Public Policy Roundup

August 22, 2016 · Paul Cotton

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.



NCQA’s Margaret O’Kane made Modern Healthcare’s “100 most influential list” for the 11th year.

Aetna is exiting 11 of 15 ACA Marketplaces after warning it would if DoJ fought its Humana merger.

Southern states & rural counties are most affected by ACA plan pullouts, leaving some with just 1 plan.

Kaiser Permanente says it is “absolutely” committed to ACA plans, and is making slight margins on them.

An RWJF report says strategies to fix 1990’s Medicare Advantage woes could help ACA Marketplaces.

Most who still lack coverage post-ACA are Latino, make <$16K, are under 35, or work for small business.

The Obama Administration is planning significant outreach to ACA-eligible people who paid fines for being uninsured.

CMS will test a tool comparing ACA plan networks on primary care, pediatrician & hospital in 6 states.

ACA coverage increased prescription drug use while reducing out-of-pocket spending for consumers.

CMS wants to stop providers from steering Medicare/Medicaid patients to ACA plans to get more pay.

JAMA op-eds say physician-based ACOs without hospitals could better prevent costly inpatient care.

Cost of PCSK9 cholesterol drugs would need to be cut by over 2/3ds for the drugs to be cost-effective.

AHIP says orphan drugs with high price increases are commonly used to treat non-rare conditions.

Drug firm payments to doctors are associated with more regional prescribing of brand drugs in Part D.

CMS issued 2014 Part D usage data by drug, cost & clinician, top spend was on Gilead’s hepatitis C drug.

Consumer advocates say the FDA is too cozy with drug makers in efforts to speed drugs to market.

ACP issued policy options, including value-based insurance design, to address cost sharing burdens.

Physician practice patterns, not patient characteristics, drive overuse of non-recommended cancer care.

ASCO & AAHPM issued joint guidance on integrating palliative care with oncology treatment.

Use of feeding tubes in nursing home advanced dementia patients dropped by half over 15 years.

More than 15M Americans received some kind of medical care via telemedicine last year.

Lack of diversity in genetic studies may lead to misdiagnoses of risk for non-whites.

Minorities have a fewer knee replacements but more complications & in-hospital death afterwards.

87% of Medicaid enrollees say they are satisfied with their benefits & 83% with their access to care.



RWJ documented that states with higher social service to health spending ratios had better outcomes.

Arizona’s Pinal county may have no ACA plans for 2017 after Aetna said it would pull out of the state.

California now has 72% of those without health insurance in 2013 covered.

Illinois’ governor signed legislation requiring hospitals to be better prepared to treat septic shock.

Louisiana reached 74% of its Medicaid expansion enrollment goal in 2 months with 278K new enrollees.

Louisiana campaigns cut Medicaid enrollees ED use by 10.2% & increased their HIT use by 23%.

Mississippi’s medical society passed a resolution supporting expansion of ACA coverage.

New Hampshire wants to add new work & cost sharing requirements to its Medicaid expansion.

New York is taking applications for coordinated population health prevention in targeted communities.

Ohio’s Medicaid managed care plans scored as average or above in the state’s 2nd annual report card.

Rhode Island Medicaid director Anya Rader Wallack is leaving after 10 months on the job.



Small & mid-sized companies are moving away from fully-insured plans for workers.

Employers see savings & increased productivity by offering telemedicine services.

Employers & unions are looking to direct contracting for health system contracts.

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