January 31, 2019 | Optum sues to block exec from Gawande-led venture

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Optum sues to block exec from Gawande-led venture

UnitedHealth Group-owned Optum is suing to block a former executive from working at the Amazon/Berkshire Hathaway/JPMorgan Chase’s health care venture headed by Atul Gawande. It is, according to Modern Healthcare, a sign of anxiety over the initiative’s “disruptive potential.” Optum claims that David Smith, who worked as vice president of product, was privy to and misappropriated trade secrets that could help the new venture compete against it. (Modern Healthcare)

CMS to allow more customized formulary in 2020

Beginning in 2020, CMS will allow Medicare Part D plans to cover prescription drugs for some indications but not others for which they’re approved. The approach, called “indication-based formulary design,” will allow health plans to negotiate formulary coverage based on specific indications. Under current Part D rules, if a plan covers a drug it must cover that drug for all its FDA-approved indications. (MedPage Today; CMS)

Hospital consortium will start providing generic drugs

Civica Rx, a new nonprofit supplier of generic drugs, expects to provide about 20 products to alleviate shortages of medicines used during surgeries and to treat life-threatening conditions, such as septic shock. Civica Rx—formed by a consortium of hospital systems—has relationships with several companies with licenses to manufacture medicines, but it wouldn’t identify them. It did say production will begin in New Jersey, Pennsylvania and North Carolina facilities already licensed to produce generic drugs. (Reuters)

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Precision medicine to allow for personalized therapies

Precision medicine—also called personalized medicine—is transforming health care, driven by advances in genetics, genomics and data mining. Conventional medicine tends to offer blanket disease-based recommendations. Precision medicine focuses on diagnostics and therapeutics customized to the individual. It will soon be able to predict one’s risk of disease years before onset. “The work also offers prospects—tantalizing or unnerving, depending on your point of view—for altering genes in embryos and eliminating inherited diseases,” National Geographic explains. (National Geographic)

How to improve e-prescribing

E-prescribing can reduce medication errors and improve prescribing safety, but it is nevertheless vulnerable to “error-prone processes,” according to the authors of a recent Health Affairs paper. Among the recommendations: Incorporate medication indications into e-prescribing; establish a single shared online medication list; and redesign e-prescribing to facilitate the ordering of nondrug alternatives. (Health Affairs)


End surprise billing, says coalition of strange bedfellows

A coalition that includes the American Benefits Council, Blue Cross Blue Shield Association, Consumers Union, National Association of Health Underwriters, the ERISA Industry Committee, the National Retail Federation and National Business Group on Health want Congress to protect consumers from excessive out-of-network charges, require provider transparency on treatment options and costs and curtail surprise billing. The issue has bipartisan support: President Donald Trump and senators from both parties have vowed to find ways to stop insurers and hospitals from leaving patients with hefty and unexpected bills, Modern Healthcare reports. (Modern Healthcare; HealthLeaders Media)

Benzodiazepine scripts double, largely due to PCPs

The percentage of outpatient visits that resulted in a benzodiazepine prescription doubled from 2003 to 2015; about half came from primary care physicians, according to research published in JAMA Network Open. “I don’t think people realize that benzodiazepines share many of the same characteristics of opioids,” says co-author Dr. Sumit Agarwal, a PCP and researcher at Brigham and Women’s Hospital. (NPR; JAMA Network Open)


Step away from the drumstick, ma’am: A new study published in BMJ finds eating fried foods may increase the risk of heart disease and premature death in postmenopausal women. “Frequent consumption of fried foods, especially fried chicken and fried fish/shellfish, was associated with a higher risk of all cause and cardiovascular mortality in women in the US,” researchers concluded. (BMJ, The New York Times  

A different kind of donor match: Many nonprofit hospitals use software that goes through public data to identify the patients most likely to give large donations. Those patients may receive extra amenities—or perhaps a visit from a hospital exec. Some even train clinicians to put especially grateful patients in touch with staff fundraisers. One bioethicist calls it “unseemly but not illegal or unethical.” (Kaiser Health News)


Map the opportunity gaps

The Opportunity Atlas, supported by the Robert Wood Johnson Foundation, lets users interactively explore data on children’s outcomes into adulthood for each Census tract. RWJF calls it a “vast and granular body of data mapped across the United States.” (RWJF; the Opportunity Atlas)


“Surprise bills are an unnecessary outrage presented to families at the worst of times. The solution to surprise billing is not to shift the bills to employers or insurers. That will only increase costs for the families we cover, a fresh outrage no one can afford.”—Neil Trautwein National Retail Federation, as quoted by HealthLeaders Media.

Jorden Gunessever