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This Week in Health Care Reform: May 4th, 2018

HHS proposes new price transparency rules for Medicare; lawmakers advance dozens of bills aimed at combatting the opioid crisis; pharmaceutical companies are found to reap the majority of overall health care profits in the U.S.; and, loneliness is identified as a public health issue.

Week in Review

Price Transparency: As our health care system looks to extract maximum value from its delivery models, new and alternative strategies find themselves increasingly in the spotlight.  The latest such example being the recent proposal by the Department of Health & Human Services (HHS) calling on hospitals treating Medicare beneficiaries to publish their prices, making it easier for patients to see the costs associated with their care.  This push towards greater price transparency by HHS, has its roots in the commercial insurance sector, where the increased focus on consumerism has resulted in more empowered patients.  In addressing the policy changes being advanced by her agency, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma pointed to the recommendations as a part of CMS’ broader effort to “put patients first”, which, she elaborated, can only be accomplished by moving away from a system that focuses solely on reimbursing for volume of services provided and towards one that rewards for the value of those services instead.

Opioid Bills: Last week, lawmakers on both sides of the Capitol advanced legislation targeting the opioid epidemic ravaging families and communities across the country.  On Tuesday, the Senate HELP Committee approved its bipartisan package, followed closely by Wednesday’s House Energy and Commerce subcommittee hearing, which produced dozens of bills of its own related to the opioid crisis.  These bills would make wide-ranging changes in the fight to combat opioid misuse, including expanding medication-assisted treatment, imposing new limits on prescribing, and encouraging research into non-addictive painkillers.  However, there’s concern among the public health community that, absent new money, these measures won’t have a significant impact on preventing or treating opioid addiction, given the widespread acknowledgment that current funding levels are insufficient.

Rx Profits:
According to financial data from last year, pharmaceutical companies, despite only handling a small portion of U.S. and global health care spending, reaped a disproportionate amount of overall profits.  In fact, 8 of the highest 15 net profit margins went to drug companies.  Further, 12 of the highest 15 net profit totals were also at drug companies.  These findings come close on the heels of a pair of other analyses that only serve to reveal the extent to which soaring drug prices have impacted health care costs.  The first, a recent Pharmacy Benefits Consultants review of average wholesale drug prices found that "20 prescription drugs saw their prices rise by more than 200%" from January 2017 to March 2018.  The second, a comprehensive review by a Senate Committee, revealed that 20 of the most-prescribed drugs for seniors saw their prices “dramatically” increase each of the past 5 years – at rates approximately ten times higher than inflation.  No surprise then, opponents point out, that the drug industry’s largest trade association spent $10 million on lobbying efforts to protect the interests of pharmaceutical manufacturers between January and March of this year, breaking its own record for spending in a quarter.

Our approach to overall health continues to evolve, owing in large part to the growing acknowledgment that a host of previously unconsidered factors influences our well-being.  One of those factors in particular has started to gain attention and is now widely considered to be America’s fastest-growing public health crisis: loneliness.  The growing value placed on “social capital” has led to experts pointing to the significance of social interaction and connectedness on overall health.  This focus has already found traction among health care organizations, as efforts to make patients feel less alone have expanded their approach to, and design of, traditional care delivery models.     

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