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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform: April 27th, 2018

A court ruling allows a CSR lawsuit to proceed; a cancer drug’s price goes up after researchers say patients can take less; EHRs continue to find traction; and, stakeholders point to the benefits of a better integrated, holistic approach to health care delivery.

Week in Review

CSR Lawsuit: Last week, a federal court cleared the way for a class action lawsuit to proceed in which plaintiffs are seeking cost sharing reduction (CSR) payments that had been halted by the Administration late last year.  As a reminder, CSRs were created under the Affordable Care Act as a way of subsidizing health coverage for low-income consumers, helping qualifying beneficiaries meet their deductibles or better manage out-of-pocket costs.  The cessation of CSR payments were shown to have had an effect on marketplace enrollment, as well on the costs consumers were charged on the exchanges.

Cancer Drug Price Increase: A new approach to tackling out-of-control drug prices was met with a deflating response recently when a group of cancer doctors found themselves at odds with cancer drug manufacturers.  Those doctors had set out to see if they could bring down the cost of care by testing whether lower – and, thereby cheaper – doses were as effective in treating patients.  They thought they’d found a prime candidate in Imbruvica, a drug used to treat blood cancer.  Early clinical evidence indicated that leukemia patients might do just as well taking fewer pills during the prescribed course of treatment.  But, then they learned of the new pricing strategy for Imbruvica by Janssen and Pharmacyclics, the partner companies selling the drug.  Within months, the drugmakers planned to stop making the original dosage of the pill, instead, offering new tablets in four different strengths – each at triple the price of the original pill.  In defending their strategy, the companies pointed to the innovation of the single-pill and its intent to improve patient adherence to prescribed treatment.  While experts agree that complicated regimens can sometimes deter patients from sticking to their course of treatment, it’s universally acknowledged that exorbitant drug prices pose a much more significant barrier to adherence.

EHR Struggles:
Health care consumers are increasingly demanding greater technological capabilities when seeking services, at least according to a new survey.  In that poll, 89 percent of respondents under 40-years old expressed dissatisfaction with their health care provider’s technologies.  Further, 84 percent said that, when considering their alternatives, their preference is to seek out the most technologically advanced and electronically communicative medical organizations available.  Experts point to the results as underscoring the vital and, heretofore, underappreciated role that electronic health records (EHR) play in meeting health care consumers’ expectations in a rapidly evolving environment.  Unfortunately, that same survey also highlights the glaring discrepancy in health organizations’ ability to meet those expectations, as more than one-third of medical record administrators say that they continue to struggle with the exchange of patient EHR largely owing to a lack of interoperability between the different platforms used by different health systems.

Better Health:
The growing focus on social determinants of health (SDoH) has broadened the approach taken by health care stakeholders to include the consideration of a host of holistic factors as they seek to impact health outcomes and costs in positive, meaningful, and long-lasting ways.  With research showing overall health to be the function of a combination of factors, including individual behavior, genetics, social circumstance, environmental factors, and health care, it’s become increasingly clear that our health care delivery model must evolve to also include socioeconomic issues that undoubtedly play a role in overall health outcomes.  As SDoH continues to gain traction, payers have shown themselves to be at the vanguard in an evolving approach to benefit design and care delivery models.   

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Spotlight

An innovative program in the nation’s capital seeks to reduce the burden of non-emergency medical requests overwhelming the city’s 911 system.  By staffing call centers with nurses, DC hopes to preserve ambulances and medics for true emergency situations and cut back on the 70 percent of 911 medical responses involving patients with non-emergency conditions.
                                            
                                            

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