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This Week in Health Care Reform: June 16th, 2017

Stakeholders continue to embrace their roles as innovators in the Medicaid space; insurers deploy new tactics to combat opioid abuse; and, analytics help support the growing movement towards value-based care.

Week in Review

Remaking Medicaid: As policymakers in Washington debate the future of Medicaid, a growing number of voters are hoping that they keep the Affordable Care Act’s expansion of the program intact, at least according to survey results released last month.  And, as budget discussions continue to take shape, a majority of respondents in a separate poll said they were opposed to the Administration’s more than $800 billion in proposed cuts to Medicaid over the next decade that had been included in its initial budget request.  Against this backdrop, stakeholders have rallied around the program, seeking to highlight the innovations in the Medicaid space that have not only led to better health outcomes for beneficiaries, but resulted in cost savings, as well.  Given that Medicaid is now the largest health program in the country, currently serving more than 70 million Americans, it’s not hard to see why so many are so keen to make sure it’s protected.

Opioids: When it comes to the drugs we take, the unsustainable price trajectory of these medicines has understandably dominated much of the conversation.  However, increased focus has been devoted to the opioid-abuse epidemic wreaking havoc in communities across the country.  As states and local leaders attempt to combat the issue using tried-and-true methods, one group of key stakeholders is deploying a different set of tactics.  Insurers, who often possess a line-of-sight that affords them a comprehensive view of a patient’s continuum of treatment, have pointed to early intervention as being a critical component of a successful opioid prescription management strategy.  For that to work, though, payers have also recognized the important role that data analytics play in establishing best practices and mitigating opioid misuse.  One insurer, Amerigroup Tennessee, a statewide provider of Medicare and Medicaid managed care services, recently announced a new partnership with axialHealthcare, a national leader in pain management and pain medication solutions.  In addition to advanced data analytics, the joint venture will provide Amerigroup’s network of providers with enhanced decision-support tools and educational resources on evidence-based pain care.

Value of Data:
It’s become next to impossible to have any kind of substantive discussion about the future of health care without mentioning data analytics.  As we look to improve our system for everyone – patients, providers, payers, employers – there’s growing acknowledgment that data holds the key to helping us achieve our goals of a 21st century health care system, inasmuch as these advanced analytics can help evolve our existing system beyond siloed interests and towards more coordinated population health management and precision care.  What that data allows us to do is reconcile outcomes against prescribed treatments, eventually establishing evidence-based guidelines, all under the umbrella of value-based care.  This focus on value has slowly become a driving trend in health care, as we move away from the traditional fee-for-service model.  As the industry looks to institutionalize this transition, stakeholders have come to embrace what’s on offer.  For instance, Anthem, one of the country’s largest health benefits companies, has increasingly leveraged its vast store of data and investment in information technology to better support new reimbursement models.  While challenges to the health care system writ large remain, value-based care continues to make inroads, especially as its benefits largely accrue from greater experience.      

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A new analysis of state health spending by the Centers for Medicare & Medicaid Services (CMS) from 1991-2014 offers up a mixed bag of data analytics, including the considerable regional variation in spending, similar growth measured in Medicaid expansion and non-expansion states, and the impact of the recent recession and recovery on outlays.

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