Week of October 19-23, 2015


ACA Implementation
Montefiore serves the Bronx, Westchester, and Rockland counties in New York. The Bronx is one of the U.S.’s poorest (31% poverty rate) and most densely populated areas. More than 80% of Montefiore revenue comes from federally insured patients who depend on Medicare or Medicaid.
Read this report from the Advisory Board, How top Pioneer ACO Montefiore approaches care management

As we enter the third Marketplace open enrollment period, we are faced with evidence that consumers do not understand health insurance, “only about half of those surveyed could correctly figure out what they would need to pay in out-of-pocket cost for a hospital stay when given the deductible and the co-pay,” and the uninsured survey participants had the most difficulty with health insurance literacy.
Read this blog post from Health Affairs, Getting Enrolled Isn’t Enough: The Importance of Teaching Consumers How to Use Health Insurance

Health Care Operations and Management
Since 2013, we have tapped our front lines – our 1,500 physicians and thousands more nurses, PA’s, pharmacists and other clinicians – for ways to improve care and reduce costs, using an innovation incubator model that adapts venture capital investment approaches to find and scale the best ideas.
Read this Harvard Business Review blog post, How Brigham & Women’s Funds Health Care Innovation

CMS and Medicare/Medicaid
North Carolina is in the process of overhauling its Medicaid program. The governor and state lawmakers are using a mixture of health care models to put the major players — doctors, hospitals and insurers — all on the hook to keep rising costs in check.
Read this article from KHN, The North Carolina Experiment: How One State Is Trying To Reshape Medicaid

Medicare’s prescription drug program spent nearly $4.6 billion in the first half of this year on expensive new cures for the liver disease hepatitis C — almost as much as it spent for all of 2014.
Read this research from ProPublica, Medicare Spending for Hepatitis C Cures Surges

As states throughout the nation work to change how health care is delivered and paid for, New York is undertaking its largest effort yet to transform the state’s Medicaid health care delivery and payment system through the Delivery System Reform Incentive Payment (DSRIP) program.
Read this Health Affairs blog, The State of Medicaid in New York:  Progress and the Road to Value-Based Payments

In 2015, after 50 years of Medicare and Medicaid, mental health reform bills in both houses of Congress (House HR 2646, the Helping Families in Mental Health Crisis Act; Senate S 1945, the Mental Health Reform Act of 2015) may help to reduce mental health coverage gaps in these programs.
Read this JAMA review article, Medicare, Medicaid, and Mental Health Care: Historical Perspectives on Reforms Before the US Congress

Health Care Finance and the Market
Authors of this new JAMA publication concluded that financial integration between physicians and hospitals has been associated with higher commercial prices and spending for outpatient care.
Read the HAMA publication, Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices

Measuring consumer responsiveness to medical care prices is a central issue in health economics and a key ingredient in the optimal design and regulation of health insurance markets. We study consumer responsiveness to medical care prices, leveraging a natural experiment that occurred at a large self-insured firm which forced all of its employees to switch from an insurance plan that provided free health care to a non-linear, high deductible plan.
Read this research abstract from the National Bureau of Economic Research, What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics


Top EHR vendors agree to interoperability metrics. (Modern Healthcare) 
Obama Administration Loses Bid for Early Review of House GOP Lawsuit.  (WSJ Law Blog) 
Many Low-Income Workers Say ‘No’ to Health Insurance.  (New York Times)
Luxury Health Benefits for Top Corporate Bosses on the Wane(WSJ) 
Aetna, Humana shareholders approve proposed merger.  (Reuters)
Suing A Nursing Home Could Get Easier Under Proposed Federal Rules.  (NPR) 
For rural Georgia County, a potential health care game-changer.  (Atlanta Journal-Constitution)
Dartmouth-Hitchcock exits Pioneer ACO program: 10 things to know.  (Becker’s Hospital Review) 
The Expensive Medical Cost of Congressional Gridlock for Older Americans. (WSJ) 
Investigation Finds Errors in Coverage and Payments Under Affordable Care Act (New York Times)
Texas’s Paxton sues feds over Obamacare fee on health insurers  (Dallas Morning News) 
Blue Shield may be heading to showdown with regulators over executive pay (Los Angeles Times)
Reclaiming the Spending Power- the House suit against Obama continues to advance in court. (WSJ)    
Hospitals Take High-Tech Approach to Supply Chain.  (WSJ)



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