6 Things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week was created by Zoe Lyon and Garret Johnson. Find them on twitter @zoemarklyon and @garretjohnson22.

This newsletter is produced each week by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research.

CQ Roll Call: Medicaid Plans Succeed in Obamacare Exchanges as Others Struggle

  • In contrast to some of the nation’s biggest insurers (e.g. United, which saw double-digit losses), several small plans with experience in Medicaid managed care (e.g. Centene, Molina) are making headway in cutting their losses in the turbulent ACA exchange market.
    • A McKinsey report recently found that these Medicaid insurers had an average profit margin of -2.7%, significantly better than other insurers.
  • Many of the big insurers had prepared for exchange enrollees behaving similarly to those enrolled in employer-based coverage. In fact, their patterns are similar to those of Medicaid enrollees.
  • One of the keys to success on the exchange has been keeping premiums low, often through narrow networks, which consumers have tolerated if they are paired with low premiums and good care coordination.
  • Heritage Foundation senior fellow Ed Haislmaier on the ACA exchange market: “This is a population that when they need care, they go to the emergency room. You’re going to have to change that behavior [to limit costs]. And [Medicaid plans] understand that population.”

WSJ: Implantable Buprenorphine Device Approved by FDA to treat Opioid Addiction

  • The FDA has approved Probuphine, an implantable device releases buprenorphine and lasts 6 months, to treat opioid addiction in patients already taking buprenorphine orally.
  • The device, which consists of 4 implants inserted into the upper arm, eases opioid cravings for 6 months and guarantees that patients will adhere to their medication (in contrast to oral buprenorphine).
  • A recent study of 175 opioid-addicted patients – funded by the manufacturer of Probuphine – found that the rates of illicit opioid abuse were no higher in those that received the arm implant than in those that continued taking oral buprenorphine.
  • Still, all medications to treat addiction face some resistance from those that see pharmacologic therapy as switching one addiction for another.
    • Nora Volkow, director of NIDA: “Scientific evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more effective in the treatment of opioid use disorder than short-term detoxification programs aimed at abstinence.”

Kaiser Health News: Missouri Hospital Association Makes Strong Push for SES Adjustment in Readmission Penalties

  • As bipartisan legislation works its way through the U.S. House and Senate to adjust the federal Hospital Readmissions Reduction Program (part of the ACA) for patients’ socioeconomic status (which has been repeatedly shown to be an independent predictor of readmissions), the Missouri Hospital Association is taking the lead in attempting to eliminate what it sees as an unfair policy.
  • Specifically, the group re-made its consumer-facing website to include a readmission rate adjusted for patients’ Medicaid status and neighborhood poverty rates.
    • It also commissioned a study which found that poverty-related factors explain 43% to 88% of the variation in readmission rates in Missouri
  • Herb Kuhn, president of the Missouri Hospital Association and MedPAC commissioner: “hospitals in difficult neighborhoods are getting worse scores, and those in affluent [ones] are getting better. It’s time to adjust [rates] for the disease of poverty.”
  • But Leah Binder, the CEO of Leapfrog Group, disagrees: “Hospitals are paid a lot of money. I think they can find a way to handle their readmissions, the way they should have been handling them all along.”

WSJ: Insurers Seek Big Premium Boosts for 2017 Exchanges

  • Reeling from losses in the first few years of the Affordable Care Act, many insurance giants are seeking hefty premium hikes for individual plans sold through insurance exchanges for 2017.
  • Beneficiaries on the exchanges in more than a dozen states would be affected by the proposed rate increases, which could exceed 50% in some cases.
    • Large plans in New York, Pennsylvania, and Georgia are seeking to raise rates by 20% or more.
    • In Georgia, the average premium increase proposed by Humana is 65.2%.
  • Proposals still have to be approved by state regulators and a full picture of final approved rates won’t be known until HealthCare.gov (and state equivalents) reopens on Nov. 1.
  • Obama administration officials are hoping that state insurance regulators will review the rate proposals and force insurers to lower those that can’t be justified.
  • Insurers staying in the exchanges feel the need to increase premiums for the same reason that some insurers have decided to leave the exchanges all together: big losses due to heavier-than-expected costs from patients who were sicker than insurers expected.

Modern Healthcare: CMS lambasted for failing to curb Medicaid, Medicare fraud and abuse

  • The government reported that nearly $80 billion was misspent on Medicare and Medicaid in 2014.
  • The Office of the Inspector General (OIG) found that:
    • 37 states had not implemented fingerprint-based criminal background checks, and
    • 11 were not performing site visits when enrolling providers in their Medicaid programs.
  • Recent review found nearly all provider names from Provider Enrollment, Chain and Ownership System (PECOS) did not match the names filed with state Medicaid agencies.
  • 12% of providers terminated for cause by a Medicaid agency in 2011 were still participating in another state’s Medicaid program in January 2012 because of CMS’s inability to identify providers that have been terminated.
  • An investigation found that weaknesses in the CMS software used to ID provider addresses lead to more than 26,000 providers with addresses not matching any on file.

Health Affairs: Uninsurance Rates and the Affordable Care Act: What does recent research show about changes in uninsurance rates since 2010?

  • A new HealthAffairs policy brief considers how uninsurance rates are changing under the ACA.
  • Both the American Community Survey (ACS) and the National Health Interview Survey (NHIS) show a decline in uninsurance rates (2013-2014) of nearly 3 percentage points, representing the largest one-year decline in uninsurance rates since 1997.
    • 2013-2014 is an important year because of the subsidized Marketplace plans becoming available and Medicaid being expanded.
  • The decline in unisnurance rates from 2013 to 2014 (when coverage provisions went into effect) is one measure of the ACA’s effect of providing “quality affordable healthcare for all”.
    • Still to be seen is how uninsurance rates continue to decline as time goes on.
    • Improving outreach to the uninsured who are eligible for Medicaid or the subsidized Marketplace is important, but just as important is creating federal and state policy changes that expand the number of people who are eligible for assistance and ensure that assistance is sufficient to make coverage affordable.

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