#6things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week is produced 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. This week’s edition includes contributions from Stephanie Caty (@stephaniecaty), Yevgeniy Feyman (@YFeyman), and Zoe Lyon (@zoemarklyon). 

Hospital employment of physicians does not improve quality of care

  • A recent study in Annals of Internal medicine finds that employing physicians does not improve quality of care.
  • The study looks at 4 key quality indicators in U.S. non-federal acute care hospitals from 2003-2012: mortality, readmissions, length of stay and patient satisfaction.
  • Comparing 803 hospitals that did switch to an integrated salary model with 2053 hospitals that did not switch, Scott et al. found that there was no effect of switching to an employment model on any of the four metrics.
  • Proponents of the hospital employer model argue that it can improve quality because it encourages coordination efforts and “continuum of care services”.
  • However, as this study underscores, simply establishing the employment relationship is not sufficient to improve quality of care.
  • Work such as this is increasingly important as the general trend of consolidation in healthcare continues to increase.

KHN: Remember The ‘Public Option’? Insurance Commissioner Wants To Try It In California

  • California’s insurance commissioner, Dave Jones, recently expressed support for a “public option” on California’s health insurance exchange.
    • Though the details haven’t been fleshed out, a public option would be a government run insurance plan that competes with other private insurers.
    • A public option was dropped from the final draft of the ACA when it passed, but the idea has gained traction recently as major insurers have pulled back from the individual market.
  • Because the public option idea has typically been for a national plan, details are particularly scarce as to how a state-run option would work.
  • Jones didn’t offer many specifics on what the plan might look like, noting that regional pilots might be one approach. Regardless of the details, a public option would require legislation.
  • Some experts questioned the usefulness of the proposal, noting that it might make sense where there are few or no alternative insurers operating. Additionally, a public option could also crowd out private insurers from the market.
    • While California has had better competition and availability of insurers than other states, 7.4 percent of the state’s exchange enrollees will only have two health plans to choose from in 2017.

Modern Healthcare: Most physicians report low morale, burden from new payment models

  • A new report from The Physicians Foundation, which surveyed nearly 20,000 physicians across the US finds that physicians have low morale and feel burdened by new reimbursement models.
  • The survey, which is conducted biennially, contains questions related to professional morale, practice patterns, health reform, and career plans.
  • A few key findings:
    • 4% of respondents reported being very unfamiliar with what MACRA is.
    • 40% of respondents aged < 45 feel as though EHRs have improve quality, while 52% feel EHRs have detracted from patient interaction.
    • 5% of respondents participating in an ACO feel that it is unlikely to enhance quality/decrease cost.
    • 54% of all respondents surveyed rated their morale in the profession as somewhat negative or very negative.

STAT: Colorado is latest state to be sued for restricting access to hepatitis C drugs

  • Colorado is the latest facing a lawsuit for restricting access to new hepatitis C medications in its Medicaid program.
    • The most recent therapies, including Gilead Sciences’ Harvoni and Sovaldi, are typically expensive but have cure rates of over 90%.
    • The lawsuit is challenging Colorado’s policy of restricting coverage of the drugs to people with advanced stage liver disease.
    • These restrictions are typically contrary to clinical recommendations that the drugs be made available at earlier stages of the disease.
  • This lawsuit comes on the heels of a push for public and private insurers to allow broader access to the drugs. Moreover, the Obama administration has already noted that state Medicaid programs might be violating federal law with these restrictions.
    • A prior lawsuit against Washington state resulted in the state being ordered to lift coverage restrictions.
  • Public programs in particular have faced budget constraints. Colorado’s Medicaid program, for instance, spent over $26 million to treat 326 patients. Coverage of every eligible patient would cost $237 million.
  • After the ACLU’s threat to sue last month, the state loosened restrictions to allow 70 percent of patients to become eligible.
    • The current lawsuit, however, claims that this did not go far enough and demands no restrictions.

The Washington Post: Skyrocketing Obamacare premiums still lower than employer-sponsored insurance

  • Many policymakers have expressed concern and criticism over premium price hikes and recent announcements by large insurers that they are leaving the marketplaces established by the Affordable Care Act.
  • However, a new study from the Urban Institute finds that even when adjusted for enrollee age and plan generosity, unsubsidized plans in the marketplaces cost 10% less than employer-sponsored insurance premiums.
  • Most people who receive employer-sponsored insurance do not pay the full premium price, as their employer covers a large portion of it in the employee benefit package, so for those in marketplaces who pay unsubsidized premiums, the full premium feels drastically higher in comparison.
  • Premiums are rising for both marketplace plans and employer sponsored plans, albeit more for marketplace plans (11%) than for employer sponsored coverage (3%).
  • Looking at marketplace prices in the context of employer-sponsored insurance prices may be useful for identifying when there are serious issues in the marketplaces; when marketplace plans are significantly higher than employer-sponsored coverage, this could signal a market issue, such as too few competitors in the market, or too many sick patients.

The Commonwealth Fund: The Health Care Reform Proposals of Hillary Clinton and Donald Trump

  • A new analysis done by RAND Health compares Hillary Clinton and Donald Trump’s health care proposals and their potential implications for insurance coverage, costs, and the federal deficit.
  • Clinton plans to maintain the ACA, whereas Trump intends to repeal it; before factoring in potential changes or replacement options, these two strategies would yield drastically different results for coverage and costs: Trump’s plans to repeal the ACA would result in 19.7 million people losing coverage and would increase the federal deficit by $33.1 billion.
  • However, both Clinton and Trump intend to do more than simply maintain or repeal the ACA, and their respective proposals have very different implications:
    • Among other things, Clinton is proposing to create refundable tax credits for those with private insurance premiums that are greater than 5% of their income, increase tax credits in the marketplaces so that eligible enrollees are paying no more than 8.5% of their income , and create a public insurance option.
    • Trump aims to replace the ACA by, among other things, making all premium payments in the individual market tax-deductible, creating block-grants for state Medicaid programs, and allowing insurance plans to be sold across state lines.
  • According to the RAND models, Clinton’s proposals would extend coverage and lower costs across the income spectrum, but especially for those with low income. However, it would likely increase the federal deficit, which could potentially be offset by some of her other policy proposals.
  • Trump’s proposals will likely be budget neutral given the large cuts in Medicaid funding, however they are projected to drastically decrease coverage.
  • Further analyses and resources can be found on the Commonwealth Fund’s website.

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