Healthcare Headlines in 2013

Policy

Revisited the Integrated Delivery Network Model

The integrated delivery network (IDN)—a concept that was developed in the 1980s and widely implemented in the 1990s—is that a network of facilities and providers can work together to offer a continuum of care in a particular geographic area. Although the concept was one that initially drew praise, the implementation of this type of system did not gain momentum from the onset. However, as time has elapsed, advancements made this model worth revisiting. http://bit.ly/1hl2Ib6

Expanded List of Unnecessary Medical Tests Aims to Reduce Healthcare Spending

The Choosing Wisely campaign, an initiative of the American Board of Internal Medicine, “is focused on encouraging physicians, patients, and other healthcare stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.” The program continues to impact the industry - http://bit.ly/1bQd9Bi

Sequester Cuts Affect Cancer Clinic Funding for Medicare Patients

As a side effect of national sequester cuts, many cancer clinics were forced to turn away Medicare patients. Jeff Varcica, chief executive of North Shore Hematology Oncology Associates in New York, said his clinic decided they no longer could afford to see one-third of their 16000 Medicare patients. http://bit.ly/1jijRqi

US Healthcare Cost Disparity Considered

Could transparency in healthcare pricing decrease the disparity of costs in routine procedures? It’s no secret that healthcare costs in the United States are remarkably more expensive than any other country in the world. A New York Times article attested to this notion, citing the $2.7 trillion annual healthcare bill that exists in the United States. The high cost is not the result of extraordinary services, but rather the high price of ordinary ones. http://bit.ly/1c0YJPZ

Option Pricing Optimal in Cost-Effective, Collaborative Care

ACA News

When providers and insurers collaborate on providing efficient care in settings like accountable care organizations (ACOs) and patient-centered medical homes, it presents them with an ability to share savings. However, when a patient’s care exceeds projected cost expectations, current models of shared-saving contracts can disproportionately affect insurers. Findings published in The American Journal of Managed Care suggested that a more cost-effective solution may be possible through option pricing. This “call options” tool may resolve many payers’ concerns about entering shared saving contracts with providers. http://bit.ly/IVrt1FObama Said No to Raising Medicare Eligibility Age for Seniors

Could two years really have made the difference? While some healthcare reforms proposals called for raising Medicare eligibility from age 65 to 67 to address cost concerns associated with the Affordable Care Act, President Obama made it clear that he would not consider increasing the age limit as a way to aid the national deficit. http://bit.ly/JHSYwu

Navigators Named to Play Critical Role in Healthcare Exchange Marketplaces

A press release from the Centers for Medicare & Medicaid Services (CMS) revealed the group’s intention to recruit “Navigators” in assisting consumers with the healthcare exchanges. The CMS issued a $54 million grant to aid in the training of hired volunteers, all of whom were entrusted with helping consumers seeking health insurance through federally-facilitated and State Partnership Marketplaces.http://bit.ly/1byYBCQ

Health Reform Cost Cancer Patients

In an effort to offset cost increases associated with the Affordable Care Act (ACA), the Obama administration intended to expand hospitals’ access of the 340B discount drug plan. While the expansion sounded promising to some, many others worried that the program would threaten the quality of care, as increased participation risks higher potential for abuse. http://bit.ly/18yQFXb

Alternatives Sought for ACA Health Plans

In the highly contentious debate over expanding Medicaid programs, states were given another alternative. Pennsylvania Governor Tom Corbett revealed a plan that would utilize federal subsidies intended to expand the state’s Medicaid to instead be allocated towards helping low-income residents buy private health insurance. Similar proposals were also seen in states like Iowa and Arkansas. http://bit.ly/18lI84v

State Exchange Enrollees Below Projections

Clinical

The initial state healthcare exchange enrollment numbers rolled in, and the amount was short of expected estimates. In the states that have opened enrollment, only 50,000 Americans signed up for insurance in the first 5 weeks. That number is 3% of the 1.4 million people predicted to enroll during the sign up period ending March 31. http://bit.ly/1jihsfa

Kadcyla Approval Spurs Oncology Drug Cost Discussion

The FDA approval of Roche/Genentech’s breast cancer drug T-DM1 (brand name Kadcyla) caused a mixed reaction from healthcare analysts. Kadcyla has been shown in clinical studies to extend the median survival of women with HER2-positive metastatic breast cancer by several months, and this is excellent news for breast cancer patients, caregivers, and providers. However, the price of treatment with Kadcyla—$9,800 per month, or $94,000 for a standard course of treatment—left many wondering what the fate of the drug would be. http://bit.ly/19y3L5O

Progress of Personalized Medicine Raises Question about Coverage, Morals

As the fields of medicine and technology continue to advance, the intersection of these two fields promises great potential. Personalized medicine has the power to look into an individual’s future and better predict susceptibility to conditions and diseases, giving them the power to better prepare for the possibilities. However, as this area of medicine continues to develop, moral questions abound. http://bit.ly/IVgDc4

Proton Therapy Treatment Centers in Risk-sharing Health Systems

Hospital systems across the country increasingly vied to establish some of the first treatment centers to provide proton beam therapy, a high-tech radiation treatment for cancer. Although promising, proton technology was almost twice as expensive as standard photon radiation, and there was little evidence that it provided more effective care than cheaper treatments. http://bit.ly/IVj8er

Unnecessary High-tech Prostate Cancer Treatments Overprescribed

In 2012, the US Preventive Services Task Force determined that the risks of routine prostate-specific antigen (PSA) testing outweighed the benefits. Yet despite their guidelines of using close monitoring in place of routine testing, many men were still receiving potentially unnecessary and costly treatments, even after being diagnosed as having prostate cancer with a low risk of dying. http://bit.ly/18RkehJ

Cancer Care Reaches Near Crisis

The ability to treat cancer in a growingly aging population reaching a near crisis level in the healthcare community. As elderly patients with cancer begin to outpace the oncologist workforce, experts are concerned about patients’ quality of care. http://bit.ly/JCdj5x

Managing Rare Disease and Orphan Drug Costs

The cost to treat rare disease can be extraordinary. Several orphan drugs were approved this year, ranging from $150,000 at the low-end, to as much as $300,000 or more annually. The high costs of these drugs raise questions as to the sustainability of such treatments, and whether or not the healthcare system might absorb these costs, or how payers will make coverage decisions.http://bit.ly/19YtwMP

HIT

Meaningful Use of HIT in the Managed Care Setting

With new models of care delivery, reformation of outdated fee-for-service payment systems, and collaboration of groundbreaking provider-payer partnerships, the changing landscape of the healthcare industry reamins irrefutable. Yet, the integration of health information technology (HIT) continues to be an area of deliberation for many managed care professionals. http://bit.ly/1kVj4qS

Big Data May Shape Future Patient Outcomes

“Big data” became an increasingly important buzz word in the healthcare industry, as it has a high potential for improving patient treatment and outcomes. The Supreme Court ruling in the Myriad Genetics case denied patenting of the BRCA1 and BRCA2 genes, yet, the ruling did not require Myriad to release the years of genetic data they had gathered in its studies—critical data that could help doctors nationwide in treating patients. http://bit.ly/1i1ATY5

Exchange Workers Stuck in 'Stone Age'

Due to glitches on the website intended to sign up millions of uninsured Americans, many volunteers were forced into relying on paper applications and telephone assistance for enrollment. The effects of a troubled Healthcare.gov rollout are still being felt. http://bit.ly/IVpla9

Stage 2 Meaningful Use Deadline Extended, Sights Set on Stage 3

The Centers for Medicare & Medicaid Services (CMS) announced that Stage 2 of the EHR Meaningful Use program would be extended through 2016, especially as many healthcare CIOs continue to struggle with health IT tool vendors. This also means that Stage 3 will be delayed until 2017. http://bit.ly/1fEYaf7