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This Week in Health Care Reform - March 18th, 2016

Supporters continue to close ranks around Medicare Advantage; new reports reaffirm drug spending’s upward trajectory; and, technology is shown to boost patient engagement.


Week in Review

Medicare Advantage: As the Centers for Medicare & Medicaid Services (CMS) gets closer to finalizing its decision regarding changes to the underlying funding structure for Medicare Advantage, stakeholders continue their efforts to protect the popular program from the latest round of harmful cuts.  As covered in previous newsletters, those changes – specifically to the risk adjustment model – would result in further deterioration of the coordinated model of care that has made Medicare Advantage so successful in helping beneficiaries manage their health care needs, especially for those patients suffering from multiple chronic conditions.  What’s distinguished Medicare Advantage from traditional fee-for-service Medicare – namely, its ability to wrap beneficiaries in a blanket of care that’s both comprehensive and tailored to their needs – continues to attract enrollees (more than 17 million, currently), the majority of whom express high levels of satisfaction with the program’s proven and replicable results.  However, year-to-year cuts have only served to erode Medicare Advantage plans’ ability to design benefit packages that focus on delivering care when and where it’s most likely to have the greatest, positive impact.  With that in mind, it should come as no surprise that the ongoing efforts to protect the program and the millions of American seniors and persons with disabilities who depend on it have drawn support from across the spectrum.  Notably, in light of the politically divisive times in which we find ourselves, Medicare Advantage seems to be that rare bipartisan issue that manages to bridge the political divide.  With CMS expected to make its final determination on its latest proposed changes early next month, there’s still time to add your voice to the growing chorus raised in defense of the program.  Be sure to take action today!

Rx Spending:
A pair of new analyses highlights the growing impact that prescription drugs are having on the health care cost curve.  The first report, released by the Department of Health & Human Services (HHS) last week, shows that spending on drugs last year rose $457 billion, accounting for 16.7 percent of overall health care spending.  Categorizing drug spending growth in 2013 as “subdued”, HHS called the nearly 13 percent uptick seen in prescription drug spending in 2014 “remarkable”.  With this increase seen in spending being driven by a combination of fast-rising prices and the increased use of costlier specialty drugs, the agency went on to say that this price trajectory will likely continue.  Separately, a new report from pharmacy benefit manager Express Scripts released earlier this week projected a similar increase in drug spending for the next few years.  Their analysis determined that spending on prescription drugs rose 5.2 percent last year, driven, again, by the increased utilization of specialty medicines and higher unit costs.  Looking forward, they expect spending to increase 6.8 percent this year, 7.3 percent next year, and 8.4 percent in 2018.  Responding to the growing calls to introduce systemic change to the pharmaceutical pricing decision-matrix, late last week the FDA made a significant policy change, announcing that the agency now plans to expedite reviews of applications for generic drugs for medicines where only one treatment is currently available.  As stakeholders seek to integrate growing cost concerns into their own decision-support mechanisms, the issue is also finding increased traction on the campaign trail.

With evidence establishing the link between patient involvement and improved outcomes mounting, there’s a growing movement to make patient engagement a higher priority in the delivery of health care.  A new survey of patients and providers from CDW seeks to understand the different needs, challenges, and motivators that exist between these two groups in further exploring the role that engagement plays in leading to better health outcomes.  While the results point to different states of readiness (providers) and varying comfort-levels (patients), it’s clear that technology has a part to play in helping to alleviate some of the traditional barriers to patient engagement.

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We encourage you to stay involved as implementation efforts surrounding health care reform progress.  Visit the Health Action Network and be sure to let us know what's on your mind.


Looking Ahead

Coming out of this week’s Presidential contests, the field of candidates continues to narrow.  Meanwhile, the President nominates D.C. Circuit Court of Appeals Chief Judge Merrick Garland to the Supreme Court, despite Senate GOP protests.

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