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The percentage of older U.S. adults with dementia declined from 11.6 percent in 2000 to 8.8 percent in 2012, a decrease of nearly a quarter, according to research published in JAMA Internal Medicine. "Population brain health seemed to improve between 2000 and 2012; increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement, but the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain." (STAT NewsJAMA Internal Medicine )

President-elect Donald Trump has tapped Georgia Rep. Tom Price, MD, to lead the Department of Health and Human Services. He named Indiana health care consultant Seema Verma to lead the Centers for Medicare and Medicaid Services. Price has long been an opponent of the Affordable Care Act, and Forbes contributor Bruce Japsen  notes that Price has also opposed some of the efforts to move to value-based reimbursement.  Verma, the CMS pick, worked with then-Gov. Mike Pence to launch Healthy Indiana Plan 2.0, the state's waiver-funded version of Medicaid expansion. ( Healthcare IT News Forbes )

Insurers are using high medication costs to deter people from signing up for coverage, according to a 60-page report produced for the National Bureau of Economic Research. "The findings here indicate that even in the face of coverage mandates such as Essential Health Benefits rules and payment system features such as risk adjustment, insurers may be able to effectively discriminate and induce selection, according to researchers. "Exchange insurers design formularies to be differentially unattractive to unprofitable individuals." (report;
Innovation & Transformation    
What if data could follow a patient? That means patients would have access to their complete medical record. That's the concept behind the Patient Centered Data Homeā„¢ (PCDH). Providers are automatically notified when one of their patients receives care outside their normal "home," and they can initiate a simple targeted query across state or other geopolitical lines to access real-time information. That's the focus of a new issue brief from Rocky Mountain Health Plans. It discusses the development and deployment of the PCDH, and explores how it could transform health care delivery. (issue brief )

Emergency telemedicine consultation during high-risk deliveries can improve outcomes and result in fewer transfers from hospitals less familiar with advanced newborn resuscitation, according to research published in Mayo Clinic Proceedings. "Telemedicine consultation for neonatal resuscitation improves patient access to neonatology expertise and prevents unnecessary transfers to a higher level of care. A highly reliable technology infrastructure that provides high-quality audio and video should be considered for any emergency telemedicine service." ( Mayo Clinic Proceedings)

Medicare Advantage patients who had tailored post-hospital visits with primary care clinicians, called POSH visits, were 12 to 24 percent less likely to be readmitted than those who did not have POSH visits, according to research published in JAMA Internal Medicine. Tailored POSH visits are scheduled for the patient while he or she is still in the hospital and focus on following up on treatment plans after discharge. In contrast, regular primary care clinician outpatient visits may focus on routine care and not cover specific hospitalization-related issues. (JAMA Internal Medicineannouncement)

The first of its kind in the nation, the all-payer ACO model allows Vermont to create a transformative payment model that moves all payers (Medicare, Medicaid and commercial) toward a prospective, value-based reimbursement system. Members of the Green Mountain Care Board who helped establish the initiative discuss what it is and how it could be a model for the nation. (Health Affairs Blog)
Consumers & Providers
Spending on health care for the privately insured increased 4.6 percent in 2015, outpacing previous years' growth, according to data from the Health Care Cost Institute. Spending grew just 3 percent in 2013 and 2.6 percent in 2014. Rising prices for prescription drugs is one of the culprits. Spending on prescription drugs grew faster than spending on any other health care service. In 2015, $649 per capita was spent on brand prescriptions, an increase of 11.4 percent from 2014. Spending on generic prescriptions reached $313 per person, a 3.3 percent increase from 2014. ( Healthcare Finance News )
Many patients with high-deductible health plans delay or avoid necessary treatment, including ambulatory and preventive care, according to a new research brief from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. "Now that the ACA has reduced the uninsured, policy makers should focus on mitigating the health and economic consequences of financial barriers to ambulatory and preventive care associated with high-deductible plans," it concludes. (research brief )
New & Noted   
SG on addiction:  The Surgeon General's Report on Alcohol, Drugs, and Health--the first ever on the topic--identifies alcohol and drug misuse and severe substance use disorders as pressing public health concerns. It estimates the yearly economic impact is $249 billion for alcohol misuse and $193 billion for illicit drug use. (news release; executive summary )

Repeal but not replace:  Insurers would have little incentive to remain in the insurance exchanges if the ACA is repealed but not replaced, reports Kaiser Health News, which offers a wrapup of coverage on the topic. (Kaiser Health News)

Financial toxicity:  Cancer patients with only Medicare coverage face steep out-of-pocket costs, spending on average almost a quarter of their household incomes on treatment. Some paid up to 63 percent of their incomes. Hospitalizations were the major factor. (Washington Post ; JAMA Oncology )
Patients and their advocates are getting an ever-larger voice in how medical research is carried out. Sharon Terry has, over the last two decades, seen the patient move from complete outsider to participant. She's a bit worried: "I think advocacy still has a place, but I'm starting to be concerned myself--and again I run one of these groups--about how much that we're becoming 'the man,' and we really need to break down our silos," she says. "We start to be insular; we start to be competitive. And that's not going to serve the people who suffer." (NPR)
MarketVoices...quotes worth reading
"You've created a situation where insurers want to avoid the high-cost people. [...] Pay the insurer more when they take on a patient that needs a high-cost drug. [...] When insurers are rewarded for covering high-cost patients, they'll likely offer better coverage that will better serve those who truly need it."-- University of Texas Assistant Economics Professor Michael Geruso speaking to Congress and quoted by CBS--Austin
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Wednesday, November 30, 2016