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Industry News
In his first executive order, President Donald Trump called on federal agencies to "waive, defer, grant ­exemptions from or delay" any part of the Affordable Care Act that imposes a financial or regulatory burden. Just what that means remains unclear, however; this lack of clarity is creating uncertainty in the industry. Kaiser Health News offers a roundup of the news and analysis discussing the order and its impact, but the order's practical implications and potential fallout are still unclear. (KHN)

A Congressional Budget Office analysis showed that at least 18 million people could lose their insurance coverage in the first year after repeal of the ACA. It also predicts premiums in the nongroup market would increase by 20 to 25 percent the first year. In an opinion piece for  Forbes, Avik Roy points out problems with the report. Among them: the CBO's previous miscalculations regarding the ACA and the fact that the analysis fails to account for a replacement for the ACA. ( CBO; Forbes )

"Repeal and replace" is a trendy phrase now, but many may be unclear about what is being replaced. Kaiser Health News and NPR outline some "sleeper provisions" of the Affordable Care Act that could be cut: in-network-based payments for out-of-network emergency care; a requirement that employers provide a non-bathroom area for breastfeeding as well as payment by health plans for breastfeeding support and equipment; expanded therapy coverage for children with autism; and coverage for habilitative care. (NPR/KHN)
Innovation & Transformation    
"Machine learning" has the potential to help physicians diagnose illnesses that can't be spotted with more traditional tests, reports the  MIT Technology Review. For example, Dr. Charles Marmar, a psychiatrist at NYU's Langone Medical Center, is collecting voice samples from veterans and analyzing vocal cues like tone, pitch, rhythm, rate and volume for signs of PTSD, traumatic brain injury and depression. Initial studies have found vocal cues can differentiate PTSD patients from healthy ones with 77 percent accuracy. ( MIT Technology Review ; Fierce Healthcare )
Tech tools such as a Bluetooth toothbrush, fitness wearables or devices in your car may encourage better habits, but they can also be used to assess risk and set premiums. One insurer uses a smartphone app to track a potential customer before giving them a quote. There are concerns the data may be used to cherry-pick customers, but Michael Barry, a spokesman for the Insurance Information Institute, says, "Insurance is such a heavily regulated industry that insurers must justify, in actuarial terms, the reason for any rate increase they're seeking in almost any line of business." ( Reuters )
Ten Republican governors met with lawmakers on Thursday to discuss options for supporting health insurance coverage for low-income Americans who gained benefits under the Affordable Care Act's expansion of Medicaid eligibility. Ohio Gov. John Kasich suggested providing premium subsidies or tax credits to help consumers buy private coverage. ( Reuters )
Consumers & Providers
Workplace wellness programs can amass troves of information, leaving employees open to privacy invasion, employment discrimination and data theft, according to a paper in the Harvard Business Review. Often, neither employees nor employers know that, besides the threat of breaches, information collected by "stand-alone wellness program vendors who are not considered health care providers, is not covered by HIPAA, and [the vendors] may sell health data to third parties without informing employees." ( Harvard Business Review)

More hospitals are competing for patients using retail strategies, such as bundled pricing, finds a new PwC report. Some doctors may be left out: Hospitals are picking partners based on their good outcomes and how competitively they are priced, says Cheri Kane of PwC's Health Research Institute, a report coauthor. Doctors may be unused to thinking in competitive price terms, but the landscape is evolving, according to the report. One big driver: the rising use of high-deductible insurance plans. ( Medical Economics ; PwC report )
Although EHRs' ability to collect data and intervene with automated alerts offers tremendous potential in addressing overutilization, health systems have yet to find the most effective approach, researchers write in a JAMA Viewpoint piece. "While innovative organizations have adopted several EHR-based approaches to reduce low-value care, the best choices remain to be determined, and combinations may work best." (FierceHealthcareJAMA)
New & Noted   
Aetna/Humana deal kaput, for now: A federal judge Monday blocked the proposed Aetna/Humana merger, ruling that the transaction would reduce competition for consumers. The company can appeal. (USA Today )

Paying for advocacy:  A national survey of 439 patient advocacy organizations (the vast majority of which were nonprofit) found that 67 percent receive funding from for-profit companies, with 12 percent receiving most of their funding from industry. (JAMA)

Listen to the hearings: The Senate Finance Committee hearings on Tom Price, the nominee for secretary of Health and Human Services, will be available online. ( Senate Committee on Finance)
Dr. Atul Gawande says we need to reconsider health care's focus on generously rewarding "heroic" physicians at the expense of those who practice "incremental medicine," such as pediatricians, psychiatrists, primary care docs and others. "[T]he biggest gains are coming right now from incremental medicine, from a commitment to the kind of steady, overtime management of complex problems like chronic illnesses that can add years to people's lives. But that's work done by some of the people with the least resources in our health care system." (PBS Newshour)
MarketVoices...quotes worth reading
"Life, increasingly, is a preexisting condition waiting to happen, now that we have more and more of this data available."--Dr. Atul Gawande, on the implications of Big Data in a post-ACA world, on PBS NewsHour.

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Wednesday, January 25, 2017