Welcome to the second edition of IMPAQ Health News. We look forward to delivering the health policy news you need to know in 2020. Remember to scroll for industry events, learning opportunities, and a fun cartoon at the end of each edition.
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A
three-year randomized study
examining the Camden Core Model, an intervention that targeted health care “super-utilizers” with high levels of health and community support after hospitalizations, did not reduce patients’ risk of returning to the hospital, number of visits, or hospital costs. While no significant results were found in the complex population in Camden, NJ, researchers are adapting their approach and searching their data for trends and lessons learned.
The New York Times
(1/8)
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An
analysis by Kaiser Family Foundation
found that premium changes and enrollment in the 2019 individual marketplace remained stable in its first year without the individual mandate penalty (which was removed as part of the 2017 tax law). Additionally, the 2019 marketplace was profitable for insurers, with the medical loss ratio (MLR) rising slightly to 75 percent, but remaining significantly below the high of 97 percent experienced by insurers in the early years of the Affordable Care Act (ACA). The MLR indicates the financial stability of insurers by comparing health care spending to premium revenue, with the remaining amount signifying profits.
The Hill
(1/6)
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Health Insurance Marketplaces & Health Law
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Over 8.3 million beneficiaries have registered for health care coverage in 2020, roughly two percent less than 2019’s enrollment. This year’s enrollment includes 2 million new enrollees. Final enrollment numbers, typically released in March after sign-up numbers from State-based Marketplaces are reported, are expected to be higher.
Associated Press
(12/20)
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Governor Janet Mills set forth legislation to merge the state’s individual and small group markets, use an ACA innovation waiver to expand the reinsurance program to small groups in the merged market, and create a Maine-specific marketplace using the federally supported platform. Additional health care-related bills are being considered during this legislative session.
MaineBiz
(1/8)
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Democratic representatives appealed to the court to review the ACA case during the current session, which would allow a decision to be made before the 2020 election cycle. A quick resolution could be detrimental to the ACA, but it could also motivate voters and strengthen the Democratic platform in 2020.
The New York Times
(1/3)
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Quality Measurement & Value-Based Care
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For the 2018 QPP performance year, 98 percent of eligible clinicians participating in the QPP’s Merit Based Incentive Payments System (MIPS) received a positive payment adjustment, which is a five point increase from the 2017 performance year. MIPS participation rates also increased from 2017 to 2018. CMS finalized changes to the MIPS program in the
2020 Physician Fee Schedule final rule
, which will become effective in 2021.
CMS Blog
(1/6)
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Two studies in Health Affairs found that joint replacements are the only clinical episode that produce savings with Medicare bundled payments, but at amounts less than previously estimated and with no impacts on quality. This is troubling for the health care industry, which has been leaning on bundled payments to transition towards value-based payments.
Modern Healthcare
(1/6)
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New research published in the New England Journal of Medicine determined that quality of care did not improve at recently acquired hospitals, despite claims from executives that mergers and acquisitions would do just that. A performance analysis of 250 hospitals undergoing mergers between 2009 and 2013 saw their quality of care decrease or stay the same, based on four CMS measures. The study also determined that patient satisfaction scores at acquired hospitals decreased on average.
Wall Street Journal
(1/1)
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A new analysis from Rx Savings Solutions found that drug makers raised prices by 5.8 percent, which is a slight increase from the 2019 coverage year. Multiple companies have increased the average sales price on different dosages of the same drug. Advocacy organizations criticize the price increases and fear prices will continue to rise until Congress takes action.
Wall Street Journal
(1/2)
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The National Academy for State Health Policy (NASHP) released the
2020 State Legislative Action Tracker
to track states’ varied approaches to curbing high Rx prices, including proposing Rx affordability review boards, capping out-of-pocket insulin costs, and more.
NASHP
(1/2)
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Opioid Crisis & Mental Health
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Annually, about half a million individuals are diagnosed with opioid use disorder (OUD) and hospital stays associated with the condition total an estimated two billion dollars. Training stakeholders to recognize the risks of OUD and changing the stigma around pain management are key strategies for hospitals treating patients with OUD, outlined in a
report
from the Institute for Healthcare Improvement.
Health Affairs
(12/20)
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A new
report by the National Academies
outlined a framework for prescribers to create evidence-based prescribing guidelines for acute pain management. The framework, stemming from an FDA request
,
recommends that resulting guidelines should be flexible for individual clinical decisions and include follow up with patients to track health outcomes.
STAT
(12/19)
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Social Determinants of Health
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As reported by the CDC, the maternal mortality rate in the United States is on the rise despite over 60 percent of deaths being preventable. Experts believe that leveraging improved health care quality and access with cross-sectional partnerships can address persisting racial disparities in maternal deaths. One collaboration developed data-sharing practices that reduced deaths by 55 percent from 2006 to 2013, with other initiatives forming across the country.
PEW
(1/6)
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The Center for Open Data Enterprise (CODE) reported that programs addressing social determinants of health are failing to collect rigorous social determinants data. The
report
outlined recommendations for HHS to develop a data strategy, including defining and standardizing data, supporting local decision makers, and creating sustainable data collection infrastructure.
MedCity News
(1/2)
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Additional Eye-Catching Headlines
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Hidden flaws in some electronic health records (EHRs) and alleged cover-ups may pose a threat to patients, according to whistleblowers, doctors, and hospitals. They believe that $38 billion in federal subsidies, intended to improve data sharing and track patient medical history, were invested in companies that were deceptive about the quality of their software. Glitches in EHRs can result in serious complications and deaths if doctors cannot access files, test results are attached to an incorrect file, or patient records are switched.
Kaiser Health News
(12/23)
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The co-founder of Aspire Health, Brad Smith, will lead CMS’ Center for Medicare and Medicaid Innovation (CMMI), the agency’s delivery model testing center. Smith’s goal is to realign provider incentives and empower patients to get better care.
Tennessean
(1/6)
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Spotlight on IMPAQ Health
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G2X Federal Emerging Technology & Consulting Hub recently announced IMPAQ as one of its
2020 NXT Up companies
, which it says are likely to experience rapid growth, invest in their people, processes and technologies, and continue to push the envelope in the Federal sector.
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In the blog post
Nutrition for All
, we explore how food insecurity affects the health of various populations including children and families, older adults, and veterans. Learn how IMPAQ is working with Federal agencies, foundations, and cities to increase access to nutritious foods.
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Health Policy - Upcoming Events, Trainings, Tools, & Webinars
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This webinar explains the Fifth Circuit Ruling on the ACA, and what to expect in the coming weeks from various stakeholders including Congress, courts, and the health care market.
Listen here
.
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This is the third webinar in a series that will focus on how to address social isolation. The series is based on a white paper that presents a case for why cross-sector collaboration is needed to address complex issues that limit health in the United States.
Register here.
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This webinar focuses on the issue of low-value or unnecessary care, including its contribution to high US health care spending. Speakers will define the problem, discuss different types of low-value care, and explore the kinds of settings where low-value care typically occurs.
Register here
.
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This webinar will explore how two health care innovators are engaging communities and using consumer feedback to rethink how services are designed and delivered. Maimonides Medical Center in Brooklyn, New York and Roots Community Health Center in Oakland, California will be in attendance.
Register here.
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This webinar will discuss factors for successful participation in Medicare Advantage, which is one of the fastest-growing health plan options today.
Register here.
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NOTE:
The information, analyses, and opinions expressed in the articles, publications, or comments contained therein are those of the authors and should not be considered verified or endorsed by IMPAQ or any of our partners or clients.
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Phone: 443.259.5500 | Email: impaqhealthnews@impaqint.com | impaqint.com
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