May 30, 2019 | Broker perks under scrutiny in proposed

Industry News

Bipartisan bill takes on high costs, surprise bills and more

Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., on Thursday released the details of a plan they hope will help bring down health costs and, among other things, eliminate surprise medical bills for patients. Alexander is chair and Murray is the ranking member of the Health, Education, Labor and Pensions Committee. Alexander told NPR he hopes to get it on the Senate floor in July. It targets nearly every area of the health care industry for reform, including surprise medical bills, prescription drugs, price transparency, public health and health information, NPR reports. (NPR)

…included in that bill

Brokers would have to reveal the fees and other enticements they’ve received from the insurance industry under the Alexander/Murray bill. Brokers are supposed to independently help employers select benefits for their workers. But a ProPublica investigation earlier this year found the insurance industry often uses undisclosed money and gifts to influence the brokers, including hefty commissions, six-figure bonuses and exotic vacations. Critics call the compensation a “classic conflict of interest” that drives up costs, according to ProPublica. (ProPublicaProPublica investigation)

Innovation & Transformation

Executive order could bring about radical transparency

President Donald Trump is expected to release an executive order as early as this week that would advance transparency by mandating the disclosure of prices in the health care industry, the Wall Street Journal reports. The order could direct various federal agencies—including the Justice Department—to pursue actions to force industry players to divulge cost data. The administration is also looking at using agencies to take on regional monopolies of hospitals and health insurance plans, the paper reports. (Wall Street Journal)

Docs more ready than ever for risk

More practices are willing to take on downside risk, according to a new AMGA survey. In 2018, 74% of respondents answered that they would be ready to participate in downside-risk payment models within two years. Back in 2015, only 42% indicated they would. In addition, the 2018 survey found that 56% of member revenues were risk-based in the federal setting, and 28% in the commercial setting. Federal fee-for-service payments declined by 20% during the years between the first survey in 2015 and the 2018 survey. Commercial FFS payments dropped by 8%. (Healthcare DiveAMGA)

Consumers & Providers

Mental health claims increasing, especially among the young

Children and young adults under the age of 23 were disproportionately represented in the increase in private insurance claim lines with mental health diagnoses from 2007 to 2017, according to a new white paper from the nonprofit FAIR Health. Overall, mental health accounts for a growing number of private insurance claims. The findings may reflect increased access to treatment, but experts warn that it’s exceptionally difficult to tease out which factors are involved. (STAT NewsFAIR Health paper

Colorado law caps insulin copays

Colorado has capped the price of co-pays for insulin—the first state to do so. Colorado residents who use insulin to control their blood sugar levels won’t pay more than $100 per month for the drug, effective January 2020, thanks to legislation signed into law by Gov. Jared Polis on Wednesday. Insulin has been around for nearly a century, but the price doubled since 2012. (Denver Post)

New & Noted

A different pet-poop issue: Pets may boost the risk for irritable bowel syndrome, according to a meta-analysis presented at Digestive Disease Week. The finding revealed no answers about why this was the case, or which animals were complicit. Also, it was not clear if certain kinds of pets posed a higher risk, co-author and cat owner Laith Al Momani, MD, told MedPage Today. “The cat is safe—for now.” (MedPage Today)

ERISA hates surprises: Among those testifying against surprise billing: The ERISA Industry Committee (ERIC). “Surprise billing undermines the value-driven and coordinated care programs advanced by large employers, and fundamentally frustrates the goals of providing quality, affordable employer-sponsored health benefits,” ERIC SVP James Gelfand told the House Ways and Means Health Subcommittee(ERIC announcement)

More screening: Post-ACA, screening for colorectal cancer and breast cancer increased in low-income adults 50 to 64 years of age in states that expanded Medicaid coverage. (MedPage Today)


Whither Medicare for All?

Capitol Hill has been busy this month with an array of health care issues, including Medicare for All. But is that trending—and trendy—concept losing steam? It looks that way, according to experts on the most recent KHN “What the Health?” podcast. Julie Rovner from Kaiser Health News, Joanne Kenen of Politico, Stephanie Armour of The Wall Street Journal and Kimberly Leonard of the Washington Examiner discuss this and other issues during the 27-minute podcast. (KHN)

MarketVoices...quotes worth reading

"When you have a chairman and a ranking member that have worked together on a bipartisan package in the committee of jurisdiction, it always gives more weight to the product,"—Dean Rosen a former Republican senior health adviser and a partner at Mehlman Castagnetti Rosen & Thomas, talking to NPR about the Alexander/Murray health care legislation.

Jorden Gunessever