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This Week in Health Care Reform - April 28th, 2017

Efforts to find agreement on a health care replacement bill gain traction; a new review shines a light on the consonant costs of non-adherence to prescription medications; and, value-based care continues to reshape our system.

Week in Review

House Replacement Bill: Last week, health insurers met with new Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma.  While the meeting offered plans the opportunity to share their perspectives on how programs like Medicare Advantage and Medicaid are helping millions of vulnerable Americans access affordable, quality coverage, attendees’ point of emphasis in the sit-down was on ways that the Administration could help stabilize the individual insurance market, specifically, through the funding of the cost sharing reduction (CSR) subsidies.  Despite leaving the meeting with no assurances, this week, the White House told Congressional lawmakers that it would, in fact, continue funding CSRs.  Democrats greeted the news positively, but industry stakeholders were more measured in their response, instead pointing out that the announcement falls short of providing the kind of long-term certainty that’s critical to the stability of the exchange marketplaces.  Against this backdrop, House GOP leaders this week took a significant step forward in their ongoing effort to advance a health care replacement bill that could find enough rank-and-file support to pass a floor vote, as members of the conservative House Freedom Caucus endorsed the newly revised legislation.  While it remains to be seen when an actual vote will take place, what’s even less clear is whether or not the reworked bill will ultimately be able to clear the Senate.

Rx Non-Adherence: The runaway prices of prescription drugs continue to dominate the conversation surrounding rising health care costs.  But, increasingly, more attention is being paid to the corollary toll that out-of-control drug prices are exacting on patients.  A recent review published in the Annals of Internal Medicine discovered that as much as 30 percent of medication prescriptions are never filled.  When combined with the 50 percent of medications for chronic diseases not taken as prescribed, it’s estimated that this lack of adherence causes approximately 125,000 deaths and at least 10 percent of hospitalizations, costing the American health care system as much as $289 billion a year.  While a number of factors contribute to patients’ non-adherence to prescribed treatment, cost is widely accepted to be a major deterrent.

Value-Based Care:
As recently covered, stakeholders continue to make the case that value-based care represents an integral piece in our pursuit of developing a health care system that accomplishes the twin objectives of delivering high-quality care at low cost to a diverse patient population.  Insurers, by virtue of the space they occupy in the health care delivery continuum, often possess a holistic perspective to health care that few stakeholders can lay claim to.  As such, these health benefits companies point to data as playing an increasingly critical role in our designing value-based arrangements and identifying gaps in care.  One such company, Anthem, this week helped illustrate the industry’s gradual shift away from the traditional fee-for-service care model that reimburses based on volume and has historically led to overtreatment and the proliferation of medically unnecessary tests and procedures, and towards a value-based model that ties payment to health outcomes, performance, quality, and encourages greater coordination of care.  In fact, the company announced this week that 58 percent of the reimbursements its affiliated health plans are now paying out are through value-based payment arrangements with providers.      

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Looking Ahead

With telehealth continuing to make inroads, the regulatory landscape governing its utilization has undergone a dramatic shift, as evidenced by the increase in state policies seen across the country.

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