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This Week in Health Care Reform - May 13th, 2016

A new report on health care cost drivers reinforces the oft-repeated narrative regarding the unsustainable trajectory of prescription drug prices; telehealth is looked to as a way of improving rural health; and, a new focus on interoperability holds the key to enhanced care coordination.


Week in Review

Rx Driving Costs: The price of prescription drugs continues to exert upward pressure on the overall health care cost curve according to a new report.  That analysis, released earlier this week by Standard & Poor’s (S&P) in their most recent health care claims indices, found that national health care costs increased by 6.5 percent in 2015, 50 percent faster than was seen the previous year.  Specifically, S&P’s research went on to find that drug costs went up by 15.83 percent in 2015, even more than the 12.58 percent increase in 2014.  By way of comparison, the cost of medical services last year increased 4.3 percent.  Experts were quick to respond, emphasizing the causal link between the uptick in the national trend and the price hikes seen in the prescription drug market.  On a separate, but related note, stakeholders continue to explore ways of introducing accountability into the pharmaceutical pricing model.  Specifically, health insurer Cigna announced this week that it had reached a value-based arrangement with drugmakers for an entire class of new cholesterol drugs, a significant step forward in the larger push towards tying how well a drug works to what they cost.

Rural Health:
One of the traditional barriers that has long stood in the way of patients getting the health care that they need has been access.  And, perhaps nowhere is this more evident than in rural communities, many of which are isolated or suffer from not having specialized care in close enough proximity to be effective.  However, pilot programs, such as Project ECHO (Extension for Community Healthcare Outcomes) in New Mexico, have begun to show just how valuable telehealth can be in helping to bridge the divide between patients in these isolated communities and the care they depend on.  With more rural hospitals closing, telehealth’s criticality has become even more pronounced, leading for increased calls to ease the regulatory burdens that continue to frustrate its wider deployment.

As the cost containment focus in our health spending shifts to value-based care, the deficiencies that persist in our delivery system become that much more difficult to ignore.  Reconciling those shortcomings will require a concerted effort to close the data exchange gap that exists between clinical systems and payment systems, at least, according to the findings from a new study performed by the Workgroup for Electronic Data Interchange (WEDI).  Those gaps in care, which they define as the “discrepancy between evidence-based recommendations…and the care that is actually delivered”, could best be addressed through an investment in the type of automated data exchange that is so critical to the successful coordination that makes value-based care so effective.  Put simply, the lack of interoperability throughout our health care system remains a barrier to our realizing the benefits of a fully integrated care coordination model across the entirety of the delivery continuum.

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Looking Ahead

Yesterday, in a closed door session for caucus members, Republican leaders in the House presented their latest way forward on dismantling the Affordable Care Act and erecting, in its place, an approach to health care reform that better harmonizes with a conservative agenda, behind which, the party hopes to unify ahead of this summer’s convention.

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