Published: 01/16/20 03:50 pm EST

Updated: 01/16/20 06:39 pm EST

COLUMBUS, Ohio (AP) Thousands of retired public employees will have to pay more of their health care costs starting in 2022 after trustees for the Ohio Public Employees Retirement System voted Wednesday to reduce health care benefits.

The trustees voted 9-2 on changes that will affect current and future retirees, beginning January of 2022. Those changes include cutting the monthly allowance paid to retirees who are eligible for Medicare ages 65 and older and eliminating the health care plan for retirees who arent eligible for Medicare.

The changes will result in cuts in health benefits for 304,000 workers when they retire and 213,000 current retirees.

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Without the changes, the retirement system projected its $11.3 billion health care fund would run out of money by 2030.

Under the changes, the monthly allowance to help offset health care costs that is paid to retirees who are Medicare eligible will drop from between $225 and $405 per month to a range of $178 to $315 per month. The system plans to give retirees not eligible for Medicare money that they can use to buy insurance on the individual market.

The retirement system has $94 billion in assets for pension benefits and serves 1.14 million people.

2020 by The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Ohio's retired public employees to see cuts in health care benefits - 10TV

A U.S. senator from Indiana wants to expand broadband and telemedicine to improve maternal and infant health.Republican Sen. Todd Young is co-sponsoring the "Data Mapping to Save Moms' Lives Act." He visited Clark Memorial Health on Friday to promote the bill, and to learn more about their OB Navigator telehealth program. The bill requires the Federal Communications Comission to track two things: broadband access and maternal health data. The information will be used to determine where to expand high-speed internet across the U.S."Smartly investing in broadband technology can really improve access to health services and reduce the cost of our health care expenditures ultimately, as well," said Young.Young says Indiana is the third-worst state in the nation for maternal mortality and the seventh-worst for infant deaths.

A U.S. senator from Indiana wants to expand broadband and telemedicine to improve maternal and infant health.

Republican Sen. Todd Young is co-sponsoring the "Data Mapping to Save Moms' Lives Act." He visited Clark Memorial Health on Friday to promote the bill, and to learn more about their OB Navigator telehealth program.

The bill requires the Federal Communications Comission to track two things: broadband access and maternal health data. The information will be used to determine where to expand high-speed internet across the U.S.

"Smartly investing in broadband technology can really improve access to health services and reduce the cost of our health care expenditures ultimately, as well," said Young.

Young says Indiana is the third-worst state in the nation for maternal mortality and the seventh-worst for infant deaths.

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Indiana senator unveils bill aimed at improving health care among mothers, babies - WLKY Louisville

SAN FRANCISCO Yet another J.P. Morgan Healthcare Conference is done. Was it worth it?

All in all, this was a really pleasant week in San Francisco. The weather this year was an A-minus. There was a noticeable drop in attendance. Meeting rooms werent jam-packed. Ubers and Lyfts were easy to hail and coffee shops were bustling but not overloaded.

Maybe thats the simple solution to the hand-wringing over the future of JPM: fewer of you, plus sun.

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But FOMO!

The JPM circus has too many tents. It wasnt always this way. Once upon a time, everyone fit semi-comfortably in a single hotel on Union Square. And it was called JPM for a reason it was to serve the monied interests of a certain large Wall Street investment bank. And, in that sense, it has continued to serve that purpose. Its pay-to-play on a billion-dollar scale. Jamie Dimons health care bankers assemble a roster of presenting companies that either already pay investment banking fees, or will eventually. The select group of investor clients who fill the seats pay trading commissions to the banks brokers.

Im not passing judgment. Thats simply the way Wall Street works.

But at a certain point, JPM changed. Other investment banks and biopharma hangers-on bumrushed San Francisco to pick Dimons pocket. Then things got complicated. The conference got bigger, more unwieldy, less fun? Last year, we reached peak disgruntlement over rapacious hoteliers and the citys well-documented social and public health problems.

Maybe wed be better leaving JPM to J.P. Morgan.

What would everyone else do? For starters, there are dozens of alternative health care investment conferences held in New York, Boston, London, Miami, and Las Vegas. There are 51 other weeks during the year to attend those meetings.

Heres another idea. BIO, the industry trade group, should rethink and revamp its own investor conferences held in New York in February and San Francisco in October. Lets be honest, these events, which attempt to promote smaller biotechs, are not showstoppers.

How about merging the BIO events with Biotech Showcase, the largest, non-awful, non-JPM Week conference that also attracts smaller biotechs and their investors? Keep the San Francisco locale but move the combined events to October. Id attend.

Similarly, non-investor biotech folks cramming into San Francisco this week have plenty of other places to go. This is not an industry lacking attractive travel opportunities. Medical, science, and research meetings span the globe. Enjoy them!

BIO, again, should show some more leadership here by expanding its annual convention. There isnt a non-investor event held in San Francisco this week that couldnt happily inhabit a bolstered BIO convention, usually held in June in wonderful cities like San Diego, Boston, or Washington, D.C.

Anywhere but San Francisco in January. Leave that to J.P. Morgan.

Excerpt from:

The truth about the JP Morgan Healthcare Conference: Less is more - STAT

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On the week of the biggest annual meeting for biotech investors, biotech funds saw their steepest outflows since late July.

In his regular note tracking a sample of healthcare/biotech-dedicated funds, Piper Sandler analyst Christopher J. Raymond wrote that in the seven days ending at the close of business on January 15, roughly $787 million left the funds. Thats a 0.95% drop and the largest number since the last week in July, when $872 million left the funds.

The week includes most of the J.P. Morgan Healthcare Conference, which drew thousands of biotech, pharmaceutical, and other health-care executives and investors to San Francisco for days of meetings. The SPDR S&P Biotech ETF (ticker: XBI) fell 2% on the first day of the conference, January 13, on disappointment over the absence of any major acquisitions. But the index rose as the conference progressed, up 2.9% on January 14 and 0.7% on January 15.

The weeks outflows followed a strong week, which saw inflows of $891 million.

The sample of funds that Raymond tracks includes 121 funds with roughly $84 billion in assets, and is reported by Lipper/AMG Data Services.

This is a key dynamic to monitor as periods of net inflows historically correspond with biotech outperformance while periods of net outflows correspond with sector underperformance, Raymond wrote.

The XBI is up 2.1% so far this year, while the iShares NASDAQ Biotechnology ETF (IBB) is up 1.5%.

Write to Josh Nathan-Kazis at josh.nathan-kazis@barrons.com

Excerpt from:

Investors Fled Biotech Funds This Week During the Biggest Health-Care Conference of the Year - Barron's

Nearly 167,000 Colorado residents signed up for 2020 health insurance through the state's official marketplace. That represents a slight decline from last year, although on average rates of enrollment have remained steady for the past couple years.

Connect for Health Colorado, the state insurance exchange set up through Obamacare, announced the final numbers of enrollees after open enrollment closed Wednesday.

Last year, the exchange reported nearly 171,000 Coloradans signed up for health coverage for 2019 by the close of open enrollment in mid-January. The year before, it saw almost 166,000 medical enrollments over the same span of time.

This has been another successful open enrollment period, said Connect for Health Colorado CEO Kevin Patterson in a statement. He said the exchange will keep working to increase access, affordability and choice for residents.

About 20 percent of the customers are new and the rest returned to buy individual plans on the exchange.

Outside the open enrollment period, Coloradans can only sign up for a health plan on the exchange if they have a significant life event like losing job-based insurance, losing Medicaid or some family changes.According to the Wall Street Journal, the administration has taken a number of steps to limit the reach of the Affordable Care Act since Congress failed to repeal it. That includes cuts to funding for outreach and publicity about ACA enrollment by 90 percent. The administration also reduced funding for groups that help consumers sign up for coverage by 40 percent.

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Fewer People Signed Up For Health Insurance Through The State Exchange This Year - Colorado Public Radio

An MRI scan that cost $1,400 here went for $450 in Britain and $190 in Holland. Thirty tablets of a drug to reduce the risk of blood clots (Xarelto) cost $380 here, $70 in Britain, $80 in Switzerland and $60 in Holland. Hospital admission for angioplasty is $32,000 here, $15,000 in Australia, $12,000 in Britain, $7,000 in Switzerland, $6,000 in the Netherlands.

Add to those differences the latest outrage in health-care costs: surprise medical billing, when even well-insured patients can wake up from surgery finding that they owe thousands of dollars, because someone treating them while they were unconscious was out of their insurance network.

Princeton economists Anne Case and Angus Deaton (a Nobel winner) recently summarized the problem by labeling it an $8,000-a-year annual health-care tax paid by U.S. families. This is the difference in costs between what we pay for health care and what people in other countries pay. As Case put it: We can brag we have the most expensive health care. We can also now brag that it delivers the worst health of any rich country.

Why call this expense a tax? Well, for one, if you want health coverage, you cant escape it. But even if you dont and good luck with that you still cant escape the tax, as both employer- and government-provided health care extract payments through lower paychecks and public financing.

Case and Deaton may be erring on the low side in their $8,000-per-family figure. The Organization for Economic Cooperation and Development puts per-person spending in the United States at $8,950 a year. That compares with $5,060 in Germany, $3,470 in Canada and just $3,140 in Britain. If we assume a family of three, we would get an annual health-care tax of $11,670 compared with Germany and more than $17,000 compared with the cost of health care in Britain.

How can such differences persist, especially in a service where consumption is so essential to well-being? If ice cream were that much more expensive here, wed have a lot to squawk about, for sure. But it wouldnt be a matter of life and death.

An obvious, and correct, answer as to why U.S. health care is so expensive is because we do so little, relative to other systems, to control costs. But its worse than that. We do a fair amount to make health care more expensive.

First, our system of private insurance costs far more than single-payer systems like Canadas, and also more than countries with private but heavily regulated insurers like Germany. OECD data show that as a share of health spending, our administrative costs are three times that of Canadas and twice that of Germanys. Getting our administrative costs closer to those in other countries would require regulating private insurers and expanding public coverage, but it could save us at least 10 percent of our total health-care bill.

Next, we pay twice as much to our health-care providers and for prescription drugs as everyone else. The latter costs us more than $3,000 per family per year. We pay more than twice as much for medical equipment, costing us a bit less than $1,500 per family per year. Doctors and dentists cost us close to an extra $750 per family per year.

One reason for the outsize costs of these inputs to U.S. health care is that government policy protects our providers. When it comes to manufactured goods, like cars and clothes and almost everything on the shelves of Walmart, economists and policymakers push for free trade and more competition. But when it comes to health-care providers, these same authorities turn protectionist.

In areas like prescription drugs and medical equipment, this protection is explicit: Manufacturers are granted patent monopolies. The government will arrest anyone who sells protected items in competition with a patent holder.

In the case of doctors, we have maintained or increased barriers that make it difficult for qualified foreign physicians to practice in the United States. We also prevent other health-care professionals, such as physicians assistants and nurse practitioners, from doing many tasks for which they are entirely competent. There is a similar story with dentists and dental hygienists.

Other countries directly control drug prices. In France, the government determines whether a new drug is an improvement or a copycat, and, if the drug is deemed useful, the government negotiates drug prices with the manufacturers and caps their revenue. When sales exceed the cap, the manufacturer must rebate most of the difference back to the government.

Here in the United States, we give drug companies and medical equipment manufacturers patent monopolies and allow them to charge whatever they want. We dont even let the government use its massive leverage to negotiate lower drug prices for Medicare beneficiaries. Thats what makes these goods expensive; theyre almost always relatively cheap to produce.

This is fixable. It would take regulating costs, reducing reimbursements to providers and increasing competition.

The pharmaceutical industrys rationale for cost-exploding medical patents is that it helps incentivize research and innovation. Without them, its likely that pharmaceuticals and medical equipment companies would do less speculative research. But it would take a fraction of the savings from reducing such protectionism to replace patent-support research with publicly supported research (for which we already spend $40 billion a year).

In terms of boosting competition, allowing foreign doctors whose training meets our standards to more easily practice medicine here would bring U.S. physicians pay in line with international standards. Of course, our doctors pay much more for their education than doctors trained elsewhere, so part of this new structure would also require reducing the domestic cost of medical education and alleviating some of the educational debt burden that U.S.-trained doctors have acquired.

Increasing competition would also require using antitrust measures to push back on the pricing power engendered by the consolidation of both hospital groups and medical practices. An analysis by the New York Times of 25 metro areas found that hospital mergers have essentially banished competition and raised prices for hospital admissions.

Even if we succeed in raising competition and reducing protectionism, health care will still be too expensive for many low- and moderate-income families, many of whom have suffered stagnant incomes in recent decades. Like every other wealthy country, we will need to get on a path to universal coverage. But whatever form that takes, if we can significantly reduce our current health-care tax, the savings will easily be large enough to extend quality, affordable coverage to every American.

Jared Bernstein, chief economist to former vice president Joe Biden, is a senior fellow at the Center on Budget and Policy Priorities.

Dean Baker is a senior economist at the Center for Economic and Policy Research.

This column first appeared in the Washington Post.

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Reducing the Health Care Tax - CounterPunch

LONGVIEW, Texas A Longview man was sentenced Friday for federal violations involving Medicare fraud, according to the U.S. Attorney Joseph D. Brown.

According to the attorney's office, Joseph Valdie Kimble, 57, pleaded guilty on Sep. 11, 2019 to health care fraud and was sentenced to 30 months in federal prison.

Kimble was also ordered to pay restitution in the amount of $751,986.30 to Medicare and Medicaid, and was ordered not to seek or retain employment in the health care fraud industry while serving three years of supervised release.

According to information presented in court, Kimble operated Tiger EMS, a business providing non-emergency ambulance transport, mostly between skilled nursing centers and hospitals and dialysis centers.

Ambulance providers may bill for ambulance services only if there is a demonstrated medical need.

Kimble disregarded medical necessity requirements and billed Medicare and Medicaid for ambulance services provided to patients for whom ambulance transport was not medically necessary.

This case was investigated by U.S. Health and Human Services Office of Inspector General and the Texas Attorney Generals Medicaid Fraud Control Unit and prosecuted by Assistant U.S. Attorneys Alan R. Jackson and Frank Coan.

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Longview ambulance operator sentenced to 30 months in prison for health care fraud - CBS19.tv KYTX

Lawmakers on Thursday introduced bipartisan legislation to boost the role of peer support professionals in Colorado, potentially easing a shortage of specialists who can help treat patients with mental health and addiction issues.

House Bill 20-1139, sponsored by state Reps. Yadira Caraveo, D-Thornton, and Rod Pelton, R-Cheyenne Wells, would authorize Medicaid to pay for additional services provided by peers caregivers who have experienced various mental health and substance-use situations and establish a tax credit to help them pay for continuing education.

Their lived experience and training enable them to relate to and connect with people in powerful ways, said Vincent Atchity, president and CEO of nonprofit advocacy organization Mental Health Colorado, in a release cheering the legislation's introduction.

Added Atchity: Without continuing education, peers may reach a professional ceiling. The tax credit gives these individuals a pathway to continued professional development and incentivizes them to pursue long-term careers in health care, thereby creating better outcomes for the mental health of our state.

The bill, which was assigned to the HousePublic Health Care & Human Services Committee, creates a refundable income tax credit available to peers who go back to school or who graduate and return to work in the health care field. It would be authorized for 10 years and capped at a total of $100,000 annually.

Caraveo and Pelton sit on the Public Health Care committee.

Moe Keller, a former state lawmaker and Mental Health Colorado's director of advocacy, told Colorado Politics before the legislative session opened that peers are considered a vital component in the behavioral health and recovery systems, but their services can only be provided in limited settings.

Some peers work in mental health centers and detox centers, but they cannot work in jails, they cannot work in emergency rooms, Keller said. Were trying to work this up so peers can run clubhouses, do mentoring, provide help with writing psychiatric advance directives.

Atchity said that encouraging peers to fill more roles and helping pay for their continuing education could increase the number of professionalsavailableto treat Coloradans. Currently, he added, only 30% of the documented need for those services is being met.

Other states that have taken similar steps foundthatrobust peer servicesdrasticallyreduced hospitalizations and helped cut psychotic symptoms among patients, Atchity said. In Georgia, reliance on peers helped save the state more than $5,000 per patient.

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Bipartisan bill introduced to support Colorado's mental health care, recovery providers - coloradopolitics.com

When it comes to government budget cuts here in Alberta and the inevitable protests that follow weve only sampled the appetizer. But rest assured the main course being cooked-up in the various ministerial back rooms of the current Kenney government promises to be a hearty humdinger of a dish.

Because the main ingredient, heck perhaps the only ingredient given the size of the resulting entree is none other than the behemoth that goes under the title of Alberta Health. This is where the provincial government hopes the future balanced budgetary goose will be cooked and that any lingering bad taste will be long forgotten when the next election rolls around.

You see, theres really not much of a choice than to attempt getting to grips with spending on health, thats if pledges of balancing the books by the end of this governments mandate are to be realized. After all, the dollars doled out are astronomical when you consider theres fewer than 4.5 million of us generally hearty souls actually living in this province.

As a mind-boggling example, this budgetary year were expecting to spend $20.6 billion on health alone. Thats a whopping 43 per cent of the entire provincial budget. So, now Albertas entire medical system is facing yet another major shake-up, according to Health Minister Tyler Shandro, whos expected to release a draft report later this month on whats going to change.

Of course, the basis for this latest kick at the can of re-inventing health care in our province will be based upon a report by Ernst & Young, which has been reviewing the operations of Alberta Health Services. Youd think nobody employed in governmental departments has any clue whatsoever whats actually going on, given politicians love of inviting all sorts of outsiders to take a look-see under the hood.

Last fall another government-appointed panel, led by former Saskatchewan health minister Janice MacKinnon, had its own take on rising health care costs announcing were often getting substandard service despite paying more per head than other similar jurisdictions in Canada.

Well best of luck to Shandro. Because hell need it if he hopes to turn back the tide of relentlessly increasing costs for taxpayers in paying for our health care system. The fights been going on for decades with the outcome rarely in doubt the bill will just keep on rising.

Heck you can go back as far as 1983 when the Lougheed government tried the tide-turning business. Then health minister Dave Russell famously suggested introducing user fees on some hospital stays $20-a-day if my memory serves me correctly. That went down like a lead balloon in Ottawa, which threatened withholding transfer payments because such levies were an assault on the Canada Health Act. The plan was shelved.

Twenty years later it was Ralph Kleins turn, coming up with some confusing bafflegab about a third way of funding health care, one involving public and private partnerships. That too ended in failure.

Back then of course the province was on a roll, thanks mainly to the revenues from spiking natural gas prices across the land. Thats certainly not the backdrop Shandro enjoys. Were more than eight-billion bucks a year in the hole and hopes that rising provincial GDP will eventually close that gap appear less and less likely with the economy stuck in neutral.

So get ready for the health-care battle. Doctors, nurses, unions and a bevy of protest groups covering the gamut of the hard done by is already preparing to march.

Pass the popcorn: this is going to be a doozy.

Continued here:

Get ready for the health-care battle - Airdrie Today

Whats the news: Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation (Senate bill 1961 and the identical Assembly bill 854) would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.

The New Jersey Senates health committee moved the bill to the floor in June 2019, but the states physicians were able to persuade lawmakers against taking up the bill to weaken the physician-led health care team during the 20182019 legislative session that closed Monday. Most states do not allow APRNs to prescribe independently.

The AMA Scope of Practice Partnership gave the Medical Society of New Jersey a grant to support its efforts to defeat the legislation. In 2019 alone, the AMA State Advocacy Resource Center worked with 35 states and secured more than 50 victories on scope-of-practice issues. That includes Mississippi Gov. Phil Bryants decision to maintain Medicares physician-supervision requirements for certified registered nurse anesthetists.

Learn more about AMA efforts on scope of practice.

Why it matters for patients and physicians: The difference in the education and training of physicians and other health professionals is vast. Physicians complete between 10,000 and 16,000 hours of clinical education and trainingthats four years in medical school and another three to seven years of residency training. By comparison, APRNs complete between 500720 hours of clinical training after two or three years of graduate-level education.

Thirty-five states representing more than 85% of the U.S. population require some physician supervision or collaboration of nurse practitioners, one type of APRN.

The issue of doctors leadership role within the health care team also is surfacing at the federal level, where the Centers for Medicare & Medicaid Services (CMS) has requested information pursuant to a presidential executive order that aims, in part, to weaken physician supervision requirements.

Patients deserve care led by physiciansthe most highly educated, trained and skilled health care professionals, says a letter to CMS Administrator Seema Verma from the AMA and nearly 100 other organizations representing hundreds of thousands of doctors nationwide. A physician-led care team is especially needed in the management of medically vulnerable Medicare patients.

We cannot and should not allow anything less, says the letter, which notes that four out of five patients prefer that doctors lead their health care team. That preference for the physician-led care team rises to 86% among patients with one or more chronic conditions.

Whats next: Implementing President Trumps executive order policies would require a combination of congressional and regulatory actions. The administration is at the beginning of the regulatory process. The AMA will actively engage the administration on these and other issues outlined in the executive order.

Meanwhile, the 20202021 New Jersey legislative session opened Jan. 16.

Each year, in nearly every state, nonphysician health professionals lobby state legislatures and regulatory boards to expand their scope of practice. While some scope expansions may be appropriate, others definitely are not.

Through resources, research and the Scope of Practice Partnership, the AMA has what you need to advance your scope of practice advocacy agenda.

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New Jersey rejects bill to weaken doctors' role as care team leaders - American Medical Association

As technology gets more sophisticated and stressed-out consumers find it harder to get some shut-eye Sleep Number (SNBR) thinks the day could arrive when a mattress can be covered by health insurance.

Sleep disorders which the Centers for Disease Control (CDC) has deemed a public health crisis have been linked to health conditions like heart disease.

Meanwhile, institutions like the Mayo Clinic are shelling out millions to fund studies on why people find it harder to rest. And just Friday, Sleep Number competitor Casper Sleep filed paperwork to go public, citing the opportunities presented by what it estimated is a $432 billion sleep economy.

Its also a hot button issue for technology companies looking to get a slice of health care spending thats set to get even larger. Apple (AAPL), Samsung (SSNLF) and Google (GOOG) which recently acquired Fitbit are all analyzing sleep patterns through wearables.

Those efforts laying the groundwork for Sleep Number, which is pivoting toward health and wellness. Already, the 32-year old company is working with Mayo to analyze Sleep Numbers anonymous data from its SleepIQ technology.

In 2012...I could see the value of having that technology in our beds, Shelly Ibach, president and CEO of Sleep Number, told Yahoo Finance on the sidelines of last weeks CES technology confab in Las Vegas.

Photo courtesy: Sleep Number

Ibach said the use of wearables helps the company take sleep analysis a step further, since a mattress functions as a whole-body monitoring system.

Still, not everyone can afford one of Sleep Numbers $1,000 mattress. To that end, the CEO said the idea of beds becoming part of the health reimbursement system wasnt far off the mark.

If we see sleep deprivation certified as a disease to the degree that it would be funded by a health care organization, then Sleep Number could become a covered medical device, Ibach told Yahoo Finance.

The Mayo Clinic is collecting data through its Sleep Numbers SleepIQ technology, and studying how sleep (or lack thereof) affects a persons health.

The $1 million endowment for sleep science and $9 million research fund will analyze SleepIQs sleep science information. SleepIQ collects more than 10 billion biometric data points each night and has analyzed 25 million sleep sessions.

To-date, the technology has helped individuals increase sleep time by at least 15 minutes per night, according to Sleep Number.

Prevention is a way to control health care costs. We expect to be able to work together and deliver evidenced-based solutions, she said.

Anjalee Khemlani is a reporter at Yahoo Finance. Follow her on Twitter:@AnjKhem

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Cigna-Express Scripts bets on digital care as the future of health

Study: The health sector is splurging on digital, but not reaping the rewards just yet

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Your mattress covered by health care? Why Sleep Number thinks it could happen - Yahoo Finance

The healthcare industry is set to see a dynamic 2020 as the presidential election approaches, with questions about who will challenge President Donald Trump and whether the call for "Medicare for All" feared by many in the industry survives the Democratic primaries.

No matter who wins the White House come November, healthcare experts say the push to reimburse providers for value and the aim for greater transparency surrounding prices will keep moving ahead. But uncertainty around the fate of the Affordable Care Act and key legal decisions will linger, including whether HHS can require hospitals to reveal negotiated rates and whether insurers are owed billions in the risk corridor case before the U.S. Supreme Court.

Consolidation is set to continue with deals already underway, though some expect fewer mega deals and more bolt-on acquisitions and regional tie-ups.

Here's a guide to big themes for the year ahead.

The legal threat to overturn the ACA, a law deeply intertwined in the U.S. healthcare system, has racked up two wins in the lower courts and now awaits a decision from the nation's highest court on whether its justices will take on the case. If the Supreme Court decides to take it on an expedited timeline, a decision could be rendered before the presidential election, which would ensure the ACA will once again be center stage throughout another campaign season.

It's unclear how the court will rule, "but there is certainly a significant risk" to the law,Dean Ungar, an analyst for Moody's, told Healthcare Dive.

It would disrupt the insurance market and pose a significant problem for insurers with a large presence on the exchanges and in Medicaid expansion states, including Centene and Molina, Moody's analysts said in a recent note.

Alternatively, the high court could wait to hear the case until the next term, which would push the issue past the election and into next year.

At the same time, Democratic challengers who hope to unseat Trump in November pose their own risk to the industry as they tout ideas for reform, though of varying degrees. The most extreme idea is the call to move to a single-payer system, boxing out traditional insurers.

"Any of it would not be good for the insurers," Ungar said of Medicare for All. "The likelihood of that happening is low, very low, but nevertheless it's there."

Other legal question marks include pending cases over whether HHS can force hospitals to reveal the secret, negotiated rates they reach with insurers for services. The legal clash is set to heat up quickly. The judge has the case on an accelerated timeline as the American Hospital Association wants a swift ruling and summary judgment.

The hospitals argue HHS has exceeded its government authority in crafting the rule, which they say violates their First Amendment rights as it would force them to disclose confidential and proprietary information.

Also before the Supreme Court is the question of whether insurers are owed billions in risk corridor payments, a program that was supposed to financially protect insurers who attracted a disproportionate share of sicker patients through the ACA exchanges. A few nonprofit co-ops were driven to close when CMS declared the program had to be budget neutral and therefore only paid out about one-eighth of the expected payments.

Payers and providers are under increasing pressure to provide heightened transparency into prices as more costs have been shifted to patients through high-deductible plans and as health spending consumes a greater portion of the nation's GDP.

The Trump administration wants providers and payers to publicly reveal the negotiated rates for services, expanding a previous push that required providers to release their chargemaster list, which shows prices for certain services but not necessarily what insurers agree to pay.

The hospital lobby is fiercely opposed to such regulation and filed suit against the final rule.

Regardless, experts say don't expect the push on prices to slow down as regulators and consumers seek to rein in healthcare spending.

"Definitely more [to come] on greater transparency, more requirements and focus on that both in terms of the proposals from CMS and the Trump administration," Rick Gundling, senior VP of the Healthcare Financial Management Association, told Healthcare Dive.

Adding fuel to the transparency push is continued frustration over sky-high surprise bills. Congress zeroed in on the practice last year but never reached a deal for legislation banning it. The issue will no doubt continue into 2020 as it has garnered bipartisan support. The only thing standing in the way is debate over how to craft a legislative solution that will effectively box out surprise bills.

"I will continue to do everything I can to keep surprise medical bills at the top of the congressional priority list until its done," Republican Sen. Lamar Alexander of Tennessee said in December. Alexander is also the chairman of the Senate health committee, which has focused on surprise billing.

Still, lawmakers (and payers and providers) have competing ideas on how to fix the problem.

Payers favor rate-setting when out-of-network issues arise and providers support arbitration, a means to dispute the issue with payers with a third-party.

Hearings on surprise billing this year have yet to be scheduled.

The industry is coming off a wave of significant deals, including CVS' buy of Aetna and Cigna's acquisition of Express Scripts as well as provider unions like Advocate-Aurora and Bon Secours Mercy Health.

Mergers and acquisitions will continue as hospitals struggle to overcome a number of headwinds and as both payers and providers seek greater scale for additional leverage. But the pace and size may slow a bit, experts say.

There are few opportunities left for mega deals, Ungar said. "And we know the Justice Department has stepped in in the past when they're too big," he said, referencing the failed deals of Aetna-Humana and Anthem-Cigna.

A recent report from KPMG also predicted a slowdown. Industry experts told Healthcare Dive they expect to see consolidation bring together more regional players.

"Although size and scale alone do not necessarily result in success, further consolidation is a logical outcome given current industry pressures," Fitch Ratings said in a recent research note finding the outlook is stable for nonprofit providers in 2020.

Still, just days into the new year, Molina said it entered into a deal to buy an Illinois Medicaid managed care provider to expand its footprint.

On the provider side, Michigan-based Beaumont Health and Ohio-based Summa Health announced merger plans.

Gundling expects continued consolidation and the rise of major regional players akin to Advocate-Aurora. Healthcare is not as consolidated as other sectors. "We don't really have a national provider across the country," he said.

Traditional health systems are under intense pressure as their operating model is under threat from the rise in consumerism and the shift in reimbursement.

This rise in the retailization of healthcare is a massive driver of change. "You can't underestimate it,"Patrick Pilch, who leads BDO's healthcare advisory practice, told Healthcare Dive.

Health systems operate in an environment now where consumers are accustomed to seamless customer experiences in other sectors. From an app on their phones, consumers can order groceries or a ride to a particular destination, and they have come to expect that packages containing their orders for just about anything will arrive on their doorstep in just two days or sooner thanks to Amazon.

Meanwhile, more healthcare consumers are saddled with high-deductible health plans and are on the hook for more of their care financially, causing them to look for inexpensive modes of care or put off care altogether.

At the same time, providers are being asked to shoulder more risk through value-based arrangement by caring for a certain set of patients and are expected to reach certain targets or risk a financial penalty (or fail to earn a bonus). Though the change has been slow, more value-based arrangements are expected to continue in 2020, experts said.

Payers and providers "that fail to respond to the imperatives of consumerism will risk losing relevance as the move to value-based payment gains traction, while consumer-savvy organizations will be positioned to thrive," HFMA CEO Joseph Fifer said in a recent report.

Nontraditional players have posed the biggest threat to hospitals in the realization of healthcare.

For its part, CVS made a bet on Aetna. Together, CVS believes it can use its pharmacists and retail clinic model to better coordinate and ultimately reduce the cost of care.

Though it's not just CVS and Aetna making bigger strides into the industry. Walmart is also attempting to make access to care quicker and more convenient for consumers who are demanding such changes by opening its own healthcare stores.

For traditional systems, it means patients are being siphoned away from their outpatient facilities.

In an ominous sign for traditional providers, outpatient visits declined for the first time in recent history for many hospitals, according to data with the American Hospital Association.

Ken Kaufman, managing director of Kaufman Hall, told Healthcare Dive hospital CEOs will need to adapt to that change by offering competitive pricing, exploring more virtual care and listening to what patients want.

"What it means is the introduction of a new business model in healthcare, where that new business model is splitting off inpatient from outpatient so you have numerous competitors who are coming in who are not interested in the inpatient sector at all," he said.

Read this article:

Key 2020 trends for payers and providers - Healthcare Dive

The top story out of this week's Democratic presidential debate was Sen. Elizabeth Warren's accusation that Sen. Bernie Sanders called her "a liar on national TV." Both progressive firebrands have a casual relationship with the truth, especially when it comes to their plans for healthcare. But Warren's pitch has grown ever more misleading.

For months, she adamantly defended "Medicare for all," a full-blown government takeover of the U.S. health insurance system. Private insurance would be outlawed, and the federal government would be granted a monopoly over payment for health services.

Many of the 180 million people with private insurance greeted Warren's plan coldly. So she began to frame her plan as a public option first, with a three-year transition to "Medicare for all." At this week's debate, she said she'd "build on the Affordable Care Act, but where we end up is we offer healthcare to all of our people. And we can offer it at no cost or low cost to all of them."

A public option would quickly become the only option for consumers. Private insurers can't match the low prices of a government-run insurer that doesn't have to cover its costs. The public option would also be able to dictate providers' reimbursement rates. Private insurers don't have that kind of negotiating power.

As a result, private insurers would exit the market, unable to compete. One analysis projects that more than 130,000 people with private exchange coverage would be jettisoned from their plans in a public option's first year. Millions more with employer-sponsored coverage could meet a similar fate.

Of course, that's the point. It's easier to nationalize the health insurance system if a government-run public option has already swallowed a few million people who previously had private coverage.

Then there's Warren's "no cost or low cost" claim. She says her plan would require a $20.5 trillion increase in federal spending over a decade more than we currently spend on Social Security, the largest line item in the federal budget. Virtually everyone else who's analyzed "Medicare for all" thinks $30 trillion-plus is more realistic.

That's some definition of "low cost." If this is the best "offer" Warren can make, no thanks.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, (Encounter 2020). Follow her on Twitter @sallypipes.

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Under Elizabeth Warren, there's no choice but government-run healthcare - Washington Examiner

Hello,

Welcome to our annual post-J.P. Morgan Healthcare Conference edition of Dispensed, which is coming to you from a coffee shop in LA. I can use all the caffeine I can get after this week, and I'm looking forward to spending the weekend exploring the city and soaking up as much sun as I can before getting back to NYC next week.

I'm feeling so grateful for all the folks I got a chance to catch up with, all the new introductions, colleagues willing to get drinks at 4 p.m. so I can do happy hour and catch a flight, and all the story ideas that'll keep me busy for at least part of 2020! Until next year, San Francisco.

Are you new to thenewsletter?You can sign up here.

Last week, I mentioned we'd be spending our week in San Francisco running around the conference. It was my fifth time, and the first time I can remember that came and went without any ground-shaking news. Based on the conversations I had around the conference seems to be connected to the elephant in the room: the upcoming 2020 presidential election.

While the election is still months and months away, the sense I got was it's a good time to be as measured as possible, rather than dream up new acquisitions or business strategies. Curious to hear if you all got the same vibe ping me at lramsey@businessinsider.com with your thoughts.

Which isn't to say there wasn't anything to follow along with coming out of the conference. Here's what you might've missed over the week.

First, Verily made waves in its presentation Monday (and ruffled some partners' feathers). I have the play-by-play.

I mentioned I'd be tuning in to both Verily's presentation and Oscar Health's. During his presentation, CEO Mario Schlosser made an interesting comment about where he sees the employer-funded (aka a prevailing way Americans get their healthcare coverage) market going.

Zach Tracer and I followed up with him about it in an interview Tuesday. Here's what he told us.

To kick off the week, we covered the ambitions of EQRx, a startup founded by former Third Rock Ventures VC Alexis Borisy and Foundation Medicine chief business officer Melanie Nallicheri, raising from investors like Andreessen Horowitz, Arch Venture Partners, and GV.

Please enjoy this view of the city from the hill near my AirBnB! Lydia Ramsey

Stocks predictably soared and dropped based off good and bad news. Notably, Adaptimmune's cancer data sent the stock up 330%, while billionaire doctor Patrick Soon-Shiong'scancer drugmaker NantKwest's stock soared 92% on an interview he gave where he mentioned that exactly one person treated with the company's drug was in remission.

Deals (albeit, smaller in scale) were struck, with telemedicine company Teladoc buying InTouch Health for $600 million, Neon Therapeutics selling to German biotech BioNTech, and Pittsburgh-based health system UPMC raising an $800 million fund to invest in life sciences.

We also got updates on company strategies. That includes the potential for the newest most expensive drug in the world, as BioMarin anticipates pricing its gene therapy for the blood disorder hemophilia between $2 million and $3 million, per the Wall Street Journal. Right now, the most expensive drug in the world carries a price tag of $2.1 million. There was also news of a partnership between digital health company Livongo and Dexcom.

More to come as I sort through my notes from our various encounters around Union Square.

Also - if you're interested in clean energy, my colleague Benji Jones just launched his own weekly newsletter, Power Line! You can subscribe here.

(Finally, please send me your LA weekend eats recommendations!)

- Lydia

Read the rest here:

Dispensed: Business Insider's weekly healthcare newsletter JPM 2020 recap - Business Insider

For proponents of the Affordable Care Act, the last couple of months have been quite encouraging, at least as far as the substance of health care is concerned. Totals from the recent open-enrollment period, for example, were solid and in line with expectations, while the latest industry data pointed to stable health care markets, Republican sabotage efforts notwithstanding.

It was against this backdrop that Utah's Medicaid expansion program got underway on Jan. 1, while policymakers in Kansas reached a bipartisan compromise to bring Medicaid expansion to the Sunflower State. Others may soon follow: Phil Cox, a former head of the Republican Governors Association and a well-known figure in D.C. circles, was quoted saying two weeks ago, "The battle has been fought and lost on Medicaid expansion."

There is, however, just one dark cloud hanging over the ACA's head. A Republican lawsuit, backed by the Trump administration, is trying to destroy "Obamacare" in its entirety, and a Texas judge has already ruled in the GOP's favor. The 5th Circuit, in a move that appeared awfully political, recently left the future of the nation's health care system in limbo, almost certainly until after the election.

The legal process may, however, move more quickly. The ACA's proponents asked the U.S. Supreme Court to take up the case, and a week ago today, the justices directed the Trump administration and Republican state officials behind the lawsuit to respond. As NBC News' Pete Williams explained, "Such a highly abbreviated timeline the rules normally allow a month for filing a response gives the court the option to take up the case during its current term, which would mean a ruling on a contentious issue this spring, just as the presidential campaign heats up."

On Friday, the administration filed a brief, effectively telling the high court to cool its heels. The Washington Post reported:

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The Trump administration and a coalition of conservative states that have been challenging the Affordable Care Act said Friday that there is no reason for the Supreme Court to rush a ruling on the issue this term. [...]

President Trump's solicitor general, Noel Francisco, replied that the [5th Circuit's] decision simply preserved the status quo until a lower court looked more closely at which parts of the law should survive. It would be premature to intervene now, he said.

The full filing is online here (pdf).

To put it mildly, the Trump administration's argument is a tough sell, at least as it relates to the ACA itself. On the one hand, the lawsuit argues that the law's individual mandate, which Republicans gutted in late 2017, was so integral to the ACA that the nation's health care system can't function effectively without it, so "Obamacare" should cease to be. On the other hand, the Trump administration is also arguing that the mandate-less ACA is working fine right now, so there's no reason for the justices to act with any haste.

Both points cannot be true.

In case this isn't obvious, political considerations appear to be at the heart of the developments. It's likely that Trump and his team realize that if the Supreme Court takes up the case in the short term, there's a very real possibility that the White House and Republicans would either (a) lose a humiliating health care case in an election year; or (b) convince five conservative justices to take health care benefits away from tens of millions of Americans in an election year.

Or put another way, this isn't a great issue for the president or his party, which helps explain why they're so eager to convince the Supreme Court to push the whole issue off for a long while.

It also helps explain why Trump is peddling truly outrageous nonsense on the issue, including a tweet this morning in which the president claimed, "I was the person who saved Pre-Existing Conditions in your Healthcare." He added, "I will always protect your Pre-Existing Conditions, the Dems will not!"

It's as brazen a lie as Trump has ever told -- and to know anything about the president is to know the competition in that category is fierce. In reality, Trump didn't "save" protections for Americans with pre-existing conditions; he fought to take those protections away through a series of far-right repeal-and-replace proposals he couldn't get through a Congress led by his own party.

Trump, of course, is also helping champion an ongoing federal lawsuit which would -- you guessed it -- strip protections for Americans with pre-existing conditions.

MORE: Today's Maddowblog

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At the intersection of Trump's health care lie and his ACA case - MSNBC

Gov. Chris Sununu has announced that New Hampshire intends to file a waiver with the federal government that could help stabilize the individual health insurance market and lower premiums by as much as 15 percent next year.

Preserving and stabilizing New Hampshires individual health insurance market has been a key priority for our administration, Gov. Chris Sununu said in a news release. Our previous efforts have kept our states three current insurance companies in the market and have lowered premiums for two consecutive years."

But Sununu said federal policy has impeded state efforts to control costs.

"However, continued dysfunction and lack of reform in Washington is likely to produce increased prices next year that could put healthcare out of reach for too many Granite Staters," he said. "Thanks to good financial management and the reforms my administration made to our states Medicaid Expansion program, this waiver, unlike previous proposals, makes sense and could reduce prices for individuals by 15 percent.

What the Section 1332 State Relief and Empowerment Waiver ultimately could do is help bring thousands more people into the individual market in New Hampshire, which currently has about 44,000 people, Greg Moore, state director, Americans for Prosperity New Hampshire, told The Center Square.

When you have more healthy people joining the pool, they will bring more stability to the marketplace, which should help bring down premiums for everyone, Moore said. "If you could bring in another 10,000 healthy people into the exchange, you would really see an effect on premiums.

The long-term success depends on bringing in uninsured people who because of high prices perhaps found it made more sense to sit it out and simply pay for health care when needed.

New Hampshire currently ranks among the nations highest for insurance costs, but premiums have improved the last two years since people with Medicaid expansion began being served through managed care organizations instead of the individual marketplace. That was a one-time opportunity, Moore noted, and now the waiver decision is a good next step.

The federal government has been encouraging innovations at the state level, Moore said, and the 1332 waiver is representative of that goal.

Its a relatively new landscape," Moore said. "Once [President] Trump was elected, his folks at HHS encouraged new and creative solutions under 1332, and states are trying to understand the landscape of whats doable and what isnt.

In theory, this could benefit everybody if it works well, Moore added.

Read the original here:

New Hampshire seeking federal waiver that could lower health insurance premiums - The Laconia Daily Sun

The final film in the epic Star Wars saga, Star Wars: The Rise of Skywalker hit theaters this weekend. It should have had fans around the world buzzing. Instead, many of them are either yawning with disinterest, or speculating on YouTube about just how bad the last installment in the 40-year-old series might be. The critics have panned the film in early reviews, with Rotten Tomatoes pegging the critical score at a meager 58%. What happened to Star Wars?

As a doctor, movie lover, and proud tech geek, I often see parallels between work and my other hobbies.

When I think about Star Wars, especially what has happened to the franchise after the Disney acquisition of Lucasfilm in 2013, some stark comparisons to the U.S. health care system come to mind. Our system is in many ways fragmented, bloated with administrative expense and, if were candid, mismanaged at the macro level. Star Wars has followed a similar path since the new Disney trilogy was launched in 2015 that, in my view, accounts for many of the problems the franchise is currently suffering from.

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Rewind to the first Star Wars movie (now called Episode IV: A New Hope), youll find a far different production than the $200 million extravaganzas produced by Disney. A New Hope debuted in the summer of 1977 and went on to become one of the highest grossing films of all time. It featured a clear plot that pitted good against evil, realistic (for the time) special effects and, most importantly, substantial character development inspired by timeless mythological storytelling. Moviegoers were thrilled, and many of them went back to the theaters to see Star Wars again and again.

A New Hope was followed up by two excellent sequels that continued the saga in 1980 and 1983, both which adhered closely to the formula established in the first film.

Fast forward 42 years, and you have a far different Star Wars. The basic elements of an action-adventure set in space are the same. Unfortunately, the iconic film series is now packed with a multitude of characters (some important, many not) and bloated storylines that ping-pong viewers between concrete plot development and over-the-top action sequences. Some moviegoers are satisfied on the surface with the glitz and fancy CGI, but true fans of the series complain that their underlying expectations werent met by the fragmented stories and lack-luster character development. Moreover, the new films now also incorporate elements of current politics that feel out of place in a story meant to transcend time.

Health care in the 1970s was, in many ways, the starting point for the system that we have today. I believe it has followed a similar course to Star Wars. The bill that laid the groundwork for what we now know as Medicare and Medicaid was being implemented, and President Richard Nixon unveiled his plan to require employers to offer health insurance to employees while providing subsidies to those who had trouble affording medical care.

The U.S. health care system made sense. It was becoming clear, affordable for most people, and was set to provide the best medical care in the world. With these legislative imperatives, it appeared everyones health care needs were now going to be met.

However, like the unravelling of Star Wars, bloat began to seep in to the health care system. A bevy of laws required more governance and more administrative staff to ensure compliance and reimbursement for medical services. One can chart the growth in how expensive U.S. health care has become by simply looking at the growth of the ratio of administrators to doctors since the 1970s.

According to a Harvard business Review blog post by Robert Kocher, there are now 10 administrators for every one doctor in the U.S. today. And 95% of new hires in health care arent doctors or nurses, they are administrative hires that have little to do with caring for patients. This represents a growth rate of over 3,200% from where we were in 1975:

By the late 1990s, national health care spending in the United States had sky rocketed and accounted for 12.1% of total GDP the highest thus far in the history of the country. Fast forward to the 2010 and the introduction of the Patient Protection and Affordable Care Act, commonly known as the ACA, which had the potential to dramatically improve the system. Unfortunately, this potential came along with new ACA requirements for electronic medical records, dramatically increasing workloads on physicians with little discernable benefit for patients. Moreover, expanded regulation and insurance benefits mandated by the ACA resulted in even more administrative expenses.

While the ACA did successfully increase insurance coverage, the additional costs were often borne by patients in the private insurance market in the form of skyrocketing insurance premiums and higher out-of-pocket deductibles. Today, the health care system now consumes an eye-popping 17.8% of GDP.

As was the case with the growth in Star Wars film budgets under Disney, bigger and more expensive didnt necessarily translate into better health care. Bigger in health care has led to a reality in which my fellow doctors have their attention diverted into electronic medical records and away from patients, a situation that has contributed to an epidemic of physician job dissatisfaction and burn out.

The following decade was one in which political divisions and competing reimbursement models created an ever more convoluted and fragmented approach. The system is again poised to be a political football in the 2020 presidential election. Recent polling suggests that health care is the number one concern among U.S. voters.

Yet it is tragic that the U.S. now ranks amongst the lowest among developed nations for health care, despite spending the most. This reality is shocking, given that the U.S. is widely acknowledged as having some of the best doctors in the world, along with the most advanced medical technologies and therapies.

As in the new Star Wars, which due to bad management decisions from the top of Lucasfilm has had a rotating cast of directors and writers, there are too many competing stakeholders in the health care system for the average patient to even keep track. And as major tech companies begin moving deeper into the industry, they have inadvertently ignited controversies over patient privacy. Drug costs that many Americans simply cant afford are another pain point. Against this backdrop, its easy to see why the system leaves so many feeling insecure and vulnerable.

In the movie business, the focus should always be on the audience. Giving the audience thrilling films that transported them to a galaxy far, far away is what made Star Wars successful in the first place. The analog in health care is a laser focus on the patient. Delivering the best care possible is what made the U.S. health care system the envy of the world. With the potential re-thinking of the health care system in 2020, my hope is that we can regain that patient focus by simply letting doctors do the work they love.

And as for Star Wars, The Rise of Skywalker, smaller might be the future. After all, who doesnt love the Internets latest sensation, Baby Yoda?

Amit Phull, M.D., is medical director and vice president of strategy and insights at Doximity.

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Star Wars and the US health care system share this: bloat - STAT - STAT

Imagine a visit to your primary care doctor that did as much to assess and treat your mental health as it did your physical health. How would such an encounter differ from the ones most of us are accustomed to? Your doctor would ask about your mental wellbeing along with questions about your diet, exercise, lifestyle choices and social behaviors such as smoking. He or she would integrate behavioral health counseling into your physical health care, providing guidance so you can self-manage your medication, nutrition and exercise.

Under this scenario, a physicians primary care practice would be fluent in behavioral health clinical guidelines and standards of care, confident in clinical decisions, and deeply familiar with the community social supports available to patients.

Sounds great, doesnt it? A growing body of research gives us good reason to think it would be. Unfortunately, making this scene a reality for primary care patients across the country is much more complicated than adding a few questions to physicians typical script. For example, while patients interact directly with a practices reception staff, physicians and other health care providers during their visit, there is a whole back-end infrastructure that patients may not be aware of that enables the practice to function from billing and coding protocols to electronic medical records systems to care management platforms that often isnt built to support behavioral health care integration.

Still, I know that the integration of mental health care into primary care is possible, in part because were making strides in this direction in New York at both the state and city levels, and in part because its a health industry-wide goal thats too important to give up on.

In my roles as a public health leader, practitioner, professor and researcher, I have focused on reconceptualizing and transforming community-based health care delivery systems. Plenty of primary care physicians are reluctant to change how they operate in order to integrate behavioral health care into their practices. This is understandable; doing so would involve developing a familiarity with new assessments, medications, diagnoses and treatment styles a new way of practicing the craft that they have honed for decades. The overhead for accommodating these changes, in addition to the back-end system changes mentioned above, is significant and often prohibitive. What will catalyze such systems-level seismic shifts in motion?

Policy has a role to play. As our countrys health care system and especially legislation regarding its financing continues to evolve at the federal, state and local levels, incentives to integrate mental health care into primary care must be baked into health care financing structures. New York is demonstrating how this might be done. The states Office of Mental Health is building incentive structures to encourage primary care providers to adopt the Collaborative Care Model, or the integration of behavioral health services into the primary care setting. The Collaborative Care Medicaid Program, launched in the state in 2015, offers primary care providers a method of financial sustainability to integrate behavioral health care into the primary care setting through supplemental monthly payments at a specified case rate.

There are still restrictions on health care practices that qualify for and maintain participation in the program; for example, practices must demonstrate achievement of quality metrics and ongoing use of patient registries to continue receiving the full case rate. Additionally, the upfront start-up costs of establishing the necessary infrastructure can be a heavy lift for many independent primary care practices.

Policy changes are not enough. Beyond changing financial incentive structures at the health care system level, we must empower primary care providers to see for themselves how integrating behavioral health care into their practices truly benefits patients and improves health outcomes. In New York City, this education is a critical part of the Department of Health and Mental Hygienes mandate to provide ongoing technical assistance to primary care providers to help them understand how offering behavioral health services will support their success in a value-based purchasing landscape.

Health departments across the country should make it part of their mission to convey the significance that behavioral health integration may have to the primary care providers they serve. Not only is what were doing in New York City replicable elsewhere, but its also highly adaptable to the unique socioeconomic characteristics and needs of other cities that can tailor the model in a culturally humble and accessible manner.

I hope that we in the health care field wont stop there. Lets continue to expand our goals, think broader, reach wider, and acknowledge that beyond the primary care environment, there are many other settings that would benefit from more focus on behavioral health. Consider hemodialysis centers, where people with chronic kidney failure undertake weekly dialysis. Or bring to mind oncology, hematology, palliative care and other community-based settings and the significant occurrence of anxiety, depression, mood disorders and other mental health conditions in these contexts. These are optimal environments to drive behavioral health integration beyond just the primary care setting.

We also must keep in mind that the integration of mental health care into primary care settings is a journey, with each step a milestone. It is part of a broader strategy towards embracing population health as an ideology, not just a model clinical outcome towards which we strive. Whether it starts with enabling a private practice behavioral health clinician to co-locate within a partnering primary care facility, or with having the primary care facility itself directly offer the full suite of behavioral health services, we need to be comfortable that each milestone itself is a means of integration across a continuum of strategies and options.

Were past the point of wondering whether behavioral health care integration can help save lives we know it does. Lets talk more about how were going to make it happen.

Hewett Chiu is an adjunct assistant professor of health administration at New York Universitys Robert F. Wagner Graduate School of Public Service. He also is executive director, MHSC at the New York City Department of Health & Mental Hygiene and president of the Academy of Medical & Public Health Services.

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Integrating mental health care into primary care will require big changes | TheHill - The Hill

Its perfectly fine for politicians to look at ways to keep prescription drugs affordable. But why does the bigger problem of soaring hospital bills get so little notice?

Centers for Medicare and Medicaid Services data out this month show that retail prescription drug prices declined by 1.0 percent last year, to $335 billion, while spending for hospital-care services rose at about the same rate as in 2017, to $1.2 trillion.

And thats nothing new: The Bureau of Labor Statistics reports that drug prices have gone down for more months this year than theyve gone up, something the White House understandably celebrated.

Hospitals represent a third of total US health-care spending, drugs just a tenth. And a new analysis in the journal Health Affairs shows that over the past four years, hospital spending jumped 15.2 percent while retail prescription-drug spending rose just 5.7 percent, less than the overall Consumer Price Index.

One reason pharmaceutical prices get all the attention is that many more people see them: Insurance typically covers a far bigger part of a hospital bill. (And people just dont use hospitals as often as they buy drugs.)

Another reason: Hospitals and unions for their staff have vast political clout. Here in New York, health-care union 1199 is universally feared, while the Hospital Association of New York spreads campaign cash all over state government.

These angles may be why President Trump is almost alone in pushing on hospital costs. His recent executive order requiring them to publicly post their prices as well as the lower prices they agree to with insurers starting in 2021 is a landmark that has the industry screaming and suing.

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Hospitals, not drugs, are the big driver of health care costs - New York Post

It was great news, meaning as many as 120,000 low-income Utahns will have access to health insurance with the feds paying 90 cents of every dollar in cost. And they can sign up on Jan. 1.

Bill Tibbitts, an anti-poverty advocate who has fought for the expansion, thanked Herbert for his work to get it done.

If only they had adopted my Healthy Utah plan five years ago, the governor replied.

For more than five years since, these legislators relentlessly fought to block Medicaid expansion and to deny care to those who desperately needed it. They succeeded, until voters revolted.

But even after voters, more than 555,000 of them fed up with the ideologically driven intransigence, took the nearly unprecedented move of backing a ballot initiative, lawmakers immediately dismantled portions of it, and opted for a scaled-back partial expansion.

Ignoring the will of the people has meant that, since April, Utah has been covering tens of thousands fewer people than otherwise would have been eligible and at a substantially higher cost while being gaslighted by legislators who claimed it was in the name of fiscal conservatism.

It was surreal watching legislative leaders patting themselves on the back Monday for a job well done.

The [approval] will provide more Utahns with the coverage they need while saving Utah taxpayers millions of dollars in potential costs, said House Speaker Brad Wilson.

Wilson was among the legislators who voted to kill Herberts Healthy Utah plan back in 2015, which, again, is nearly identical to the proposal Wilson is now championing.

The five-plus years of delay had a significant cost.

Over the past nine months when lawmakers were clinging to their scaled-back partial expansion Utah has foregone more than $530 million in federal Medicaid support, according to calculations by Joe Weissfeld of Families USA. Spread over the course of the past six years, it has cost the state an estimated $5.5 billion money you and I paid into the Medicaid program but which Utah lawmakers refused to accept when it was supposed to come back to help the poor.

Thats the dollars and cents or nonsense side of it. Then there are the lives lost.

Even if you think that estimate is inflated, go ahead and cut it in half and it is still a heartbreaking toll.

Stacy Stanford, an analyst with the Utah Health Policy Project, said she got involved in the fight for expansion because she was one of those who spent five years in the so-called coverage gap. Along the way, she said, she encountered a lot of people in the same circumstance and a lot of them died without ever getting the coverage they needed.

There are just so many stories like that, she said. Now we dont have to tell those stories anymore.

Now the challenge becomes getting people signed up. Since the partial expansion got underway in April, enrollment has fallen well short of the projections about 40,000 now covered, rather than the 70,000 expected.

Now, tens of thousands more will be eligible for coverage and at long last have access to preventative care, and possibly early life-saving diagnoses. Theyll be free from the threat of one health crisis leading to financial ruin. Finally, those people have the prospect for a healthier, happier new year.

To find out if youre eligible for Medicaid and to enroll, visit medicaid.utah.gov.

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Robert Gehrke: Getting health care to low-income Utahns never should have taken so long or cost so much - Salt Lake Tribune