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This Week in Health Care Reform: September 21st, 2018

The Senate passes a legislative package aimed at tackling the opioid crisis; experts take a look at where our spending on prescription drugs actually goes; a lack of interoperability hampers value-based care; and, a new study focuses on health systems’ growing influence on rising health care prices.

Week in Review

Opioids: On Monday, Senate lawmakers overwhelmingly passed a sweeping package of bills targeting the opioid epidemic that continues to impact families and communities across the country.  While ambitious in scope – the package of 70 bills expands, creates, and renews programs overseen by multiple agencies and costs $8.4 billion – experts and public health advocates caution that it doesn’t include everything.  For instance, as covered last week, the agreed upon package differs from the one passed by the House earlier this summer in a handful of ways, such as updating a law (42 CFR Part 2) that currently keeps mental health records, such as those concerning substance use disorders (SUD), separate from other health records.  Stakeholders have marshaled their efforts to urge Senators to include a provision that makes addiction-related health records easier to share between doctors and insurance plans ahead of lawmakers from both the House and Senate making ready to reconcile their respective versions of comprehensive opioid legislative packages.  That includes the hundreds of letters that Health Action Network members have already sent to their Senators.  For those that haven’t, there’s still time to reach out to your lawmakers to urge them to remove these harmful barriers to more effective SUD treatment.  ACT NOW!

Rx Spending: Despite the concerted efforts of the pharmaceutical industry, out-of-control prescription drug prices persistently dominate much of the conversation surrounding rising health care costs.  And, it’s not hard to see why when you do a quick scan of the myriad examples of recent drug price hikes.  Stakeholders, having long past had their fill of drugmakers’ attempts to shift blame and distract attention away from the issue, continue to push back.  Taking a more measured approach, some experts have begun to question exactly where all the money we’re spending on drugs in this country ultimately goes.

Value: Our system’s gradual transition to a more value-based care model continues to reshape how health care is both delivered and reimbursed.  Already, we’ve seen the benefits of these arrangements; whether achieved through accountable care organizations (ACOs) or patient-centered medical homes (PCMHs), evidence continues to mount, establishing that better coordinated care results, not just in better health outcomes, but in lowering the total cost of care.  However, challenges remain, as was highlighted at a recent House Energy & Commerce Health Subcommittee hearing examining barriers to expanding innovations in the Medicare program.  Specifically, persistent problems with electronic health record (EHR) interoperability were highlighted as obstructing care coordination, health data exchange, and clinical efficiency.  A lack of interoperability, witnesses elaborated, makes it difficult for providers to participate in value-based care arrangements, not to mention complicates patient access to health information.  Any efforts to improve interoperability, they continued, need to be patient-centered to ensure that our rapidly evolving health care system is optimized towards improving patient health outcomes and care quality

Rising Prices:
To expand on another item from last week’s Health Action Network newsletter, a recent Health Affairs study sought to examine the impact that the consolidation trend reshaping California’s health care provider system is having on consumer costs and utilization.  As their research shows, premiums and outpatient prices have spiked as physician groups have been systematically snatched up.  Researchers point out the ubiquity of this trend across the country, claiming that in no state has less than one-quarter of its physicians been purchased.  Economists refute hospital executives’ assertion that more centralized control will produce greater coordinated care, stating that larger health systems only raise prices, dwarfing any purported efficiencies of scale.      

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