"Medicare for all" could lead to permanent doctor shortage, Verma says | CMS official: Direct contracting in Medicare won't hurt insurers, MA | Study shows importance of evidence-based diabetes interventions
October 17, 2018
AHIP Solutions SmartBrief
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"Medicare for all" could lead to permanent doctor shortage, Verma says
"Medicare for all" could lead to permanent doctor shortage, Verma says
(Mandel Ngan/AFP/Getty Images)
CMS Administrator Seema Verma said the "Medicare for all" idea being pushed by some Democrats would decimate doctor networks and create a permanent physician shortage because the program doesn't cover full health care provider costs. "Under 'Medicare for all,' you either take private insurance away from those 170 million Americans, or greatly restrict access to it, meaning there is no relief valve for physicians facing up to 40% payment cuts," Verma told attendees at AHIP's Medicare conference in Washington.
Kaiser Health News (10/16),  Modern Healthcare (tiered subscription model) (10/16) 
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CMS official: Direct contracting in Medicare won't hurt insurers, MA
Center for Medicare & Medicaid Innovation Director Adam Boehler told private insurers that their Medicare Advantage business won't be adversely affected by a direct provider contracting model being considered by the CMS to cut traditional Medicare costs. Speaking at AHIP's Medicare conference in Washington, Boehler urged insurers to increase their use of value-based insurance design, which uses low copayments to incentivize high-value clinical care, and said he would consider promoting the model for prescription drug plans.
Modern Healthcare (tiered subscription model) (10/16) 
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The ‘A’ in ACOs is for Accountable
ACOs taking on downside risk are outperforming those that don't. Given the increasingly hard line of government healthcare officials on assuming risk, now is the right time for ACOs to evaluate their readiness to assume downside risk.
Providers & Suppliers
Study shows importance of evidence-based diabetes interventions
Researchers surveyed 376 individuals who worked in public health and found that implementing and supporting evidence-based diabetes management interventions at local health departments could help control diabetes across the US. The findings in BMJ Open Diabetes Research & Care revealed that among the implemented evidence-based interventions, the Diabetes Prevention Program is offered by 82% of the local health departments, while 81% offered diabetes self-management education and 67% offered diabetes screening and referrals.
Endocrinology Advisor (10/15) 
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Nearly half of youths with bronchiolitis receive unneeded imaging in ED
Researchers found that 46.1% of children with acute bronchiolitis in emergency departments underwent radiography between 2007 and 2015, without significant year-to-year changes, even though 2006 and 2014 American Academy of Pediatrics guidelines and 2013 Choosing Wisely recommendations advise against imaging for pediatric bronchiolitis diagnosis. The findings in the Journal of the American Medical Association "suggest that nationwide quality initiatives are still needed to translate bronchiolitis guidelines into practice," researchers concluded.
Medscape (free registration) (10/16),  AuntMinnie (free registration) (10/16) 
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Transform Provider and Member Data into Meaningful Insights
Come and see how LexisNexis® Risk Solutions is empowering healthcare workflows with reliable data and powerful analytics. Stop by booth 107 at the CAHP Conference. Learn More
Medical Update
Researchers find link between stress, sudden cardiac arrest, but not Mondays
A study published in Heart Rhythm revealed no evidence that sudden cardiac arrest was more likely to happen on Mondays, as was previously believed, and just 13.9% of 1,535 adults who died from sudden cardiac arrest died between 12 a.m. and 6 a.m. Researchers analyzed data from The Oregon Sudden Unexpected Death Study and found that increased stress levels were associated with an increased likelihood of sudden cardiac arrest at any time.
Healthline (10/15) 
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Overweight, obesity tied to reduced life expectancy, study finds
Men who were classified as overweight or obese in their 20s and 30s are expected to lose eight years and ten years of life, respectively, while women who are overweight or obese are predicted to lose up to six years and eight years of life, respectively, researchers reported in the International Journal of Obesity. The findings, based on 12,091 adults ages 20 to 69, showed that obesity was associated with a reduced life expectancy of 4.1 years among women in their 40s and 5.1 years among men in their 40s.
Philippine Daily Inquirer/Agence France-Presse (10/15) 
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Emerging Trends
CDC reports more cases of acute flaccid myelitis
CDC officials reported that 62 of 127 possible cases of acute flaccid myelitis in 22 states have been confirmed so far this year, which is a significant increase from last year, with more than 90% of confirmed cases involving youths ages 18 and younger. The CDC will release weekly updates on AFM cases, so "people can better anticipate increases in confirmed cases in the following months," said Dr. Nancy Messonnier of the CDC.
The Washington Post (tiered subscription model) (10/16),  MedPage Today (free registration) (10/16) 
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Health Insurance Provider Company News
The Future of Care Transitions is Here
naviHealth does more than transition patients. We're pushing an entire industry forward. A unique combination of quality clinical services and proprietary technology is Guiding the Way, so every patient receives the right amount of post-acute care, in the right setting, for the right amount of time. Learn more.
Solutions Provider News
Pharma News
Database tracks drug industry ties to Congress
Drugmakers have donated more than $100,000 to each of 34 federal lawmakers since the beginning of 2017, according to a new Kaiser Health News database that tracks drug industry contributions to senators and representatives.
Kaiser Health News (10/16) 
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Pfizer's breast cancer drug wins FDA nod
Pfizer's once-daily talazoparib was approved by the FDA as a treatment for patients who have advanced breast cancer associated with BRCA mutations.
Reuters (10/16) 
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Policy Watch
Nearly 8,500 Ark. Medicaid recipients lose coverage under work rule
Arkansas officials said 4,109 Medicaid beneficiaries lost coverage this month after failing to comply with new rules that require them to work or be involved with other activities like training for 80 hours per month for three months in a calendar year. The total number of people dropped from the state's expanded Medicaid program is close to 8,500, and an additional 4,800 people are at risk of losing their benefits if they fail to meet the requirements by the end of this month.
ABC News/The Associated Press (10/15),  The Hill (10/15) 
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Must-attend webinars. Register today.
Join us, Wednesday, Oct. 24, 1 to 2 p.m., for "Effective Strategies to Manage Members with Complex Conditions" and learn how to address the clinical and administrative burdens that are unique to complex member cases. Join us, Thursday, Oct. 25, 2 to 3 p.m. ET, for "Shattering Legacy IT" and learn how regulatory changes triggered a transformation of people, process and technology for a regional Midwestern health plan, including dramatic results. 
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Confused by insurance jargon? We're here to help
Health insurance terms still confuse most Americans. The online resource MyHealthPlan.guide offers consumers a glossary of common words and phrases, helpful tips and checklists to help them get the most out of their health insurance benefits. Learn more.
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At AHIP's Consumer Experience & Digital Health Forum you'll meet health plan decision makers seeking new ways to leverage technology to drive quality, value, and customer satisfaction. Opportunities are targeted, scalable, and ROI-focused. To craft a sponsorship plan that puts your tech/digital solutions in the spotlight, contact BusinessDevelopment@ahip.org.
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