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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform: November 8th, 2019

Premiums driving consumer choice during open enrollment; a new transparency law reveals dramatic price increases to wholesale drugs in one state; insurers deploy data to enhance population health management; and, Medicaid expansion is found to have reduced hospitalizations.

Week in Review

Open Enrollment: Last Friday, open enrollment on the health insurance exchange marketplace got underway.  Consumers now have until December 15th to make changes to their current health care plans or shop for new coverage.  For the second straight year, premiums have edged lower (down 4 percent on average).  In addition, shoppers will now find more options in some markets.  However, even though premiums have gone down, out-of-pocket costs have gone up (depending on the plan tier).  Against this backdrop, new polling shows that of the many factors guiding consumers’ shopping behavior this open enrollment period, the price of their monthly premiums has the most influence over their decisions.

Rx Price Transparency: Back in 2017, drugmakers fought hard against California’s drug price transparency bill.  Now that state officials have released their first report, it’s not hard to understand why pharmaceutical manufacturers were so keen to keep that bill from becoming law.  According to the report, between 2017 and the first quarter of this year, drug companies raised the “wholesale acquisition cost” (or, list price for wholesalers without discounts or rebates) by a median of 25.8 percent.  Generic drugs saw the largest increase at 37.6 percent over that period.  By comparison, the annual rate of inflation during that same time was 2 percent.  Further, of the more than 1,000 drug price increase reports submitted, more than two-thirds failed to give any explanation for the hikes, despite the law’s requirement that manufacturers show how expenses and improvements justify the price increases.

Population Health: As our understanding of the role that social factors play in whole person health evolves, so, too, does our expectations of what a redesigned health care delivery model should look like.  With that in mind, stakeholders have worked to better integrate this focus on social determinants of health into how consumers interact with the health care system.  Specifically, insurers have deployed data to advance population health management.  Leveraging these capabilities has allowed payers to develop real-time line-of-sight into the connections that exist between social, behavioral, mental, and physical health.  It’s also set the stage for innovators to positively disrupt the population health management model
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Medicaid Expansion:
Sidestepping the political rhetoric that’s come to dominate the conversation surrounding Medicaid, a new study found that states that expanded the program under the Affordable Care Act saw a greater reduction in hospitalizations than non-expansion states.  Researchers observed a 3.5 percent reduction in annual “ambulatory-care sensitive” condition discharge rates in expansion states, in addition to a 3.1 percent drop in inpatient days in 2014 and 2015.  Hospital costs also went down by nearly 3 percent.  The study’s authors suggest that their findings make the argument that Medicaid expansion could save money, while lowering preventable hospitalizations.  This latest research only adds to the growing body of evidence pointing to how expansion of the program has already led to improved health outcomes, which also explains why the issue has polled so favorably.      

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Spotlight

Another recent infographic from the National Institute for Health Care Management (NIHCM) takes a look at the state of rural health care in America and how shifting population trends are leaving people behind.
                                            
                                            

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