What’s New in Health Care Reform: July 6


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.

Young Adults Can Face Challenges to Health Enrollment

The Obama administration is making a push to get young adults covered on the health insurance marketplaces, both for their own good and that of the marketplaces, which need healthy people to balance sicker ones in the risk pool. While experts applaud the beefed up outreach planned for the coming months, they point to several factors that may throw a wrench into enrollment plans for young people. Via Kaiser Health News.

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Manufacturers Paid $7.52B to Physicians, Teaching Hospitals Last Year

Health industry manufacturers paid $7.52 billion to physicians and teaching hospitals last year, according to open payments data released by the Centers for Medicare and Medicaid Services. The release of the data publicizes the financial relationships between physicians and teaching hospitals and the health care industry, such as device makers and pharmaceutical companies. The $7.52 billion was transferred in the form of general payments, research payments, and ownership and investment interests to physicians and teaching hospitals. Via Morning Consult. 

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ACA's Risk Adjustment Hammers Small Plans Again

Small, regional health insurers and upstart co-op plans again incurred large charges under the Affordable Care Act's risk-adjustment program, according to new data the CMS released. Calendar year 2015 marks the second year of risk adjustment, and many smaller insurers have had to pay into the program both years. The data also show payouts for the ACA's reinsurance program. For ACA plans sold in 2015, the reinsurance payments total $7.8 billion. The temporary reinsurance program, which expires at the end of this year, protects health insurers against costly claims. Via Modern Healthcare.

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Obamacare Enrollment Drops to 11.1M

The Centers for Medicare and Medicaid Services (CMS) said enrollment fell to about 11.1 million, down from the 12.7 million who signed up for coverage before the Jan. 31 deadline. A dropoff was expected, and has occurred in previous years as well, given that some people who sign up do not pay their premiums. The CMS said 87 percent of enrollees remained signed up, within the expected range of 80 percent to 90 percent retention. The administration says it still projects that about 10 million people will remain signed up by the end of the year. Via The Hill.

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Participation in New Cancer Care Model Exceeds Expectations, HHS Says

Physicians and insurers in 31 states will participate in the Department of Health and Human Services’ Oncology Care Model, the Department of Health and Human Services announced. The five-year model seeks to increase quality of cancer care while lowering costs through episodic and performance-based payments. Medical practices may receive performance-based payments for chemotherapy administration to Medicare patients with cancer in addition to a care management payment each month for each beneficiary they are treating. Via Morning Consult.

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Court Strikes Down Obama Health Care Rule on Insurance Standards

A federal appeals court has ruled that consumers must be allowed to buy certain types of health insurance that do not meet the stringent standards of the Affordable Care Act, deciding that the administration had gone beyond the terms of federal law. Via NY Times.

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Personalized Medicine Gets Boost from Court Ruling on Patents

The business of diagnostic treatments and personalized medicine got a boost after an appeals court made it harder to invalidate certain patents by claiming they simply cover laws of nature. Patents can be obtained for processes relating to laws of nature if they go at least one step further, the U.S. Court of Appeals for the Federal Circuit said. The Washington court, which specializes in patent law, overturned a ruling that a patent owned by closely held Rapid Litigation Management Ltd. was invalid, and revived an infringement suit against a unit of Thermo Fisher Scientific Inc. Via Bloomberg.

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White House to Announce New Opioid Regulations

The White House will announce a set of administrative regulations aimed at addressing the opioid crisis, as a funding fight in Congress threatens to derail bipartisan bills from both chambers. The administration’s actions come as a congressional conference committee on bills that easily passed both chambers is poised to end in a partisan fight over a lack of funding. Democrats have vowed not to sign a conference report that doesn’t include “significant funding” to address opioids, and a bill released this week by Republicans includes no new funding. Via Morning Consult.

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House Mental Health Bill Would Reduce Medicaid Spending

A mental health bill expecting a vote in the House this week would likely reduce net direct Medicaid spending by $5 million between 2017 and 2026, according to the Congressional Budget Office. The legislation would not increase net direct spending or on-budget deficits for any of the four consecutive 10-year periods beginning in 2027, the CBO predicts. The bill would reduce federal Medicaid spending and would similarly result in lower state Medicaid spending between 2017 and 2026, the office projects. Via Morning Consult.

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Medicaid Plans Can Now Pay Mental Health Institutions. Most Won't Until 2017

A policy that lifts a 50-year ban on Medicaid pay for mental health institutions kicked in Tuesday, but it may be months before many enrollees can take advantage of the new coverage. Since the creation of Medicaid in 1965, the program has excluded payment for institutions of mental disease (IMDs) for beneficiaries 21 and over. Most residential treatment facilities for mental health and substance-use disorders with more than 16 beds did not qualify for Medicaid reimbursement. Via Modern Healthcare.

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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.