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This Week in Health Care Reform - April 29th, 2016

A national coalition of health care stakeholders unveils a new policy platform aimed at addressing rising prescription drug prices; despite gains in adoption, telehealth still finds itself limited; and, CMS releases its final rules for Medicaid Managed Care.


Week in Review

Rx for Rx Prices: With so much attention being paid to the trend of escalating drug prices, the focus has steadily shifted to finding solutions to address the issue currently wreaking havoc across our health care system.  That focus took center stage earlier this week, as a nationwide coalition of health care stakeholders unveiled a policy platform that they believe is an important first step in reining in out-of-control drug prices.  A project of the National Coalition on Health Care, the Campaign for Sustainable Rx Pricing (CSRxP) brings together providers, insurers, employers, and other vested organizations under the rubric of finding sustainability in prescription drug costs.  Prior to this week’s launch of their new platform, the Campaign had focused its efforts on opening up a national dialogue on the issue by shining a spotlight on the need to find solutions.  Their platform represents a shift in the coalition’s efforts as the group lays down a marker it believes will lead our health care system down a more sustainable path where drug prices are concerned.  The main thrust of their market-based proposal focuses on how increasing transparency and promoting competition and innovation in the pharmaceutical space will ultimately result in better value for consumers.  At the launch event, CSRxP stated its hope that the release of its new policy platform would encourage a further dialogue with drugmakers, whose response to the Campaign’s proposals was somewhat predictable.  The coalition’s efforts build on similar work seen earlier this year, bringing together other distinct voices from different sides of the conversation, who offered up a joint proposal of their own in seeking to find a solution to a problem that threatens to overwhelm our health care system.

Telehealth Barriers:
Despite the benefits offered up by telehealth, practitioners continue to find roadblocks on the path to its widespread deployment.  Practically speaking, while many states have acknowledged the need to create a regulatory environment that’s conducive to telehealth’s embrace, their diverging policies often lead to confusion.  A new report from the Center for Connected Health Policy identifies a number of key policy trends impacting telehealth, highlighting disparities in how states approach regulating its utilization.

On Monday, the Centers for Medicare & Medicaid Services (CMS) finalized its long-awaited rule overhauling how Medicaid Managed Care (MMC) is administered.  Clocking in at over 1,400 pages, the final rule – which hadn’t been updated in a decade – was initially proposed last May and represents the culmination of a nearly year-long effort by stakeholders to preserve and protect the MMC program and the 46 million Americans enrolled in these plans.  The majority of the states, including the District of Columbia, have essentially outsourced their Medicaid programs to these managed care plans in an effort to cut costs and improve budget predictability.  The rules encompass a host of provisions governing MMC’s administration, including quality, reporting, and network adequacy.

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