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This Week in Health Care Reform: August 3rd, 2018

Recent polling finds divisions over value, but general consensus on costs in health care; drugmakers’ tactics are exposed in Medicaid; stakeholders expand their focus beyond traditional care settings; and, the consumer-provider relationship goes under the microscope.

Week in Review

Value vs. Costs: It’s no overstatement to say that we find ourselves living in pretty polarized times.  That holds true across a broad range of issues, not the least of which being perceptions of the overall value of medical treatments as it relates to costs.  However, where there appears to be general consensus is in the belief that health care is increasingly unaffordable, at least according to a new survey from the Pew Research Center.  Of those polled, nearly half (48 percent) said that medical treatments were worth the cost, while slightly more (51 percent) held the opposite opinion, saying such treatments often create problems.  But, regardless of where respondents fell along that spectrum, the vast majority (83 percent) said that the high cost of medical treatments makes quality health care increasingly unaffordable.  This would seem to be reinforced by the findings of a separate survey of health care CEOs – performed by the Advisory Board Co. – who listed cost containment as their number one priority.  In that poll, nearly two-thirds of executives said that preparing their organizations for sustainable cost control was their top aim, followed closely by adopting innovative strategies to reduce expenses and diversify revenue streams.

Medicaid Rx: A recent investigation undertaken by NPR and the Center for Public Integrity uncovered the pervasive and nefarious influence that drug companies exert over the process used by Medicaid programs to determine which drugs make it onto their “preferred drug lists”.  Those lists are used by states to determine which drugs work best and are also affordable.  As background, Medicaid accounts for more than a quarter of 26 states’ budgets, with the cost of prescription drugs driving that spending higher.  In fact, between 2008 and 2016, Medicaid drug costs grew nearly 50 percent per patient, almost doubling the program’s drug spending to $31 billion.  The investigation pulled back the curtain on how drug companies have infiltrated the process that determines how their products will be covered by taxpayers.  The tactics employed by these manufacturers to influence state Medicaid drug cost controls included: free dinners and consulting gigs; paying for officials’ attendance at all-inclusive conferences; and, putting forward experts to testify about their drugs, while failing to disclose financial ties with their companies.

Focus on Wellness:
Our health care system continues to shift in fundamental ways.  Some of those changes are driven by the evolving nature of the relationship between health plans and providers.  Other changes, by consumer expectations and the focus on removing barriers to access.  Whatever the impetus, stakeholders across the health care spectrum find themselves reimagining their approach to helping patients – in particular, those with low incomes or chronic conditions.  Whether it’s providing rides to fitness centers or checking in with patients to ward off loneliness, there’s growing recognition that so much of a person’s health depends on what happens outside of a traditional care setting.

Consumer Engagement:
A pair of recent surveys seeks to shine a spotlight on the changing nature of the patient-doctor relationship.  The first, undertaken by Black Book, gauged respondents’ opinions on health providers’ engagement capabilities.  Tellingly, most consumers (92 percent) said health systems should make improving the customer experience a top priority.  Further, 90 percent of patients said they no longer feel obligated to stay with a provider who fails to meet their digital needs.  And, 88 percent said that they’d choose their next provider based on the strength of their online presence.  The second survey, performed by global brand marketing consultant Prophet, focused on health care executives across a range of industries and geographies, seeking to identify shifts their organizations were focusing on in pursuit of greater consumer centricity.  Those shifts included moving from:

  • Tactical fixes to a holistic experience strategy
  • Fragmented care to connected ecosystems
  • Population-centric to person-centered care
  • Incremental improvements to extensive innovation
  • Insights as a department to a culture of consumer obsession      


We encourage you to stay involved as implementation efforts surrounding health care reform progress.  Visit the Health Action Network and be sure to let us know what's on your mind.



In the latest example of how innovative partnerships are reshaping our health care delivery model in order to keep pace with evolving consumer expectations, health benefits company Anthem, through its LiveHealth Online application, announced a new collaboration with technology giant Samsung and telemedicine organization American Well.  The new partnership streamlines existing arrangements between the three companies, embedding American Well’s platform into the Samsung Health application, a service which will now be opened up to Anthem’s 74 million members.

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