From The Staff

Exhibit of the Month: Improving Pharmaceutical Innovation


February 27th, 2015

Editor’s note: This post is part of an ongoing “Exhibit of the Monthseries. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below.

This month’s exhibits, published in the February issue of Health Affairs, illustrate annual new drug approvals by the Food and Drug Administration (FDA), industry spending on research and development, and more specifically, the number of drugs approved per $1 billion spent on research and development. Read the rest of this entry »

Health Affairs Web First: Assessing Health And Health Care Perceptions In sub-Saharan Africa


February 27th, 2015

A large share of Western aid to developing countries goes to sub-Saharan Africa, a region where spending on health care is around $100 per person in 2005 price-adjusted terms. This region, which experienced large gains in life expectancy in the years following World War II, suffered health-related setbacks in the closing years of the twentieth century as a result of the HIV/AIDS epidemic.

The authors of a February 25 Health Affairs Web First study used data from the Gallup Organization’s 2012 World Poll to investigate health and health care perceptions in sub-Saharan Africa compared to other regions of the world. The poll found that sub-Saharan Africans’ overall evaluation of their well-being was lower than that of any other population in the world. Additionally, only 42.4 percent of residents in that region were satisfied with the availability of high-quality health care in their community, also the lowest level in the world. Even so, when sub-Saharan Africans were asked to name the issues that should be the highest priorities for their government, health care was not seen as the most pressing issue. Read the rest of this entry »

New Health Policy Brief: Risk Corridors (Updated)


February 26th, 2015

The latest Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) provides an update to an earlier brief on the Affordable Care Act (ACA)’s risk corridor program, which allows the Department of Health and Human Services (HHS) to collect and make payments to qualified health plans. As the brief explains, a recent amendment to federal appropriations raises questions as to whether insurers will receive their full risk corridor payments for 2014.

While the Consolidated and Further Continuing Appropriations Act of 2015, which funded the government for the 2015 fiscal year, did give HHS the authority to collect user fees, an amendment was included that specifically prohibited HHS from transferring money from either trust fund.

The amendment did not eliminate the risk corridor program, nor did it prevent HHS from using payments received from insurers to pay out claims under the program (that is, user fees), but it effectively made the risk corridor program budget neutral unless HHS can find another source of funding. As a result, insurers expecting payments from HHS may not receive the full amount due.

Read the rest of this entry »

The Latest Health Wonk Review


February 19th, 2015

Last week Peggy Salvatore posted a Valentine’s Day edition of the Health Wonk Review at the Health System Ed blog. Peggy includes Ron Pollack’s Health Affairs Blog “Contributing Voices” post arguing that both the text of the Affordable Care Act and congressional intent indicate that premium tax credits should be available in states using the Federally Facilitated Marketplace. Read the rest of this entry »

Health Affairs Web First: Recent US Hospital Productivity Growth


February 11th, 2015

Between 2002 and 2011, US hospitals increased their productivity in treating Medicare patients for several serious illnesses, refuting fears about a “cost disease” in health care and potentially mitigating concerns about provider payment under the Affordable Care Act.

The study, released today by Health Affairs as a Web First, addresses the quality of care and the severity of patient illness (considerations not fully taken into account by previous studies on this topic) found that during those years, the annual rates of productivity growth were 0.78 percent for heart attacks, 0.62 percent for heart failure, and 1.90 percent for pneumonia.

When the authors John Romley, Dana Goldman, and Neeraj Sood calculated productivity growth rates without factoring in trends in the severity of patient conditions or outcomes achieved after hospitalization, the annual productivity rates were different: -0.64 percent for heart attacks, -0.91 percent for heart failure, and -0.39 percent for pneumonia. Read the rest of this entry »

New Narrative Matters: How Access, Knowledge, And Attitudes Shaped My Sister’s Care


February 6th, 2015

Health Affairs‘ February Narrative Matters essay features a woman who helps her sister get the care she needs when a tooth infection turns into a health emergency. Elizabeth Piatt’s article is freely available to all readers, or you can listen to the podcast. Read the rest of this entry »

Request For Abstracts: Health Affairs Food And Health Theme Issue


February 4th, 2015

Health Affairs is planning a theme issue on food and health in November 2015. The issue will present work that explores the relationship between the food we consume and our wellbeing on the individual, societal, and global levels. Articles will address causes and consequences of dietary excess and insufficiency, analyze policies and programs aimed at influencing these, and explore the roles of public policy, industry, and stakeholder groups in the context of dietary behavior.

We invite all interested authors to submit abstracts for consideration for this issue.

The issue will consider the implications of global food production and distribution for the health of consumers and food workers, environmental quality, and food prices, among other things. It will also examine actions taken from the community level upward to address increasingly universal concerns about food-related illness. Several papers will provide broad overviews of key issues, but we are particularly interested in empirical analyses of specific policies, programs, and practices aimed at influencing dietary behavior and clarifying our thinking about food’s role in health. Read the rest of this entry »

Health Affairs Event Reminder: Biomedical Innovation


February 3rd, 2015

Biomedical innovation lengthens and enriches our lives through breakthroughs in medications and care, but it is has also been the leading source of health care cost growth over the past few decades. The February 2015 thematic issue of Health Affairs examines the topic from many perspectives.

You are invited to join us on Thursday, February 5, at a forum featuring authors from the new issue at the W Hotel in Washington, DC. Panels will cover pharmaceuticals; biotechnology; medical devices; and accelerating, diffusing, and financing innovation.

WHEN: 
Thursday, February 5, 2015
9:00 a.m. – 12:30 p.m.

WHERE: 
W Hotel Washington
515 15th Street NW
Washington, DC, Great Room, Lower Level

REGISTER NOW!

Follow live Tweets from the briefing @Health_Affairs, and join in the conversation with #HA_BiomedInnovation.

See the full agenda. Among the confirmed speakers are: Read the rest of this entry »

Health Affairs’ February Issue: Biomedical Innovation


February 2nd, 2015

The February issue of Health Affairs includes a number of studies examining issues pertaining to biomedical innovation. Some of the subjects covered: how declining economic returns for new drugs may affect future investments, the changing landscape of Medicare coverage determinations for medical interventions, the slowly emerging US biosimilar market, and more.

With declining economic returns, can manufacturers afford to continue investing?

Ernst Berndt of Massachusetts Institute of Technology’s Alfred P. Sloan School of Management and coauthors compared present values of average lifetime pharmaceutical revenues to present values of average drug research and development, and lifetime operating costs. Upon examining new prescription drugs launched over four distinct time periods between 1991 and 2009, the authors found that net economic returns reached a peak in the late 1990s and early 2000s. Read the rest of this entry »

The Latest Health Wonk Review


January 30th, 2015

On January 29, Jason Shafrin at Health Care Economist published a “Super Bowl” edition of the Health Wonk Review. Jason’s round-up contains no hot air, but it’s not at all deflating — it includes two Health Affairs Blog posts on the present and future of Medicare ACOs by Mark McClellan and coauthors and Scott Heiser and coauthors.

We also want to give a delayed shout-out to the nice “shake the winter blahs” Health Wonk Review that Vince Kuraitis published at e-CareManagement on January 15. Vince included a Health Affairs Blog post by Uwe Reinhardt reacting to Jonathan Gruber’s controversial remarks and explaining why Americans aren’t stupid but are often ignorant about policy issues. Read the rest of this entry »

Contributing Voices

Building A Framework To Assess The Impact Of Change


February 27th, 2015

Editor’s note: This post is part of a series of several posts related to the 4th European Forum on Health Policy and Management: Innovation & Implementation, held in Berlin, Germany on January 29 and 30, 2015. For updates on the Forum’s results please check the Center for Healthcare Management’s website or follow on Twitter @HCMatColumbia.

Health care systems and organizations need to adapt to a rapidly changing societal and technical environment. In theory, this seems simple to do: policymakers and boards of organizations assess the nature of the developments, analyze the gap between the present and the desired situation, design a policy to reduce this gap, translate the policy in concrete measures, implement them, and reap the fruits of successful change — then start the cycle all over.

However, in the reality of daily practice, policies rarely have the intended effect and policy measures can lose effectiveness before they reach the intended point of impact. Sometimes, they may have the opposite impact than expected, raising costs for example, instead of reducing them. Read the rest of this entry »

The Patient Access Imperative: A Potential Triple Win For Payors, Providers, And Patients


February 26th, 2015

Long patient wait times, frustratingly high no-show rates, lack-luster call center performance, and under-utilized physicians. Does any of this sound familiar? Although a small set of health systems have boldly declared that their physicians guarantee their outpatients same- or next-day appointments, across the United States patients more typically face long wait times to both make and get appointments, as well as poor access to care.

To succeed in the future, health systems will need to have the customer orientation of a five-star hotel and the operational discipline of a factory floor. Our experience suggests that many systems can achieve substantial improvements with their existing resources and generate a 10 to 20 percent improvement in outpatient profitability within 6 to 12 months — and improve patient satisfaction too. Read the rest of this entry »

What Happens When A Retail Pharmacy Decides To Stop Selling Cigarettes?


February 26th, 2015

Editor’s note: This post is part of a series stemming from the Third Annual Health Law Year in P/Review event held at Harvard Law School on Friday, January 30, 2015. The conference brought together leading experts to review major developments in health law over the previous year, and preview what is to come. A full agenda and links to video recordings of the panels are here.

The sale of cigarettes and tobacco products at retailers with pharmacies has received considerable attention over the past year. The national debate reignited in February 2014, when CVS/pharmacy announced that we would quit the sale of cigarettes and tobacco products in our 7,800 pharmacies nationwide. In September 2014, we announced we were officially tobacco free — one month earlier than planned. This was met with kudos from the media, public health officials, and even the President of the United States.

But one question that did not receive anywhere near that level of attention was whether or not our actions would make a difference in the prevalence of smoking and, ultimately, in the public health. Read the rest of this entry »

Top 5 Health Care Trends to Watch in 2015


February 25th, 2015

With a new Congress, health care is once again an issue of tremendous scrutiny and debate. Many of the federal policy debates in 2015 will be largely symbolic, resulting in little more than tweaks to existing law.

However, health care policy is not just a matter for Congress to consider. A range of issues will play out in the states and the private sector, effectively shaping the future. Below are the top trends we’re watching this year.

The Year of Living Interoperably

From electronic health records (EHRs) to clinical measures and decision support tools, providers are inundated with new technologies that automate processes and capture new types of data. However, these systems are limited in their potential because they don’t all “talk” to one another. They’re locked away within proprietary technologies that render them the equivalent of an email account that only sends messages to people in your company, or a phone that only makes calls in your house. Read the rest of this entry »

State Expectations: Setting The Record Straight In King v. Burwell


February 25th, 2015

On Wednesday, March 4, the Supreme Court will hear the latest attack on the Affordable Care Act (ACA): the case King v. Burwell. The King petitioners allege that the Internal Revenue Service overstepped its authority by issuing regulations authorizing residents of states with federally run exchanges to access premium tax credits. The petitioners claim that Congress intentionally limited access to premium tax credits to residents of state-based exchanges as a way to encourage states to run their own exchanges.

In support, some state officials claim that they interpreted the law in this manner and that it impacted their state’s decision not to operate a state-run exchange. These assertions, like their analysis of the statutory language, fall flat under any serious scrutiny, however.

Between October 2012 and March 2013, with the support of the Commonwealth Fund, the Center on Health Insurance Reforms (CHIR) conducted a comprehensive review of publicly available information in 50 states pertaining to their decisions to operate either a state or federally run exchange. Read the rest of this entry »

Implementing Health Reform: Beginning The Cadillac Tax Regulatory Conversation And Other ACA News (Updated)


February 24th, 2015

March 1 update: Challenge to Congress’ participation in DC SHOP exchange turned back.  On February 25, 2015, Judge Herbert Dixon of the District of Columbia Superior Court dismissed plaintiff Kirby Vining’s complaint charging the D.C. exchange had illegally permitted members of Congress to purchase coverage in the D.C. SHOP exchange; the plaintiff argued that Congress, with 12,359 employees, is not a small business.

The court held that the plaintiff had no standing to challenge the D.C. Code provision allowing members of Congress to purchase coverage through the SHOP exchange.  It went on to hold, however, that the ACA is ambiguous about whether members of Congress should purchase coverage through the individual or SHOP exchange and that the interpretation of the law by the Office of Personnel Management and HHS was permissible.  Judge Dixon therefore upheld the D.C. Code provision, which was consistent with the HHS and OPM rules.

February 25 update:  King v. Burwell what ifs.  As has been widely noted, a Supreme Court decision to invalidate the Internal Revenue Service rule that permits consumers to access advance premium tax credits and cost-sharing reduction payments through the federally facilitated marketplaces would have a devastating impact on lower- and moderate-income Americans who receive those benefits, on state individual insurance markets, and on health care providers.  As the March 4, Supreme Court oral arguments draw near, the search for a Plan B should the Court decide against the government becomes more urgent.

On January 28, 2015, the Republican leadership of the House Energy and Commerce Committee wrote to Health and Human Services Secretary Burwell asking whether HHS was developing contingency plans in the event the Court ruled against it.  Specifically the letter asked:

1) What actions, analysis, and/or contingency planning has HHS undertaken in advance of the Supreme Court’s King v. Burwell decision? Please include a description of:

  • All scenarios considered or evaluated;
  • Any attempts or efforts to anticipate or access the possible permutations and/or practical consequences of the Court’s coming decision;
  • Any options, proposals, and/or recommendations that have been considered, adopted, or rejected, or which are currently under consideration; and
  • Any related memoranda or analyses produced in connection with, or as a result of, efforts to anticipate, ameliorate, or otherwise address the impact of the coming King v. Burwell decision.

2) Please describe the authorities that would be implicated to implement the measures, options, proposals, or recommendations referenced in item No. 1.
3) Please describe any other federal agencies with which HHS is coordinating or planning possible responses to the Court’s ruling in King v. Burwell;
4) Please provide any documents that your department has prepared or relied upon in conducting any review or analysis described in Items No. 1-3 above.

Read the rest of this entry »

How Menu Labeling Could Spark Change Beyond The Menu Board


February 24th, 2015

If there’s one thing we’ve learned about catalyzing changes that prevent illness in the first place, it’s that passage of a single policy can be like lighting a match — illuminating the way towards strategies with greater impact and igniting the energy of leaders. The success of a menu labeling might be the match needed to inspire further policy change to shift the trend of increased diet-related chronic disease in the United States.

In November, the Food and Drug Administration released the final rule guiding calorie labeling of menu items at chain food service establishments with 20 or more outlets nationally. The rule will apply to fast-food and sit-down restaurants, supermarkets, convenience stores, and movie theaters, and will take effect on December 1, 2015.

Once implemented, calorie counts will be posted for all items (including alcoholic drinks) on menus and menu-boards, and on display tags for salad bars, bakery items, and soda dispensers. A companion rule requiring calorie labeling for vending machines will take effect one year later. Read the rest of this entry »

Indirect Effects From Menu Labeling Can Improve The Public’s Health


February 24th, 2015

Just this past November, the U.S. Food and Drug Administration (FDA) released sweeping final rules requiring that calorie information be posted on menus, menu boards, and vending machines. The regulations expand the proposed rule to include a wide variety of food outlets with more than 20 locations: quick service and table service restaurants, grocery stores and superstores, movie theaters, amusement parks, ice cream shops, takeout and delivery, vending machines, and even alcoholic beverages.

In the press release for the final rule, FDA Commissioner Margaret Hamburg stated, “making calorie information available on chain restaurant menus and vending machines is an important step for public health that will help consumers make informed choices for themselves and their families.”

Although the scientific evidence linking menu labeling to consumers’ purchasing behavior is weak, indirect effects may contribute more to incremental gains in public health. We highlight a few in the following blog post. Read the rest of this entry »

Putting Humpty Dumpty Together Again: Consolidating Regulatory Authority Over Food Safety


February 23rd, 2015

The fragmented nature of regulatory authority over food in the United States is well known. More than a dozen federal agencies are responsible for the safety of the nation’s food supply. The Food and Drug Administration (FDA) and the Department of Agriculture (USDA) have the lion’s share of responsibility, together overseeing over 80 percent of the nation’s food safety.

Generally, the USDA regulates meat, and the FDA regulates everything else, but overlaps, exceptions, gaps, and therefore examples of resulting absurdities abound: the FDA regulates frozen pizza, unless it has pepperoni. The FDA regulates seafood, unless it’s catfish. The USDA has jurisdiction over packaged open-face meat sandwiches, but if the sandwiches are closed, authority shifts to the FDA.

This division in regulatory authority is neither planned nor rational. It is instead a historical accident, originating in the early twentieth century. When the Pure Food and Drug Act and Meat Inspection Act were passed on the same day in 1906, both targeting the adulteration of the food supply, their oversight was assigned to different departments within the USDA. The fissure widened when the FDA was moved out of the USDA in 1940. This divided regulatory framework is not the only reason for the fragmentation of regulatory authority over food in the US, but it is a main driver. Read the rest of this entry »

Implementing Health Reform: Final 2016 Letter To Federal Exchange Issuers


February 22nd, 2015

Each year the Centers for Medicare and Medicaid Services (CMS) releases a letter to issuers (insurers) in the federally facilitated marketplace (FFM) setting out the ground rules for coverage through the FFM for the coming year.  A draft letter is published for comments, followed by the final letter.  The letter addresses insurers that issue qualified health plans (QHPs) in the FFM, including stand-alone dental plans (SADPs), and covers the small business (FF-SHOP) marketplace as well as the individual marketplace.

On December 19, 2014, CMS published the draft 2016 letter which I covered here.  On February 20, 2015, CMS published the final letter to issuers in the federally facilitated marketplace.  Not surprisingly, since it covers the third year of operation of the marketplace, the 2016 letter is quite similar to those of preceding years.   The letter is based on previously published rules governing QHPs and the marketplaces, as well as on the final 2016 Benefit and Payment Parameters Rule, covered here (CITE) and here (CITE), from which it incorporates many provisions. Read the rest of this entry »

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