What’s New in Health Care Reform: April 13


What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.

Cancer Drugs among Those Most Affected by Medicare Drug Payment Proposal

Proposed changes to how Medicare reimburses health care providers for prescription drugs would lower reimbursements for drugs that cost more than $480 per day, meaning physicians who treat cancers and other diseases would see greater reductions, an analysis released today from Avalere Health finds. Via Morning Consult.

Final Medicare Advantage Rate Policies a Mixed Bag for Insurers

Did the Obama administration indulge health insurance companies with friendly changes to Medicare Advantage rate policies for 2017? Or did CMS officials stick to their guns on proposals the industry aggressively lobbied to kill? Experts say it was a little of both. “It embodies the definition of compromise,” said John Gorman, a Washington-based Medicare Advantage consultant and former CMS official. Via Modern Healthcare. 

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Prices and Health Care Quality: Many Consumers Don’t See a Link

Most consumers don’t believe the adage that “you get what you pay for” in health care, according to a new study. The report in this month’s issue of the journal Health Affairs analyzed the responses of 2,010 adults to four questions about the relationship between health care prices and quality, such as “Would you say higher prices are typically a sign of better quality medical care or not?” and “If one doctor charged less than another doctor for the same service, would you think that the less-expensive doctor is providing lower quality care or would you not think that?” Via Kaiser Health News.

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Watchdog: Security Flaws Plague State Obamacare Exchanges

A federal watchdog has found security flaws in state-run Obamacare exchanges in California, Kentucky, and Vermont, potentially putting millions of customers’ data at risk. The three states were found to have cybersecurity weaknesses such as insufficient encryption and inadequate firewalls, according to a months-long study by the Government Accountability Office. Via The Hill.

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Medicare Plan for Payment on Cancer Drugs Stirs Battle

A Medicare proposal to test new ways of paying for chemotherapy and other drugs given in a doctor's office has sparked a furious battle, and cancer doctors are demanding that the Obama administration scrap the experiment. The vehement reaction is raising questions about the government's ability to tackle high drug costs, the top health care concern for the public. Via Associated Press.

Sales of Short-Term Health Policies Surge

A type of limited health coverage with features largely banned by the Affordable Care Act is flourishing, as some consumers grab onto an alternative they say is cheaper than conventional plans sold under the law. Sales of short-term health insurance are up sharply since the health law’s major provisions took effect in 2014, according to insurance agencies. New sales figures show the temporary policies, traditionally sold to consumers who are trying to fill coverage gaps for a few months, have continued their surge recently—even though people who buy them face mounting financial penalties because the coverage doesn’t meet the ACA’s standards. Via Wall Street Journal.

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AHA-Backed Antitrust Bill Could Ease Hospital Mergers

Health care industry leaders are closely watching a House-passed bill that could make it easier for hospitals to merge without getting tangled in lengthy antitrust challenges. The American Hospital Association supports the Republican-sponsored bill, which passed the House late last month, arguing that it “removes a deterrent to hospital integration and realignment, which is essential for success in the changing health care landscape.” Via Modern Healthcare.

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Alone on the Range, Seniors Often Lack Access to Health Care

The rural American population is older: About 15% of residents are 65 or older, compared with 12% in urban areas, largely because many people have left in search of education and jobs. Via NY Times.

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UnitedHealth Quitting Obamacare Markets in Georgia, Arkansas

UnitedHealth Group Inc., the largest U.S. health insurer, has decided to call it quits in two state Obamacare markets, in the latest challenge to President Barack Obama’s health care overhaul. The insurer won’t sell plans for next year in Georgia and Arkansas, according to state insurance regulators. Tyler Mason, a UnitedHealth spokesman, confirmed the exits and declined to say whether the company would drop out of additional states. Via Bloomberg.

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A Great Divide in American Death: Statistics Show Widening Urban-Rural Health Gap

The Post’s analysis, which builds on academic research published last year, shows a clear divide in the health of urban and rural Americans, with the gap widening most dramatically among whites. The statistics reveal two Americas diverging, neither as healthy as it should be but one much sicker than the other. Via Washington Post.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.