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HEALTH ACTION NETWORK - ADVOCATES FOR BETTER HEALTH CARE SOLUTIONS

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This Week in Health Care Reform: May 3rd, 2019

Congress holds its first “Medicare for All” hearing; eliminating rebates won’t lower drug prices; a necessary component of whole-person health; and, operationalizing our transition to value-based care and our embrace of consumerism poses challenges.

Week in Review

Medicare for All Hearing: On Tuesday, the House Committee on Rules held the first hearing on the “Medicare for All” bill sponsored by Rep. Pramila Jayapal (D-Washington).  While stakeholders on both sides of the issue looked to the hearing to reaffirm their positions, experts gave voice to the numerous unanswered questions surrounding just how much it would cost the U.S. to enact such sweeping legislation.  With estimates running as high as $38 trillion, it’s not hard to see why support for these efforts faces considerable headwinds.  In fact, recent polling shows that the vast majority of Americans would rather Congress prioritize lowering prescription drug costs and continuing protections for those with pre-existing conditions over efforts to replace the Affordable Care Act or enact proposals like the one considered in Tuesday’s hearing.  And, pointedly, experts go on to caution that implementation of a government-run program like this would severely disrupt the current health care system, while doing nothing to address the issue of affordability.

Rx Rebates: Drug prices are high for a host of reasons, not the least of which have to do with pharmaceutical manufacturers’ relentless efforts to manipulate the system in order to protect their ability to price their products however they please.  But, recent efforts targeting pharmacy benefits managers and their role in negotiating more affordable rates on behalf of patients and consumers is largely misplaced, experts contend.  In fact, they point out, eliminating rebates – which presently represent the only viable tool for purchasers to rein in costs – would ultimately cost payers, governments, and patients more.

Whole-Person Health: As we continue to integrate social determinants of health (SDoH) into our evolving health care delivery model, our understanding of the factors that contribute to our whole-person health expands.  For example, in order to maximize the success of these targeted interventions, specific SDoH factors must first be identified.  But, beyond those considerations, stakeholders have also focused their efforts on better coordinating health, behavioral health, and social services, in pursuit of a person-centered care delivery model, recognizing the important role that this kind of holistic approach plays in whole-person health
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Consumerism and Value:
Converting financial data into actionable information continues to be a stumbling block for providers.  That struggle is felt more acutely as pressure builds to better align health systems’ care delivery approach with meaningful value-based care metrics, and compounded further by the ongoing integration of consumerism into our larger health care delivery model.  While technology certainly has a role in facilitating this transition, challenges remain as stakeholders seek to operationalize this evolution.      

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Spotlight

Digital technologies have heightened patient expectations around convenience, flexibility, and ease of use, in regards to how, when, and where they are now able to access medical services.  These expectations have also led to unique approaches in how health systems foster better patient engagement.
                                            
                                            

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