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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform: April 5th, 2019

Proposed changes to Medicare Advantage are finalized; telehealth use surges; experts poke holes in drugmakers’ defense of their pricing practices; and, standardization is pointed to as a systemic imperative.

Week in Review

Medicare Advantage: On Monday, the Centers for Medicare & Medicaid Services (CMS) finalized proposed rule changes to the underlying funding structure for the popular Medicare Advantage program for 2020.  While stakeholders continue to digest how those changes will fully impact the nearly 22 million American seniors and persons with disabilities enrolled in the program, specific aspects of the finalized rules were widely acknowledged, such as the positive improvement to the proposed growth rate for plans, changes to the risk adjustment model for certain medical conditions, and the expansion of supplemental benefits.

Telehealth Surge: Technology continues to revolutionize our health care delivery model.  As consumer expectations and comfort-levels with digital tools grow, so, too, do the opportunities for health care stakeholders.  With that in mind, it should hardly come as a surprise to learn that telehealth utilization jumped 53 percent from 2016 to 2017, outpacing all other sites of care.  This surge was found to have grown at nearly twice the rate in urban areas compared to rural ones over that span.  Of further interest, while the majority of consumers used telehealth for common injuries like bruises, open wounds, and digestive problems, it’s also helped to break down some of the stigmatic barriers to mental health care, opening up access more broadly and becoming a prominent source of treatment for these conditions.

Rx Defense: As legislative focus surrounding out-of-control drug prices ratchets up, stakeholders are working to remind policymakers and regulators how urgently a solution is needed.  One key way they’re doing so is to point out how hollow and false the justifications offered up by drugmakers in defense of their pricing practices really are, asking, just how expensive do drugs need to be in order to fund innovative research?  Excessive drug prices remain the single biggest category of health care overspending in this country.  Compounding the issue, estimates go on to project that drug prices will rise 6.3 percent over the next decade, compared to other health care costs, which are projected to go up 5.5 percent
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Standardized Definitions:
It may seem like the only thing more complicated than understanding rising health care costs is getting folks to agree on what should be done to address the issue.  Some point towards greater quality and price transparency as holding the key to unlocking that mystery.  Others counter that transparency alone isn’t enough, calling instead for more price competition.  However, what’s largely unaddressed in these arguments is the underlying necessity of first establishing a value baseline.  Accordingly, there’s growing appreciation for the need to embrace standardized definitions of care episodes, the thought being that, until systems can agree on what constitutes a health event, measurements of efficacy or clinical outcomes – which, in turn, are used to determine value – are vulnerable to too much variability and open interpretation.      

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Spotlight

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