Latest Morning Briefing Stories
The method of finding the most expensive, hard-to-treat patients and better coordinating their care was touted as a popular idea for containing health care costs. A new study offers a harsh reality check on the benefits of such a strategy though. The surprising lack of results offers a cautionary tale about how difficult it is to improve patients’ care and reduce costs.
“Just because you’ve been in jail for a short period of time, that shouldn’t automatically knock you off the [Medicaid] rolls,” said David Davis, the Democratic sheriff of Bibb County, Georgia. “You then have to go through enrollment all over again.” The disruption in enrollment can often negatively effect an already vulnerable population of people. Other Medicaid news comes from Iowa, Kansas, Missouri, Georgia, California and the South.
A new study found that in Canada, a country with a single-payer system, the cost of administrative work is $551 per person, a year. In America, it’s $2,497. Other news on costs looks at what states are –and aren’t– doing to keep health care affordable and more on surprise medical bills.
The American Action Network, which received $2.5 million from PhRMA in 2018, derided House Speaker Nancy Pelosi’s drug pricing plan as socialism. The group is trying to build support for the House Republicans’ plan, which would not allow price negotiation but does cap out-of-pocket costs for seniors on Medicare.
Read about the biggest pharmaceutical development and pricing stories from the past week in KHN’s Prescription Drug Watch roundup.
It’s standard practice to analyze the samples while the patient is still under, but new artificial intelligence helps brain surgeons do so in two to three minutes rather than the half-hour it used to take. In addition to speeding up the process, the new technique can also detect some details that traditional methods may miss.
Screening women when they present to the hospital for conditions that make them vulnerable to complications such as substance abuse disorder or obesity could avoid issues during labor, experts say. Hospital news comes out of Pennsylvania, New Hampshire, Missouri, Georgia, and Michigan.
The VA model involves a combination of regulation, negotiation, and a national formulary. The combined effect makes it possible for veterans to obtain medicines with either a low or, in some cases, no copayment. In other pharmaceutical news: “guided-missile” cancer treatments, psychedelic mushrooms, and distribution permits.
The federal government, hospitals and physicians have been gravitating toward bundled payments, but new studies challenge the belief that they help achieve cost savings. Meanwhile, CMS is proposing changes to Medicare Advantage payments for 2021, including an increase in the percentage of patient “encounter data” used to calculate payments.
The regulations would address a pollutant that’s linked to heart and lung disease. Health and environment groups are skeptical of the new rules, worrying that they could stymie even tighter restrictions that are expected out of California.
The battle for the Brookline, Massachusetts clinic’s doors to stay open reveals a larger struggle across the country, where facilities are facing financial issues even in blue states. Abortion news comes out of Ohio and Wyoming, as well.
The position leading the agency’s Center for Medicare and Medicaid Innovation largely focuses on driving value-based care transformation across the country, Brad Smith says. CMS Administrator Seema Verma praised Smith as an “outside-the-box” thinker who will “help us build on the important work the Trump administration has undertaken to transform our healthcare system to deliver better value to patients.”
A key measure of insurers’ financial strength — the percentage of premiums insurers collect that they pay back out in spending on claims — remained relatively strong. Experts say these numbers demonstrate resiliency within the marketplaces despite political turmoil surrounding the health law. Meanwhile, the Supreme Court set a Friday deadline for the Trump administration to respond to Democrats’ request to expedite the health law case.
Two big issues — addressing surprise medical bills and high drug prices — have the chance to draw bipartisan deals even in this divided Congress. But as the 2020 election season ramps up into high gear, neither side wants the other to be able to claim a victory. “If we couldn’t come to a consensus in 2019, it’s hard to imagine for 2020,” Rep. Susan Wild (D-Pa.) told Politico.
Media outlets focus on news from Mississippi, Washington, Arizona, Missouri, Kansas, California, Texas, Wyoming, Georgia, Oregon and New Hampshire.
Getting coverage can be just the first hurdle when it comes to navigating the high costs in the health industry. Many patients are delaying or even skipping care completely because they can’t afford it. In other news on health care costs and the industry: uninsured children, Medicaid payments, Oscar Health, the senior care-home industry, another Johnson & Johnson lawsuit, and more.
Doctors are prescribing the drugs sparingly and patients only need to take them a week or two at a time. In a world where pricey million-dollar cancer drugs are king, drugmakers producing modest antibiotics are crashing just when the country needs them the most. In other pharmaceutical news: pay-to-delay deals, blockbuster treatments and a failed promise.
Sen. Elizabeth Warren (D-Mass.) said that big changes in health care, a “deeply personal” issue, can make people “uneasy.” Warren has been hammered over her “Medicare for All” plans and has begun to emphasize a 3-year grace transition period into the new system. Meanwhile, KHN takes a look at how other countries pay for health care.
An appeals court ruling kicked the case back down to the lower court for further work, which means it wouldn’t make its way to the Supreme Court until after the 2020 elections — during which health care is expected to be a major concern for many voters. By keeping the case front of mind for the public, the Democrats are trying to own what has proven to be a winning issue for them in the past.
“I don’t want to jinx it, so I’ll just let it go where we are talking and I’m confident that we’ll get something,” Gov. Laura Kelly said. Medicaid news comes out of Texas, as well.