What’s New in Health Care Reform: April 20


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.

CMS to Launch New Medicare Payment Program

The Centers for Medicare and Medicaid Services is launching a primary care payment mode aimed at moving further away from a fee-for-service system under Medicare. The Comprehensive Primary Care Plus model will make it easier for physicians to offer the type of care they’re interested in providing, Patrick Conway, CMS’s deputy administrator and chief medical officer, told reporters when he announced the program. The five-year model will offer up to 5,000 primary care practices around the country a choice between two tracks that would shift the providers towards a new payment system. Via Morning Consult.

Medicare Seeks Savings and Innovation with a Switch in Doctor’s Pay

The Obama administration is recruiting as many as 20,000 primary care doctors for an initiative it hopes will change the way physicians get paid and provide care. The program will be run by the Centers for Medicare and Medicaid Services. The aim is to stop paying doctors based on the number of billable services and visits provided to Medicare beneficiaries and instead to tie payments to overall patient health and outcomes. Via NPR. 

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Obamacare’s Risk-Adjustment Model Working, Actuaries Say

The risk-adjustment model under the Affordable Care Act is working to compensate insurers for covering higher-cost enrollees, at least in part, a report from the American Academy of Actuaries says. “Insurers receiving risk adjustment payments generally tended to have higher loss ratios than insurers making risk adjustment payments,” the report reads. “This is consistent with the program operating as intended, by shifting funds from insurers with low-cost enrollees to insurers with high-cost enrollees.” Via Morning Consult.

Customers Shouldn’t Worry about Proposed Large Premium Hikes, HHS Report Says

When health insurers announce preliminary market rates for next year over the next few months, people shouldn’t worry about proposed premium changes that show major spikes for customers, the Department of Health and Human Services argues in a new report and blog post. Full monthly premiums among all plan selections increased 8% between 2015 and 2016, although insurers had predicted double-digit spikes, according to the report. The average monthly premium among all plan election increased from $356 in 2015 to $386 in 2016. Via Morning Consult.

Health Care’s Hard Realities on the Reservation

The federal government is obligated by law to provide medical care to American Indians and Alaska Natives, and it does it through the Indian Health Service (IHS), an agency of the Department of Health and Human Services. There are also tribal-run health centers set up on reservations. And 20 states have Urban Indian Health Programs, which receive IHS funding to provide medical services and support to American Indians who don’t live on reservations. But there are still significant gaps in care, both on the reservation and in town. Via Kaiser Health News.

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Obamacare to Launch New Payment Scheme

Six years after President Obama’s health reforms became law, officials in his administration told POLITICO they are launching the largest-ever initiative to transform primary care in America, an effort to give doctors more flexibility and reward them for producing better results for their patients. The experiment the administration will announce today, a program called Comprehensive Primary Care Plus, is intended to shake up the way 20,000 doctors and clinicians treat more than 25 million patients when it goes into effect in January 2017. In a sharp departure from the current “fee-for-service” system, which offers reimbursements per visit or procedure, providers who volunteer to participate will received fixed monthly fees for every patient and bonuses for meeting various quality goals. Via Politico.

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Red Tape May Tank New CMS Primary-Care Payment Model

The CMS' newest experiment to change the way primary care is delivered and reimbursed may have a tough time getting off the ground and reaching its goals, experts say. The new model involves Medicare working with commercial payers and state Medicaid programs to tweak the way they pay providers for care management in an effort to find better and less expensive ways to improve health outcomes. Via Modern Healthcare.

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People May Be Warming up to Health Reform—But Not to "Obamacare"

A new study finds that although the public remains stubbornly split on the Affordable Care Act, a slight shift may be occurring beneath the surface—with a growing minority of people coming around to the opinion that the law is having a real impact on access to health care. To be clear, the analysis is based on two-year-old data, and it shows more people are opposed to the law (45.6%) than in favor of it (36.2%). Via Washington Post.

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Supreme Court’s Birth-Control Compromise Gets Mixed Reaction

The U.S. Supreme Court got a mixed reaction from the Obama administration and religious groups to its unusual proposal to resolve a clash over employee insurance coverage for contraceptives. In a court filing, U.S. Solicitor General Donald Verrilli said the government had already gone far enough to accommodate religious groups’ objections to providing coverage for some forms of birth control. He said the alternative proposal suggested by the court last month, while feasible, would "impose real costs." Via Bloomberg.

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Prescription Drug Spending Hits Record $425 Billion in U.S.

Spending on prescription drugs in the U.S. rose 12% to a record $425 billion before discounts last year, boosted in part by the introduction of breakthrough medicines for cancer and the growing number of patients seeking treatment for hepatitis C. Via Bloomberg.

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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.