March 1, 2018
ACA favorability hits an all-time high

Results from the Kaiser Health Tracking Poll this morning show the proportion of Americans who have a favorable view of the ACA has hit an all-time high of 54%. According to Kaiser Family Foundation pollsters, the uptick comes from a growing percentage of independents that view the law favorably (55% in February compared with 48% in January). The partisan split on the law remains wide: 83% of Democrats view the ACA favorably while a similar percentage (78%) of Republicans view it unfavorably. 
"ACOs don't save money"-them's fightin' words

Kip Sullivan's zesty takedown of ACOs in a post on Monday on the Health Care Blog stirred up a lively debate on Twitter and elsewhere.
Sullivan throws a zinger at Ezekiel Emanuel and Jeffrey Liebman: ACOs haven't even come close to displacing the insurance industry as they predicted, he says. His more substantive point is that the major cost savings just haven't materialized because ACO proponents didn't have new ideas about how to tame the health care cost beast: "At no time in this higgledy-piggledy ACO-creation process did any of the participants publicly address the question, 'How will ACO magic differ from HMO magic, and if there is no difference, why are we doing this?'"
Jeff Goldsmith weighed in on the Health Care Blog's comment section that the "ACO was a blunderbuss aimed at the wrong decade's problem." Health care cost escalation slowed down as the CMS ACOs were getting started, so the ACOs that "won big" are only in high cost areas like Boston, wrote Goldsmith. And Goldsmith delivered another dig: "The Obama-nauts made a major strategic error by focusing so much of their policy energy on ACOs, instead of on the dual eligible conundrum, where all the cost and risk is. Thanks, Bob and Zeke."
Harvard's Michael McWilliams nicely counterpunched in a 10-part Twitter thread. Among his points: CMS Benchmarks systematically underestimate savings and "evidence to date suggests modest but growing spending reductions." And his Harvard colleague, Michael Chernew, tweeted out a link to his June 19, 2017, Health Affairs blog post last year that argues that CMS benchmarks aren't a true reflection of ACO savings. 

Zeke's peak at the future: Hospitals are goners

Speaking of Zeke Emanuel prognostications: In a New York Times op-ed this week, he predicted the demise of the hospital as we've known it, citing the trend toward outpatient care and procedures and "hospital at home" programs. In the Emanuel crystal ball, hospitals will fight back with mergers and lobbying efforts for higher payments. 

Report: Google eyeing population health

Google (aka Alphabet) and, more specifically, its health care unit is talking to insurers about jointly bidding on contracts, according to CNBC. The story is vague and anonymously sourced ("three people familiar with the company say") but it says that Verily (the current name of the health care unit) might partner up with insurers to tackle population health problems. According to CNBC, Verily posted four openings for jobs that involve managing patient populations. A job posting for a health plan executive on the Verily website mentions a "deep understanding of health plan product design" and "building core capabilities necessary to the shift to value based payment models." Time to update your resume and apply?

The problems with biosimilars in a nutshell

Richard Frank provides an excellent summary (full text available) of the reasons biosimilars aren't making much of dent in U.S. drug costs in this week's New England Journal of Medicine. Frank, a professor in the Department of Health Care Policy at Harvard Medical School, suggests that the drug regulators here look to Europe and Australia for how to shape interchangeability rules. Following MedPAC's suggestion to put biosimilars and reference products under the same billing code would also help, he says. 

The future of AHPs

Avalere's new white paper on association health plans projects that between 2.4 million and 4.3 million Americans will enroll in the plans between 2018 and 2022. The Trump administration has proposed a regulation that would broaden access to association health plans; promoting AHPs is one of several ways the administration is whittling down the ACA-compliant individual market.
Avalere foresees lower premiums as luring people in: It predicts that by 2022, AHP premiums will be between $8,700 and $10,800 less expensive on an annual basis than premiums in the individual market. Why? AHP plans are expected to attract healthier people. They may also have skimpier benefits, including higher out-of-pocket costs.
The flipside to all this is that premiums in the individual and small group markets will go up as healthier folks leave to get AHP coverage. Avalere also sees pricier premiums in those markets resulting in a greater number of uninsured Americans.

Guidance for immune checkpoint inhibitor side effects 

ASCO and NCCN have gotten together to write guidelines for managing the side effects of the immune checkpoint inhibitors. So far, the FDA-approved inhibitors include atezolizumab, avelumab, durvalumab, ipilimumab, nivolumab, and pembrolizumab. The two organizations have also, to their credit, created a patient-friendly infographic about the possible side effects. Serious side effects are relatively rare (affecting less than 5% of patients, according to ASCO and NCCN) but mild ones are common (affecting 30% to 50% of patients).

Nudge, nudge in the ICU

Behavioral economists have investigated how we can be gently influenced into making a wide variety of health care and health insurance choices. In this month's Critical Care Medicine, UPenn's Scott Halpern, MD, looks at how the nudge mind-set might be applied in ICUs to improve the quality of care of there. One example: require free-text justification in the EHR for red blood transfusions for patients with hemoglobin levels above a certain threshold (7 g/dL). 

And from our ICYMI file
A thumbs down for Jane Brody 

Alan Cassels at slammed Jane Brody, the long-time New York Times health writer, for disease-mongering in her piece about bone density tests.

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