Week of November 23-27, 2015


Strategy and the Health Care Marketplace
Trinity Health, a Catholic health system with 88 hospitals, announced Thursday it will invest $80 million in six communities it serves over the next five years to improve public health, with a particular focus on obesity and tobacco use.
Read the press release here,

Medical practices are complex, and there’s no golden rule for achieving the perfect care setting. But physicians can take certain measures to ensure their practices are prepared for evolving technology, increased patient demands and shifting payment models, Bruce Bagley, MD, senior advisor to the professional satisfaction and practice sustainability effort at the American Medical Association (AMA), told a group of physicians at the 2015 AMA Interim Meeting.
Here are five things every practice will need to thrive.

ACA Implementation
The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services (CMS) broad authority to test out new payment models that have the potential to reduce Medicare spending, as long as those models preserve or enhance the quality of care provided to beneficiaries. Sylvia Mathews Burwell, secretary for health and human services, has committed to tying 50 percent of Medicare payments to these new alternative payment models by the end of 2018.  This brief from Health Affairs, describes the different models being tested and CMS’s experience with the project to date.
Bundled Payments for Care Improvement Initiative,

The CMS released a memo (PDF) late Thursday that reiterated the federal agency’s desire to pay out risk corridors payments despite the massive shortfall in the near term. The memo stated that if health insurers are still owed money under the risk corridors program for 2016, HHS “will explore other sources of funding for risk corridors payments, subject to the availability of appropriations.
Read the memo,

One-quarter of privately insured working-age adults have high health care cost burdens relative to their incomes in 2015, according to the Commonwealth Fund Health Care Affordability Index, a comprehensive measure of consumer health care costs. This figure, which is based on a nationally representative sample of people with private insurance who are mainly covered by employer plans, is statistically unchanged from 2014. How High Is America’s Health Care Cost Burden?
Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July–August 2015,

Nearing the one year anniversary of the Administration’s announcement for the future of the Medicare program, including clear goals and a timeline for shifting Medicare payments from volume to value, CMS is actively working to turn the vision into reality. In a blog post, CMS Acting Principal Deputy Administrator, Chief Medical Officer, and Director of the CMS Innovation Center, Dr. Patrick Conway, reflects on the progress towards transforming our healthcare system into one that is better, smarter, and results in healthier people.
Continuing the shift from volume to results in American healthcare,

Proposed mergers in the health insurance industry and consolidation occurring among hospitals and physician groups are raising alarms that major premium and price increases are soon to follow. In a new Commonwealth Fund issue brief, Northwestern University health care economist Leemore S. Dafny reviews the recent history of insurer consolidation, finding that mergers tend to lead to premium increases, despite the lower provider prices those carriers with large local market shares are generally able to command.
Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience,

A new guide from the United Hospital Fund distills information about the State’s value-based payment roadmap for several critical audiences, including health care providers, health plans, policymakers, and other Medicaid stakeholders. The guide Navigating the New York State Value-Based Payment Roadmap frames the State’s plans to transform the way it finances health care services, moving from volume- to value-based payments—a payment transition broadly recognized as essential for delivery system reform.

The Affordable Care Act’s health insurance tax credits are designed to limit the premium contributions made by marketplace enrollees to a percentage of their income. Critics seeking to repeal and replace the law have instead advanced the idea of “premium support,” which would provide enrollees with a fixed subsidy amount—regardless of their premium costs. In a new analysis for The Commonwealth Fund Blog, Evan Saltzman of the University of Pennsylvania’s Wharton School and Christine Eibner of RAND discuss how premium-support models could place financial burdens on low-income and older individuals.
What Happens If the ACA’s Tax Credits Are Replaced with Premium Support?

A few peculiarities in UnitedHealthcare’s business model and some little-understood aspects of the ACA help shed some light on United’s surprising announcement that it might stop selling insurance through the ACA’s health exchanges in 2017.
Is the ACA in trouble?, 

Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage.
As HMOs Dominate, Alternatives Become More Expensive,


HHS proposes more consumer-friendly rules for ACA health plans, The Washington Post
Pfizer and Allergan Reach $150 Billion Merger Deal, The New York Times
Deficiencies In End-Of-Life Care Extend Across Ethnicities, Kaiser
States Lead Effort to Let Pharmacists Prescribe Birth Control, The New York Times
End Of Medicare Bonus Program Will Cut Pay To Primary Care Doctors, Kaiser 
How Injectable ‘Biologic’ Drugs Are Busting Medicare’s Budget, The Fiscal Times,
Why Painkiller Addiction and Abuse Are Rising Health-Care Priorities, The Wall Street Journal
The Role of Big Data in Medicine.  Read this McKinsey and Co. interview with Eric Schadt, PhD, the founding director of the Icahn Institute for Genomics and Multiscale Biology at New York’s Mount Sinai Health System, McKinsey and Co.
Primary Care Practitioners’ Perspectives on Delivery System Changes, JAMA 
Uber delivers flu shots in 36 cities, in one-day experiment, The Boston Globe



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