October 3, 2019 | Impeachment vs. health policy?

October 3, 2019

INDUSTRY NEWS

Premium costs outpace salaries: KFF

Premiums and deductibles are making employer-based coverage too pricey for many, according to a new analysis released last week by the Kaiser Family Foundation. The average premium for employer-sponsored health insurance in 2019 rose 5% to $20,576 for family coverage and 4% to $7,188 for individual coverage. Despite employers paying a significant portion of those premiums, the employee share of coverage costs has grown faster than wages. Over the past five years, employee contribution to insurance premiums increased 15% for single coverage and 25% for family coverage; the average deductible increased 36%. Wages increased 14% over the same period. (New York Times; Kaiser Family Foundation)

CMS to Insurers: Embrace transparency, quality

Insurers need to support the Trump administration’s policies on transparency, value-based payments, interoperability and data access, CMS Administrator Seema Verma warned in a speech at the America’s Health Insurance Plans’ 2019 National Conference on Medicare. Verma said that patients are tired of high costs, surprise bills and a system that’s too complex and difficult to navigate. (Modern Healthcare)

INNOVATION & TRANSFORMATION

Just what is value, anyway?

For most of its history, Medicare paid for health care volume over value. That changed with the Affordable Care Act’s goal of 90% of Medicare payments being tied to quality. But “[i]t doesn’t mean that the vast majority of the care Medicare purchases is linked to actual value,” warns NYU health economist Sherry Glied, After looking at the evidence and talking to an array of experts, Austin Frakt concludes, “Paying for health care value is a popular slogan, but Medicare is still figuring out how to do it. (New York Times)

More Americans are using technology to compare

More than one-third of Americans now use the internet or mobile apps to compare pricing for health care services, representing a steady increase in online comparison shopping over the last several years, according to the fourth annual UnitedHealthcare Consumer Sentiment Survey. Nearly half (45%) of respondents said they would be interested in their physician using artificial intelligence in care decisions. (Becker's Hospital Review; survey findings)

CONSUMERS & PROVIDERS

DSH cuts on track for 2020, hospitals fight back

Hospital groups are beginning to push back on CMS’ plan to cut Medicaid disproportionate-share hospital (DSH) funds in 2020. (It published a final rule to that effect last month.) Modern Healthcare reports CMS is calculating Medicare disproportionate-share hospital payments based in part on hospitals’ bad debt in prior years, when bad debt was lower. DSH funds are meant to help hospitals with uncompensated-care costs; hospital groups had agreed to cuts under the ACA as one of the trade-offs for Medicaid expansion and other policies. The cuts have not yet been implemented. (Modern Healthcare; final rule)

Generics, biosimilars becoming more costly

It’s become more difficult than ever for generics and biosimilars to compete on formularies. More generics are getting placed on higher formulary tiers, significantly increasing the copay. Branded manufacturers use rebates and other strategies to try to limit the reach of new generic products, Drug Topics reports. “Generally, what we have been observing and hearing from members are increasing challenges in terms of formulary access, both with respect to older commoditized generics and newer generic launches,” says Craig Burton, VP, Association for Accessible Medicines. (Drug Topics)

NEW & NOTED

A valid stereotype? A recent Cleveland Clinic survey of nearly 1,200 men found that 72% would rather do household chores than go to the doctor. Only half said they consider getting their annual check-up a regular part of taking care of themselves. (Cleveland Clinic)

Impeachment vs. health policy? With impeachment consuming all oxygen, what now? How will the impeachment investigation affect work on legislation to restrain the cost of prescription drugs and surprise medical bills? Kaiser Health News’ What the Heath? podcast takes on these and other questions. (KHN podcast)

MA premiums down: Medicare Advantage premiums are expected to hit a 13-year low in 2020, CMS Administrator Seema Verma announced last week. On average, premiums are expected to decline 14% compared with 2019. (Healthcare Dive)

MULTI-MEDIA

Dōmo arigatō, Dr. Roboto

The New Yorker’s “Paging Dr. Roboto” piece follows robotic surgery pioneer Dr. Pier Giulianotti and explores the impact of robotic surgery. The article is available as text and audio. (New Yorker)

MARKETVOICES...QUOTES WORTH READING

“We don’t even know what we mean by value. How do you pay for something when you don’t know what it is?”—Sherry Glied, a health economist and dean and professor at the Wagner School of Public Service at N.Y.U., quoted in the New York Times

Jorden Gunessever