November 13, 2017
Trump names former Pharma exec as new HHS head
President Trump plans to nominate Alex Azar as the new Secretary of Health and Human Services. Azar was most recently an executive officer at the pharmaceutical company Eli Lilly and also served as deputy secretary and general counsel at HHS under President George W. Bush.
Administration slows push for value-based care
Value-based care is seen by many as a potential solution to curbing America’s high health care costs; however, some critics—especially physicians—believe HHS implemented value-based programs too forcefully and quickly under the previous Administration. Over the past year, the Trump Administration has slowed or rolled back much of that work, often through Medicare payment models, which serve as a benchmark for private insurers. As part of this effort, CMS has converted value-based programs from mandatory to voluntary and has also granted wide-reaching exemptions to physicians for other value-based initiatives. Some have been frustrated by the Administration’s efforts to slow a shift from fee-for-service payment structures.
Fewer consumers choosing silver plans
Although they remain the most popular option on the ACA exchanges, silver plans are losing ground to the more comprehensive “gold” plans and cheaper “bronze” plans according to the latest data in this enrollment period. An end to the ACA’s CSR subsidies has led to higher premium subsidies, allowing some consumers to acquire bronze plans at no cost and others to purchase gold plans at lower prices than silver ones. So far, bronze plan signups have increased by 3 percent from last year and gold plans have increased by 2 percent. Meanwhile, silver plan signups have decreased by about 8 percent.
Providers worry about CMS deregulation strategy
Providers across the country are worried that CMS does not have a clear and well-communicated strategy to support the agency’s promise to relieve hospitals from unnecessary regulatory burdens and that it is not listening to industry enough before weighing regulatory decisions. Ignoring strong opposition from hospitals, CMS cut $1.6 billion from the 340B federal drug discount program, despite reams of data and anecdotes provided by hospitals demonstrating the importance of the 340B funding. The decision on 340B and other recent rulemaking decisions has some providers questioning whether the agency is seriously committed to moving from a fee-for-service system to a value-based system.
ACA insurer participation declines
Three quarters of consumers, or have a choice of two or more insurers on the ACA exchanges, despite less competition in the marketplace, according to an analysis from Kaiser Family Foundation. The study also found that every single county in the country has at least one insurer. The report shows that the average number of insurers per state declined to 3.5 for 2018, a drop from 4.3 in 2017 and 5.6 in 2016. While most consumers have options on the exchanges, competition has seriously constricted over the past few years; fewer than 2 percent of enrollees in 2016 and 21 percent in 2017 had only one option on the exchange.
Potential unintended consequences for Medicare heart failure rule
An ACA rule requires Medicare to levy penalties against hospitals that have especially high numbers of heart failure patients returning to the hospital for treatment shortly after their discharge for treatment. Data show that the penalty has been successful in lowering the number of readmissions, but that there has also been higher rates of death among the patient group. Prior to passage of the ACA, one-fifth of heart failure patients returned to the hospital within 30 days. After the penalties went into effect, the figure dropped to 18 percent, but mortality rates increased from 7 percent before the ACA to almost 9 percent after the penalties. That equates to about 5,400 additional deaths a year for Medicare beneficiaries not in managed care plans. The research, published in JAMA Cardiology, does not claim to show cause and effect but that the results, “support the possibility that the [penalty] has had the unintended consequence of increased mortality in patients hospitalized with heart failure.”
Administration pushes the use of insurance agents
For the current enrollment period, the Administration cut 41 percent of funds for nonprofit groups that help people obtain health insurance under the ACA. Now the Administration is encouraging the use of insurance agents and brokers who are often paid by insurers when they help people enroll. However, a shift to brokers may provide some pitfalls for consumers. Industry pressures—including smaller commissions and more complicated health plans—have led some brokers to leave the field, which could make it hard for consumers to find a broker. Also, some health policy experts warn that a shift from impartial nonprofit groups to brokers and agent could carry risks for consumers.
Artificial intelligence may become crucial in value based care
Professionals in the healthcare industry are predicting ways that artificial intelligence (AI) will help transform provider systems. Ideally, health care professionals believe that AI will help spur patient engagement through data collection and optimize patient outcomes at a lower cost through computing power and tactical decision making. The healthcare industry is already at the early stages of leveraging interpretive intelligence into daily clinical workflows. Machine learning, along with AI, is expected to become a more integral part of the healthcare ecosystem.
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