Obama calls for more states to expand Medicaid eligibility | Report: CMS could add social risk factors to value-based payments | N.Y. coaches bridge gaps for better health
October 21, 2016
AHIP Solutions SmartBrief
Top Stories
Obama calls for more states to expand Medicaid eligibility
President Barack Obama said Thursday that the Affordable Care Act needs optimization rather than replacement to deal with rising premiums and other challenges, saying "no major social innovation in America has ever worked smoothly at the start." Obama called for states that have not expanded Medicaid eligibility to do so, as well as an expansion of tax credits for exchange enrollees.
USA Today (10/20),  The Washington Post (tiered subscription model) (10/20) 
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Report: CMS could add social risk factors to value-based payments
Medicare could incorporate social determinants of health into value-based payments, but the CMS would need demographic data on factors such as ethnicity, education, marital status and income, according to a report from the National Academies of Sciences, Engineering and Medicine. The report also suggests collecting information on "neighborhood deprivation" metrics, such as suitability for walking and access to health care.
AAFP News (10/19) 
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Medicare Advantage Plans Are Facing Real Change
MA plans are facing a rapidly changing landscape; aging boomers, changing service and reimbursement models and more. You need a strong core to handle these and all the changes in the industry. Check out how a core platform, designed for the rigors of Medicare Advantage, can help you survive and thrive in the new healthcare environment. Click Here for more info.
Providers & Suppliers
N.Y. coaches bridge gaps for better health
City Health Works health coaches help New Yorkers with chronic illnesses, particularly those who live in poor neighborhoods, manage their conditions, navigate the health system and advocate for themselves. The organization partners with health care providers such as Mount Sinai Health System, and its coaches visit patients' homes in a model that seeks to ward off catastrophic health problems before they occur.
Kaiser Health News (10/20) 
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Medical home model saved Ore. $240M in 3 years
Most Oregon Medicaid beneficiaries enrolled in a coordinated care organization have a patient-centered primary care home, and researchers at Portland State University say the model saved the state $240 million over three years. For every $1 in additional spending on primary care, the health care system saved an average of $13, and the longer a clinic had been operating as a patient-centered home, the larger the per-patient savings, the researchers found.
The Business Journals (tiered subscription model)/Portland, Ore. (10/18) 
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Defining the Provider Data Dilemma
The CAQH white paper summarizes major challenges with creating and maintaining high-quality data, and proposes areas to make demonstrable progress towards addressing this critical issue. Download the CAQH white paper
Medical Update
CDC releases color-coded Zika map for Miami
The CDC created a color-coded map for Zika-infested areas in Miami to help warn residents, especially pregnant women, against traveling to certain zones that are declared to be of significant risk for Zika virus transmission. Pregnant women should avoid going to red areas because of the high levels of Zika virus transmission, and should get tested for the virus, even without showing any symptoms, if there is a connection to the areas, according to the CDC.
NBC News (10/19) 
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Experts: Prostate cancer often doesn't need immediate treatment
A Swedish study published in JAMA Oncology found that over 90% of patients with very low risk prostate cancer opt for active surveillance, wherein patients undergo regular blood tests and biopsies, rather than immediate treatment, and the authors say more US patients should follow suit. In the US, immediate treatment is far more common, subjecting men to side effects including erectile and urinary difficulties.
HealthDay News (10/20) 
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Research Brief: Bundled Pricing Cost Variation
As the industry moves toward bundled pricing, Truven Health, an IBM company, is studying cost variation and drivers in the commercially insured population—using recent claims data gathered into simulated bundled payment episodes. Download our research brief on bundling for joint replacements.
Emerging Trends
Insurers offer data for assessing telemedicine savings
The Congressional Budget Office received a letter from 11 private insurers asking the agency to consider payer data beyond Medicare when reviewing cost savings related to telemedicine. "Available data supports the value proposition of telehealth and shows that there are significant savings to be gained even as it increases access to care," according to the letter.
MobiHealthNews.com (10/19) 
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Pilot program aims to integrate patient-generated data into EHRs
Mobile health app
(Nicholas Kamm/Getty Images)
A joint pilot program between Validic and Sutter Health will test how patient data generated via mobile applications, clinical in-home devices and wearables can be integrated into the EHR systems or clinical dashboards of care teams. This program, which will focus on type 2 diabetes patients at Sutter Health, is part of an ONC-funded project.
BeckersHospitalReview.com (10/19) 
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Study: Nearly half of Ky. schoolchildren need dental care
About 88% of Kentucky third- and sixth-grade students surveyed this year had dental insurance, which is 15% higher than in 2001, but 49% need treatment for dental disease, compared with 32% in 2001. Access to dentists may be a problem, especially for the 436,000 children who receive Medicaid, said Clifford Maesaka, president and CEO of Delta Dental of Kentucky, which helped fund the study.
Lexington Herald-Leader (Ky.) (10/19),  The Courier-Journal (Louisville, Ky.) (tiered subscription model) (10/19) 
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Health Insurance Plan Company News
Are you achieving your value-based care goals?
Learn how a successful ACO achieved $10M in shared savings and a huge earning of $4.7M in 2015. Join this webinar to gain insight on how they reduced cost, increased their quality score, and met regulatory requirements. Achieve your value-based care goals with a unique analytics and data approach. Click here to register.
Solutions Provider News
Pharma News
FDA faces an overflow of orphan drug applications
FDA faces an overflow of orphan drug applications
Woodcock (Win McNamee/Getty Images)
The FDA is struggling to keep up with the rise in orphan drug submissions, which have doubled since 2010, because incentives and greater patient advocate involvement have encouraged more drugmakers to develop drugs for rare diseases, according to agency officials at the National Organization for Rare Disorders Breakthrough Summit. FDA Center for Drug Evaluation and Research Director Janet Woodcock said the agency's problem is its failure to recruit and retain adequate staff, not the increase of development programs.
Medscape (free registration) (10/19) 
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Policy Watch
HHS official breaks down Zika fund disbursement for 2017
Caitlyn Miller, director of discretionary programs at HHS, discussed how the $1.1 billion in Zika funding approved by Congress will be disbursed in 2017. Aside from returning borrowed funds from other programs, health agencies such as the NIH and the CDC will receive large portions for research, vaccine development, mosquito control and other Zika-related initiatives, and states and cities will have to bid for funding.
Reuters (10/18),  NBC News (10/18) 
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Take your leadership ability to the highest level
Invest your talent in AHIP's Executive Leadership Programs (ELP), yearlong Fellowship programs exclusively for seasoned health insurance plan professionals. The ELP experience opens you up to different perspectives on how the health care system works -- and how to effect changes that help evolve the system. The Call for Applications is open. Learn more and see if you meet the criteria.
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Knowledge is power for health care consumers
October is Health Literacy Month. By giving consumers the information, education, and support they need, they can confidently and actively manage their physical health and financial well-being. Learn more on the blog.
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Webinar: Pharmaceutical drugs -- impact on the triple aim
There's a pharmaceutical crisis in health care - drug misuse, abuse, and underuse are all affecting the industry's ability to achieve the Triple Aim. This webinar on Oct. 25 from 3 to 4 p.m. ET will explain approaches different stakeholders can take to address pharmacy drug issues so that we can achieve better population health, improved patient experience, and rein in costs.
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