Feb. 9, 2017
Mega-merger slam-dunk double whammy
Federal trial court judges, in tough-worded opinions, have blocked in back-to-back sequence the mega-mergers proposed by Anthem-Cigna and Aetna-Humana. On Jan. 23, U.S. District Judge John Bates ruled against Aetna, and yesterday U.S. District Judge Amy Berman Jackson, citing similar anticompetitive concerns as Judge Bates, ruled against Anthem. Anthem has indicated they will appeal the ruling. Both plans, if these rulings are sustained, would be required to pay to their respective partners substantial sums, totaling between them over $2 billion.

Judge Jackson wrote: "Anthem is asking the court to go beyond what any court has done before: to bless this merger because customers may end up paying less to health care providers for the services that the providers deliver even though the same customers are also likely to end up paying more for what the defendants sell," an important acknowledgment by the court of the monopsonistic consequences of mega-mergers.

Judge Bates additionally observed, after Aetna pulled their exchange business out of 11 of 17 states, including markets where they competed head-to-head with their betrothed, Humana, "Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger." The court's ruling sets an important precedent by acknowledging, as the AMA, Colorado Medical Society and other state medical associations argued, that Medicare Advantage is a separate and distinct market that does not compete with traditional Medicare, a legal fiction Aetna was promoting in order to justify substantial consolidations of those programs with Medicare Advantage competitor, Humana.

AMA attorneys worked closely with CMS and the other high-concentration states, providing valuable physician survey data and experts to buttress the case for the Department of Justice. "This collaboration between the AMA and state medical societies made for a powerful case by the DOJ against some of the largest health plans inthe country," said CMS President Katie Lozano, MD.

She warned, "This was an important pushback against what will likely be a determined, sustained effort by the health plans."
There's still time to register for the first program in the free CMS Physician Leadership Skills Series
As changes in Colorado health care accelerate, it is more important than ever to have well-trained and active physician leaders guiding the way. Thanks to a generous grant from the Physicians Foundation, the Colorado Medical Society is proud to present the Physician Leadership Skills Series (PLSS) to help enhance physician leadership capacity in Colorado and provide current and emerging physician leaders with the knowledge and skills they need to serve their patients, their practice, their profession and their community.

Registration for the first of eight innovative programs is available, and dates have been set through April. These programs, held Saturday mornings in person around the state or weeknights via video conference, are aimed at deepening your awareness, developing crucial skills and equipping you with the tools and experience you need to lead tomorrow's health care in Colorado. This series is free for CMS members; non-members are ineligible.

The first program, Giving and receiving feedback / Building social capital, will be held Feb. 11, 8 a.m. - 12 p.m. in Denver. Find more information and links to register for all programs at www.cms.org/events/leadership-skills. CMS is finalizing curriculum and speakers for the other events and will post information as it is available.
Rules adopted for Proposition 106, the End-of-Life Options Act
The Board of Health adopted emergency rules on Jan. 18, recommended by the Colorado Department of Public Health and Environment (CDPHE), to outline compliance with Proposition 106, the End-of-Life Options Act. These rules incorporate the "bulk of the recommendations made by CMS and other stakeholders," according to Kirk Bol, manager of the Registries and Vital Statistics Branch of CDPHE. Permanent rulemaking will take place in April.

One concern CMS raised, around certifying the cause of death on death certificates, was discussed but ultimately decided to be beyond the scope of emergency rulemaking. The manager stated that this issue and others will be addressed formally through further stakeholder engagement before the permanent rules are adopted.

The act requires the prescribing physician and the health care professional dispensing aid-in-dying medication to provide the Colorado Department of Public Health and Environment (CDPHE) with certain documentation. Individual information collected will be held confidential, but aggregate data will be compiled into an annual statistical report.

Following are the required forms: Completed forms can be sent to kirk.bol@state.co.us through secure email, accessed here. Click here for more information. Click here to read the emergency rules.
CMS, AMA and others call for prior authorization reform
A coalition that includes the Colorado Medical Society, American Medical Association and 15 other health care organizations released a set of 21 principles on Jan. 25 for health plans, benefit managers and others to use to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.

Requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions, the coalition stated in a press release. Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with the newly created set of 21 principles.

Prior authorization programs could be improved by applying the principles' common-sense concepts grouped in five broad categories:
  • Clinical validity,
  • Continuity of care,
  • Transparency and fairness,
  • Timely access and administrative efficiency, and
  • Alternatives and exemptions.
Read the full set of reform principles here.
Colorado Medicaid interChange: Guide to go live
On March 1, 2017, the Department of Health Care Policy and Financing (HCPF) will launch a new Claims Payment System, the Colorado interChange, for processing payments for services rendered on behalf of Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) members. In addition, the new Provider Web Portal will launch Feb. 6, 2017, and a new Pharmacy Benefits Management System (Pharmacy Point of Sale system) will launch Feb. 25, 2017. This will not only be a transition to new systems, but to new vendors and new processes as well.

HCPF has created a guide to help inform and prepare providers for these changes, providing general guidance. Click here to access the guide.
SIM office to release cohort 2 RFA
The SIM office will release its request for applications for cohort 2 next week on Feb. 15, and has developed a quick-hit resource that outlines benefits to encourage participation. Read this document, share with practice staff and colleagues, and see how you can integrate behavioral health and primary care to improve patient outcomes with SIM. 
 
Additional resources:
Colorado Primary Care Collaborative to host payment and delivery reform event
Mark your calendars: The Colorado Primary Care Collaborative will host a convening event on June 8, 2017. The theme is "Primary Care Payment and Delivery Reform: What's on the Horizon," and it will be held at the Embassy Suites Denver - Tech Center, 10250 E. Costilla Ave., Centennial, CO 80112 from 8:15 a.m. to 4:15 p.m.
 
Topics include the state and national payment reform and the central role of primary care, payment models for primary care, and payment reform from the perspective of employers and insurers. Go to www.coloradoafp.org/cpcc to view the full agenda and register.
Sponsors
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For more information, call (720) 858-6000 or visit www.callcopic.com.


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GreenLight is the national leader in web-enabled behavioral health testing with over half a million assessments in 35 states. GreenLight is designed to help physicians enhance patient care, improve population health and add incremental revenue to the practice. Visit www.Greenlight.md or call 866-602-1778.

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Rates as low as 2.14% variable and 3.25% fixed. Visit www.LKrefi.com/co-med. Phone: 888-549-9050 Email: customer.care@lendkey.com

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Check out the latest Colorado Medicine, the innovation issue
In the January-February issue of Colorado Medicine, we meet forward-thinking Colorado companies that are using innovation to drive down costs, improve quality, and improve the care experience for both patients and practices. These leaders have created an ecosystem of Colorado entrepreneurs and investors to accelerate and foster good ideas that will flex the health care system and influence positive change. In many examples throughout this issue, improving health care starts with an individual, takes root through partnerships, and spreads through strategic action and collaboration.

Click here to access the January-February electronic issue of Colorado Medicine.

To comment on something you read in ASAP or to update your contact information, send an e-mail to enews_editor@cms.org. Visit us online at www.cms.org.
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