new Commonwealth Fund Health Care Affordability Index, 

Enrollment in health insurance marketplaces is generally limited to annual open enrollment periods (OEPs). However, some events, such as termination of health coverage due to job loss, can qualify consumers for special enrollment periods (SEPs) that let them sign up for marketplace plans at other times. The authors of this research report estimate that fewer than 15 percent of these uninsured consumers are enrolling through SEPs for which they qualify.   Urban Institute/RWJF,

America’s Hospitals: Improving Quality and Safety The Joint Commission’s Annual Report 2015, View the report,
How Paris hospitals responded to last weekend’s terrorist attacks, Becker’s, 
Many Say High Deductibles Make Their Health Law Insurance All but Useless, NY Times, 
Three insurers agree to take NY Health Republic customers, Politico NY,
Supreme Court takes up major challenge to abortion restrictions, Washington Post, 
How nonprofit hospitals overcharge the (under and) uninsured, Washington Post, 
Preventable Colon Cancer Deaths Cost The Economy $6.4 Billion, NPR, 
Excessive OR traffic during surgeries leads to postoperative infections, News Medical,  
Elder Abuse, NEJM,
State Efforts to Reduce Consumers’ Cost-Sharing for Prescription Drugs, Commonwealth Fund,
Laboratory Developed Tests, FDA alert,
Supreme Court Won’t Hear Case Over Planned Parenthood Documents, NY Times,
CMS Initiative For Hip And Knee Replacements Supports Quality And Care Improvements For Medicare Beneficiaries, Health Affairs, 
Hospitals Seek Delay with CMS Hip-Knee Replacement Test Program, CQ HealthBeat,
Here’s How Hospitals Cheat Medicare, And Why They Should, Forbes
CMS to terminate Houston hospital’s Medicare contract, Becker’s,
Memorial Sloan-Kettering operating margin falls as labor costs grow. Becker’s,
Financing Long-Term Services And Supports: Options Reflect Trade-Offs For Older Americans And Federal Spending, Health Affairs,
UnitedHealth’s test of plan with no-charge primary care will be closely watched, Modern Healthcare
VA looks to revamp private care for veterans in ambitious plan, Washington Post,
UnitedHealth Group May Leave Obamacare Exchanges By 2017, Forbes,
How hospitals are prepping for Medicare’s mandatory bundled-pay test, Modern Healthcare, 



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