Public Policy Weekly Clips: March 1, 2016
March 1, 2016 · Paul Cotton
Every Tuesday NCQA gives a rundown of the best national, state and private sector health care articles from the week. Here are our picks for today’s Public Policy Weekly Clips:
National:
GAO says CMS has taken a “passive approach” to fighting fraudulent Marketplace enrollment.
CMS will now require proof of eligibility for Marketplace sign-ups outside open enrollment.
70% of the uninsured got ACA penalty exemptions, largely because they could not afford coverage.
Readmissions dropped from 21.5-17.8% for ACA targeted conditions & from 15.3-13.1% for others.
Obama rejected the NGA’s bid to fight opioids by limiting how many painkillers can be prescribe at a time.
Average prescription drug costs for a year doubled to over $11K in just seven years.
Novartis signed value-based pricing deals with Aetna & Cigna for its CHF drug Entresto.
The 1% of patients with highest costs account for 21.5% of total health spending; the top 50% for 97%.
US obesity rate reached an all-time high of 30.4% in 2015, despite improved physical activity rates.
Mastectomies increased 36% from 2005-13 while breast cancer rates remained constant.
Cancer death disparities dropped from 47-24% for black vs white men & 19-14% for women since 1990.
Up to half of gay or bisexual African-American men are projected to contract HIV, vs 25% of Hispanics and less than 10% of whites.
Just 10.7% of privately insured patients get follow-up care after opioid-related hospitalizations.
Statins may lower cirrhosis & liver cancer risk in hepatitis C patients.
29 states & DC require insurers to cover telehealth at parity with in-person care, up from 11 in 2011.
The Senate confirmed new FDA head Robert Califf in an 89-4 vote.
AHRQ’s Rick Kronick is resigning to return to UCSD; Sharon Arnold will be acting director.
State:
Iowa got final CMS approval for moving to Medicaid managed care plans.
Kansas’ hospital association says lack of Medicaid expansion has cost the state over $1B.
Oregon’s ACA coop filed a class action lawsuit saying the feds owe up to $5B in risk corridor payment.
Private:
Employers worry that oncology clinics are linking with hospital outpatient departments to up costs.
Employers are focusing on chronic conditions since ~50% of adults have at least one.
Workplace stress contributes to at least 120K deaths each year and up to $190B in health costs.
A consultant says private exchanges don’t control costs, but let insurance companies retain more profit.
53% of employers have added new usage restrictions for specialty prescription drugs.
81% of employers say they offer telehealth to employees because they are cheaper than in-office visits.
Wellness efforts evolving to include behavioral health.
