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This Week in Health Care Reform - December 16th, 2016

A new study highlights the impact of rising drug prices on an already vulnerable group of stakeholders; the states are looked to as the conversation surrounding the future of Medicaid ramps up; telehealth is shown to be as effective as in-person treatments for our nation’s veterans; and, a chorus of expert voices raises the alarm over the proposed merger of two dominant regional hospital systems.

Week in Review

AARP Study: Earlier this week, AARP released a new study focused on the rising price of prescription drugs.  In it, the powerful senior lobby argues that market forces have failed to moderate “excessive brand name drug price increases”, warning that these expenditures are not sustainable.  In urging lawmakers to address the problem, AARP highlighted the prices of more than 250 drugs most commonly used by older Americans, which, on average, rose 15.5 percent between 2014 and 2015.  In fact, overwhelmingly, the vast majority of those drugs (97 percent) saw a price increase last year.  Further, the average annual retail price increase for those treatments in 2015 was more than 130 times the rate of general inflation seen over the same period.  While the issue has drawn attention from every corner of the health care spectrum, AARP’s report contextualizes the problem, warning that seniors could stop taking their prescription medicines if something isn’t done to curtail these price increases.
Medicaid & the States: As the conversation surrounding health care reform continues to evolve, many are looking to the states to play a lead role in mapping out next steps.  One area in particular that has garnered much of the focus is Medicaid, which should come as no surprise given that, of the 20 million Americans that have gained health coverage under the Affordable Care Act, officials estimate that 12 million of those have done so through Medicaid.  With so much at stake, Republican members of the Senate Finance Committee announced plans to hold a roundtable discussion next month with GOP governors about what changes they’d like to see to the Medicaid program.
Telehealth & PTSD:
A new study offers hope to veterans suffering from posttraumatic stress disorder (PTSD) but who are unable to make it to in-person therapy sessions.  According to researchers, the best treatments for PTSD can be delivered to patients with no loss of efficacy through telehealth, compared to the veteran having to come into a clinic.  This latest study adds to the growing body of research demonstrating that telehealth, when folded into existing clinician and provider workflows, can help patients overcome the traditional barriers to treatment that keep so many of them from receiving the physical and mental care they need. 
Tri-Cities Opposition:
As covered in a previous newsletter, the proposed merger of the two dominant hospital systems in Northeastern Tennessee and Southwestern Virginia has been met with growing opposition.  Should it be approved, the combination of Mountain States Health Alliance with Wellmont Health Systems in the Tri-Cities region would result in that new system controlling 71 percent of that geographic area.  In their opinion, issued earlier in the fall, the Federal Trade Commission (FTC) argued that the combined entity would not only result in an anticompetitive environment in Virginia, but could result in higher prices and lower quality care for consumers, as well.  More recently, the FTC, alongside dozens of health economists, urged officials in Tennessee, where both hospital systems are headquartered, to reject the merger.   

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Looking Ahead

With open enrollment in full swing, sign-ups through the website are gaining momentum.  Meanwhile, as the incoming Administration makes ready to assume control of the Executive Branch, analysis abounds as to how the transition is unfolding.

This will be the last newsletter of the year. But, look for us again on the other side of the calendar.

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Have a safe and wonderful holiday season and a Happy New Year!