Public Policy Weekly Clips: March 1, 2016

March 1, 2016 · Paul Cotton

Every Tuesday 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:



GAO says CMS has taken a “passive approach” to fighting fraudulent Marketplace enrollment.

CMS will now require proof of eligibility for Marketplace sign-ups outside open enrollment.

70% of the uninsured got ACA penalty exemptions, largely because they could not afford coverage.

Readmissions dropped from 21.5-17.8% for ACA targeted conditions & from 15.3-13.1% for others.

Obama rejected the NGA’s bid to fight opioids by limiting how many painkillers can be prescribe at a time.

Average prescription drug costs for a year doubled to over $11K in just seven years.

Novartis signed value-based pricing deals with Aetna & Cigna for its CHF drug Entresto.

The 1% of patients with highest costs account for 21.5% of total health spending; the top 50% for 97%.

US obesity rate reached an all-time high of 30.4% in 2015, despite improved physical activity rates.

Mastectomies increased 36% from 2005-13 while breast cancer rates remained constant.

Cancer death disparities dropped from 47-24% for black vs white men & 19-14% for women since 1990.

Up to half of gay or bisexual African-American men are projected to contract HIV, vs 25% of Hispanics and less than 10% of whites.

Just 10.7% of privately insured patients get follow-up care after opioid-related hospitalizations.

Statins may lower cirrhosis & liver cancer risk in hepatitis C patients.

29 states & DC require insurers to cover telehealth at parity with in-person care, up from 11 in 2011.

The Senate confirmed new FDA head Robert Califf in an 89-4 vote.

AHRQ’s Rick Kronick is resigning to return to UCSD; Sharon Arnold will be acting director.


Iowa got final CMS approval for moving to Medicaid managed care plans.

Kansas’ hospital association says lack of Medicaid expansion has cost the state over $1B.

Oregon’s ACA coop filed a class action lawsuit saying the feds owe up to $5B in risk corridor payment.


Employers worry that oncology clinics are linking with hospital outpatient departments to up costs.

Employers are focusing on chronic conditions since ~50% of adults have at least one.

Workplace stress contributes to at least 120K deaths each year and up to $190B in health costs.

A consultant says private exchanges don’t control costs, but let insurance companies retain more profit.

53% of employers have added new usage restrictions for specialty prescription drugs.

81% of employers say they offer telehealth to employees because they are cheaper than in-office visits.

Wellness efforts evolving to include behavioral health.

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