Public Policy Roundup

August 29, 2016 · NCQA Communications

US_Capitol_west_sideIt’s that time again: NCQA gives a rundown of the best national, state and private sector health care articles from the week. Here are our picks for today’s Public Policy Weekly Clips.



CMS has delayed nationwide implementation of plan ratings on

Safety net PCMHs reduce ED use & increase office visits among Medicaid patients.

Team-based PCMHs have higher quality, lower use of acute care & lower actual payments.

Medicare ACOs saved over $1.29B since 2012, and MSSPs improved on 84% of quality measures.

HHS says nearly 3/4ths of ACA enrollees can get 2017 coverage for under $75 a month with tax credits.

HHS says ACA premiums are about 7% lower in Medicaid expansion states vs non-expansion states.

Insurers doing well in state Marketplaces tended to target Medicaid enrollees before the ACA.

Aetna & Humana say DOJ’s attempt to block their merger neglects their competition with FFS Medicare.

Avalere says ACA enrollment will be 10.1M at the end of 2016, less than half what CBO said in 2010.

The AHA is urging HHS to make several changes to stabilize ACA Marketplaces.

The House GOP’s ACA replacement plan would increase the uninsured rate while decreasing premiums.

Sens. Grassley & Klobuchar want FTC to probe Mylan’s steep EpiPen price hike from $57 to $500.

FDA says drug companies are using citizen petitions to attempt to delay generic drug approvals.

Private sector drug coupons use may mean Medicare pays more for physician-administered drugs

Tightening standards for secondary drug patents could reduce prices & spur more medical innovation.

On-site mental health clinic pharmacies increase adherence & lower behavioral hospitalizations.

Gene tests can ID nearly half of early stage breast cancer patients who do not need chemotherapy.

Tailoring breast cancer screening intervals to women’s risk can better balance benefits & harms.

86% of National Comprehensive Cancer Network guideline authors have large conflicts of interest.

Folic acid significantly delays progression in patients with mild-moderate chronic kidney disease.

The Surgeon General is sending all physicians a letter asking them to help solve the opioid epidemic.

“Activated” patients develop less chronic disease than those unable to manage health or health care.

Hospitals with poor patient safety tend to have higher all-cause mortality & unplanned readmissions.

Community-based care management helps reduce racial disparities in blood pressure control.

NIH established a new research program to address chronic disease health disparities.

CDC says cancer is poised to pass heart disease as the leading cause of death.

CDC says sepsis is a medical emergency that requires prompt diagnosis.

CDC says to not use attenuated influenza vaccines that work poorly against the A(H1N1)pdm09 strain.

ASPE issued its report to Congress on federal efforts & challenges in telemedicine.

FDA recommends that all blood donations nationwide be tested for Zika.



Florida’s BCBS ACA plans assigned new enrollees to care managers & are “thriving.”

Kentucky submitted its controversial Medicaid expansion plan with work requirements to HHS.

New York is holding a conference on the behavioral health vision for value-based payments.

Tennessee says its Marketplace is “very near collapse” as it approved large premium hikes.



DoL says 4 in 10 private-sector employees get no paid sick leave, increasing odds of infecting others.

Employer adoption of value-based insurance design  is slowly taking hold.

Employers can use game theory to drive employee engagement on health benefits utilization.

Prescriptions now comprise 17% of total health costs & 19% of employer-based insurance benefits.

Health insurance deductibles rose by 50% as employees pay more for out-of-network care & ER visits.

Simplify ^ standardize health insurance plans, advise behavioral economists.

Insurance companies raise deductibles and other costs for customers using prescription copay coupons.

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