Republicans may move to overhaul Medicare | Health care spending up 4.6% in 2015, report finds | How San Antonio is keeping mental health patients out of the ED
November 28, 2016
AHIP Solutions SmartBrief
Top Stories
Republicans may move to overhaul Medicare
House Republicans have long called for major changes to Medicare, and House Speaker Paul Ryan has advocated for a plan involving premium support for beneficiaries, who would shop an exchangelike structure for coverage, choosing from private plans and traditional Medicare. President-elect Donald Trump's transition website lists "modernize Medicare" among his priorities, but he has not shared any specifics.
The New York Times (free-article access for SmartBrief readers) (11/24),  National Public Radio (11/26) 
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Health care spending up 4.6% in 2015, report finds
Rising prices for prescription drugs and medical care pushed health care spending for privately insured consumers up 4.6% in 2015, compared with increases of 2.6% a year earlier and 3% in 2013, the Health Care Cost Institute found. Emergency department utilization, surgical hospital admissions and primary care visits fell, while utilization of outpatient care, laboratory tests and specialty care have increased.
Healthcare Finance News (11/23) 
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 Collaborating for the Consumer Highlights - Presented at AHIP 2016 Highlights from the AHIP 2016 presentation Collaborating for the Consumer. The complete presentation is available at:
 Collaborating for the Consumer Highlights - Presented at AHIP 2016 Highlights from the AHIP 2016 presentation Collaborating for the Consumer. The complete presentation is available at:
How do you maximize value in value-based care?
At AHIP 2016 a panel of experts showed how you can succeed in value- and data-driven healthcare when the consumer, and comprehensive information, is at the center of the system. Click here for a summary of the AHIP 2016 presentation, "Collaborating for the Consumer".
Providers & Suppliers
How San Antonio is keeping mental health patients out of the ED
A transitional care clinic at the University of Texas Health Science Center at San Antonio treats as many as 1,500 patients with serious mental illness each year while they await care, keeping them out of emergency departments. Hospital staff can schedule appointments for patients at the transitional care clinic through a web-based system, and a Medicaid pilot program covers extra services for up to five patients who use care at high levels.
Kaiser Health News (11/22) 
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New Medicaid eBook on Engagement
Engaging the Medicaid population to attain quality-based incentive goals requires personal motivation to get members to take action. This complimentary eBook shares proven strategies to improve health outcomes and lower costs. Read the eBook now.
Medical Update
Post-birth microcephaly found in infants with Zika syndrome
Eleven of 13 Brazilian infants with congenital Zika syndrome and normal head circumference at birth developed microcephaly in the following months. A report in the CDC's Morbidity and Mortality Weekly Report said the infants had a range of symptoms of congenital Zika syndrome, including muscle and joint problems and difficulty moving and swallowing.
The New York Times (free-article access for SmartBrief readers) (11/22),  Reuters (11/22) 
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Asian-Americans less likely to be screened for diabetes, study finds
Researchers found that although Asian-Americans have a heightened risk for type 2 diabetes, they are 34% less likely to be screened than non-Hispanic whites. The findings in the Journal of General Internal Medicine were based on a telephone survey involving more than 500,000 individuals.
HCPLive (11/21) 
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7 Helpful Tips to Get Your Business in Shape
Ever feel like you take too long to do something that should be simple? Or feel like your business's processes just have way too many steps? Don't worry — help is here. Download seven ways to up your efficiency today!
Emerging Trends
Insurance companies investigating hospice consult quality metric
New quality metrics are being studied to assess whether patients receive hospice care consultation quickly enough, writes Dr. Lori Rousche. More than half of patients said they wished they had gone the hospice route earlier in their illness.
Medical Economics (11/26) 
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Study: Telemedicine improves newborn care at community hospitals
Newborn baby.
(Philippe Huguen/Getty Images)
A study published in Mayo Clinic Proceedings showed that telemedicine consultations for newborns implemented at six health system sites helped prevent unnecessary transfer of patients to a larger hospital for higher levels of care and improved access to neonatologists. The Mayo Clinic's Division of Neonatal Medicine in Rochester, Minn., provided 84 telemedicine consultations for high-risk deliveries over 20 months. (11/22) 
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Why Platform Matters When Choosing an ERP System
In order to survive, grow, and compete in the digital age, organizations need an ERP that is highly flexible and able to adapt. So, what are the tough platform questions you should ask yourself when shopping for an ERP?
Download the report to find out!
Health Insurance Plan Company News
Solutions Provider News
Top talent 25% off – Cyber Monday sale
AHIP's Career Center is quick, easy, and delivers candidates with health care experience. You'll enjoy online management, tracking, and more. Take advantage of the Cyber Monday sale with 25 percent off job postings now through Dec. 2. Use discount code CYBER25 and start posting today!
Hot Topics
Pharma News
Sanofi's diabetes drug wins FDA nod
The FDA has approved Sanofi's Soliqua 100/33, or insulin glargine and lixisenatide injection, as a treatment for type 2 diabetes in adults whose disease is not adequately managed on basal insulin or lixisenatide. The drug will be available as a single prefilled pen in January. (11/22) 
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Policy Watch
States restrict Medicaid coverage of opioid painkillers
Forty-six Medicaid programs cap prescriptions for opioid pain drugs, 45 require prior authorization, 42 require proof of medical need and 32 have step-therapy rules.
STAT (11/23) 
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Obama administration, ACA advocates continue outreach to young invincibles
HHS, Enroll America and other Affordable Care Act advocates are continuing to encourage eligible Americans younger than 35 to enroll in a health insurance plan through a publicly run exchange. Participation by young, healthy people is needed to balance risk pools and ensure stability in the individual market, experts say.
Bloomberg (11/22) 
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Consumer/digital health. A new way of thinking.
Join us Dec. 6 to 8 in Chicago as we focus on new ways of thinking and working, as we put the consumer in the center of the health care system. Designed for marketing/communications/branding, digital, product development, innovation, business strategy, customer service, wellness, technology, and telehealth teams, the Consumer Experience & Digital Health Forum focuses on digital strategies that are transforming how health care is coordinated, delivered, and paid for.
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Year-end sale -- take 30% off select courses
Take 30% off select courses now through Dec. 31. Browse the wide variety of course offerings and professional designations, and register today for 30% off! Use coupon code 2016YESALE at checkout; some exclusions apply. Learn more and enroll today.
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Cyber Monday sale -- top talent 25% off
AHIP's Career Center is quick, easy, and delivers candidates with health care experience. You'll enjoy online management, tracking, customization options, bundled pricing and more. Take advantage of the Cyber Monday sale with 25% off job postings now through Dec. 2, 2016. Visit AHIP's Career Center and use discount code CYBER25.
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Your assumptions are your windows on the world. Scrub them off every once in a while, or the light won't come in.
Alan Alda,
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