Public Policy Roundup

September 19, 2016 · NCQA Communications


Obama urged ACA insurers to step up efforts to enroll the uninsured, especially young & healthy.

Insurers asked Obama to tighten rules special enrollments and grace periods to strengthen Exchanges.

Enroll America made several recommendations for improving ACA enrollment & stabilizing premiums.

Census data shows the uninsured rate at 9.1%, or 28M people, down 1.3% from 2014

PCMHs gain substantially more revenue under PMPM or PMPM/P4P pay but not with increased FFS pay.

CMS says readmission rates feel by 8% (104K) from 2010-15 nationwide & by over 13% in 2 states.

Physician groups of nine or less dropped from 40-35% from 2013-15; groups of 100+ rose from 29-35%.

Choosing Wisely had only a short-term effect on oncologist overuse of expensive anti-nausea drugs.

Physicians given data on outcomes, actual patient costs & variation improved both costs & quality.

Treatment does not affect early prostate cancer 10-year survival rates but cuts progression by over 50%.

Among treatments, prostatectomy most harms sex/urinary function; radiation most harms bowels.

Drug firms not reporting to could be fined up to $10k per day or barred for NIH funding.

GAO says Part D generic drug prices declined overall, but more than 300 had price hikes of over 100%.

A bipartisan bill would require drug makers to justify price hikes >10% & to data on costs.

Spending on opioid dependence or abuse care jumped 1,375% from $32M in 2011 to $446M in 2015.

States with medical marijuana have fewer opioid-related car accidents, especially among ages 21-40.

26% of Medicare enrollees on anti-hypertensives are non-adherent, with higher rates for minorities.

NIH’s SPRINT trial shows tighter blood pressure control could save more than 100K lives a year.

African American stroke patients have 26% lower odds of getting TPA to clear blood clots than whites.

ONC says access to view, download, transmit & securely message doctors rose significantly in 2014-15.

CMS is developing a registry repository to help ID entities accepting electronic public health data.

Telemedicine is as affective as in-person visits for children’s asthma care.

RWJF CEO Risa Lavizzo-Mourey is stepping down after 14 years on the job.

CMS bundled payment initiative shows promise at reducing costs for an episode of care.

CDC found more hospitals using broad-spectrum antibiotics, increasing risk of drug-resistant bacteria.

Study finds privately insured cancer patients were diagnosed earlier and lived longer.

MA bonus payments have not effectively reduced racial disparities in access to preventative care.



Kentucky’s controversial Medicaid plan is open for public comment to CMS through Oct. 8.

New Jersey’s ACA co-op is closing, leaving just 6 of the original 23 in business.

New York issued emergency regulations to fix federal risk adjustment & stabilize the small group market.

Oklahoma’s Health Care Authority named Medicaid Director Becky Pasternik-Ikard its new CEO.

Texas Medical Board’ strict telemedicine rules “evade the substance” of anti-trust rules says DOJ & FTC.



Worker premiums will rise 3% in 2017 to $18K for a family but deductibles are up almost 50% since ‘11.

A new surveys suggest employers may slow down on shifting health costs to employees.

Growth of high deductible plans is renewing interest in gap plans that cover out-of-pocket costs.

38% say they little or nothing about employer-sponsored benefits such as health care.

Covering specialty medications can save employers up to $17,000 per employee per year.

Out-of-pocket costs for employees with high deductible health plans is 1.5x higher than the average.

NBGH finds that specialty pharmacy was the number one driver of medical costs for large employers.

Kaiser study finds Collaborative Care Model improves chronic and mental health care.

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