Sunday, November 30, 2014

Health Technology Forum Meet Up in Washington, DC on December 11

Colleagues,

I would like to invite you the Health Technology Forum Meet Up in Washington, DC, on December 11, from 6-9 p.m.

Our December 11 Meet Up will address the theme of Clinical Evidence in mHealth.

We have three speakers confirmed so far:

• Sandeep Pulim, MD, Chief Medical Information Officer of @Point of Care,  a new business incubated by StartUp Health which provides a streamlined practice-based tool to allow for the delivery of content at the clinician’s fingertips at the time it is acutely needed, built on IBM's Watson cognitive technology.

• Anand K. Iyer, Phd, MBA, Chief Data Science Officer of WellDoc, a healthcare company that uses technology to improve disease management outcomes and reduce health care costs. Dr. Iyer previously PRTM Management Consultants' Wireless Solutions practice where he helped companies in both the commercial and government sectors capitalize on the convergence of three mega trends: Internet ubiquity, emerging wireless technologies and innovative business models. He is a pioneer in the realm of Telematics and Telemedicine, where he has developed and launched several initiatives with OEMs to transition their basis of competition from a product-base to a service-base.

• Michael Slage of LiftOffHealth, the DC-area'a only incubator/accelerator focused exclusively on health care. LiftOffHealth will be welcoming its first class of entrepreneurs soon. If you have a new business idea you do't want to miss his presentation! Mr. Slage has over two decades of experience building new healthcare businesses.

More speakers will be announced soon. Your nominations are welcome.

To learn more, and RSVP, become a member of the Health Technology Forum: DC Meet Up, which takes only a few clicks of the mouse..

Saturday, November 29, 2014

Real Health Spending Continues Moderate Growth

The Bureau of Economic Analysis released its second estimate of 3rd quarter GDP and it confirms what was observed in the advanced estimate: Real growth in health spending is moderate.

Indeed, real GDP growth was revised upwards from 3.5 percent to 3.9 percent, but health spending was not really changed from the advanced estimate.

Read the entire column at NCPA's Health Policy Blog.

How the U.S. Single-Payer System For Seniors' Health Compares Internationally

The Commonwealth Fund has published another survey of health care across countries. The Commonwealth Fund’s widely reported surveys, while thorough, are frustrating because they invoke abstractions (for example “universal health insurance coverage“) to explain why the U.S. health system underperforms.

The latest survey should be able to get around this problem because it surveys only people aged 65 years and older in 11 developed countries. Because almost all American seniors are on Medicare — a single-payer, government-run program that is mostly funded by taxpayers — we might expect the Commonwealth Fund to find that the U.S performs about as well as other countries.

No such luck.

Read the entire column at NCPA's Health Policy Blog.

Premiums Hiked 10 Percent For Most Popular Obamacare Plans

Consultants at Avalere have confirmed that which I previously suggested: Obamacare plans that won market share in 2014 are hiking their premiums significantly. Although Avalere’s analysis does not diagnose why these plans are increasing premiums almost twice as much as premiums for group benefits, it is almost certainly because they experienced medical claims higher than they had anticipated.

Read the entire column at NCPA's Health Policy Blog.

On The Wrong Side of Wall Street?

It looks like I am zigging when the smart money is zagging. I’ve written that Obamacare will struggle to reach the Administration’s target of 9 million in 2015. At last week’s “Wall Street Comes to Washington” roundtable, sell-side analysts Carl McDonald of Citi and Ralph Giacobbe of Credit Suisse predicted that 2015 enrollment in Obamacare exchanges will reach 11 million.

Read the entire column at NCPA's Health Policy Blog.

Saturday, November 22, 2014

"Inexcusable": Administration Over-Counted Obamacare Sign-Ups By 380,000

The media seems to think that Obamacare’s second open enrollment is going just swimmingly. (How could it be going worse than last year’s?)

Unfortunately, the Administration still isn’t counting last year’s sign-ups accurately. Jonathan Cohn of The New Republic has called the Administration’s over-counting of Obamacare sign-Ups “inexcusable“. And that’s from one of Obamacare’s biggest fans.

What happened is that the Administration counted 400,000 dental-only plans as Obamacare plans.

Read the entire column at NCPA's Health Policy Blog.

Gilead Pays $125 For FDA Priority Review Voucher

Last May, we discussed Priority Review Vouchers, a type of intellectual-property right whereby the inventor of a drug for a rare disease, which is unlikely to be profitable because very few patients suffer from it, earns a marketable voucher that it can sell to another drug-maker that it can cash in at the FDA for a priority review of another new drug.

In the previous case, Knight Pharmaceuticals figured it could sell the voucher for $125 million to $300 million. Well, the market is now proven to function. Gilead Sciences has paid Knight $125 million for the voucher.

Read the entire column at NCPA's Health Policy Blog.

Right To Try Laws Now In 5 States

After this month’s elections, the number of states that have “right to try” laws for experimental drugs has hit five. One in ten states: Not bad for an effort run out of one think tank in Arizona.

Read the entire column at NCPA's Health Policy Blog.

Thursday, November 20, 2014

Post-Obamacare Reform: Will Insurers Be Redeemed?

Robert Pear of the New York Times recently described the “symbiotic” relationship between the Obama Administration and health insurers. It was not always so, but it is now "symbiotic".

This poses quite a challenge for health reform after Obamacare is repealed by the next President in January 2017. Will health insurers resist, focused on consolidating their Obamacare gains, or will they accept the need for real reform? Although not immediately apparent, there is hope that health insurers will be ready to move beyond Obamacare.

Read the entire column at Forbes.

Tuesday, November 18, 2014

Your Kaiser Permanente Doctor Will See You Now - At Target

You probably won’t find more criticism of large health systems on any other health policy blog than you will here. Nevertheless, we like innovation wherever we find it happening, and it is happening in some large health systems:

In a move that reflects the increasing wave of consumer-driven healthcare, Target Corporation is teaming up with Kaiser Permanente to open four in-store Target Clinics in Southern California, taking a host of services directly to thousands of customers.
The clinics opened at Target stores in Vista, San Diego and Fontana, and a fourth clinic will open in West Fullerton Dec. 6. They will be staffed by nurse practitioners from Kaiser.
Read the entire column at NCPA's Health Policy Blog.

Monday, November 17, 2014

The "Average" Obamacare Rate Hike May Be Much Lower Than Advertised - And That May Indicate More Adverse Selection

Now that we are on the third day of open enrollment, it may be time to puncture the balloon of “tame” Obamacare premium hikes. There has been a drumbeat of positive news about premiums in the Obamacare exchanges.

Good news? Well, not really. First, we have no idea what the “average” change in premium will be until after the dust settles on open enrollment next February 15. A simple average of rates announced prospectively does not tell us much until we see which plans Obamacare enrollees actually choose.

Read the entire column at NCPA's Health Policy Blog.

American Telemedicine Association Backs Telemedicine Compact

Our blog usually does not cheer the American Medical Association, because it is largely responsible for the Soviet-style centrally fixed prices that prevail in Medicare. Well, today we applaud the AMA for pledging its support to an important initiative that will increase the adoption of telehealth.

Read the entire column at NCPA's Health Policy Blog.

Saturday, November 15, 2014

Medicaid Spending Has Exploded

According to the Centers for Medicare & Medicaid Services (CMS), spending on Medicaid, the jointly funded state-federal welfare program that provides health benefits to low-income people, increased 6.7 percent in 2013 to $449.5 billion. And it will keep growing at a fast rate.

Read the entire column at The Daily Caller.

Friday, November 14, 2014

Health Insurance Without An Expiration Date

Hangsheng Liu and Soeren Mattke have written a useful short article at Health Affairs, promoting “health insurance without an expiration date,” criticizing the one-year term of most U.S. health insurance, which features open enrollment at the end of each calendar year.

Read the entire column at NCPA's Health Policy Blog

HSA-Eligible Plans Are Widely Available In Obamacare Exchanges

Paul Howard and Yevgeniy Feyman of the Manhattan Institute have conducted a thorough examination of plans available on Obamacare’s exchanges:
The report finds that, far from becoming obsolete under the ACA, high-deductible plans are widely available — 98 percent of uninsured Americans have access to at least one HSA-eligible plan. Moreover, these plans also make up about 25 percent of total offerings on Obamacare exchanges. We also found that they remain significantly less expensive than traditional plan designs, offering savings of about 14 percent, on average.
However, we must also recall that Obamacare exchanges encourage plans to compete by attracting the healthy and deterring the sick form applying for coverage. So, we should be careful about concluding that Obamacare’s HSA-eligible plans are really consumer-driven plans. Health insurers may be offering them as a method of selecting less expensive risks.

Read the entire column at NCPA's Health Policy Blog.

"Peak Obamacare" Will Exchanges End With A Bang Or A Whimper?

The U.S. Supreme Court has agreed to hear King v. Burwell, an important case about Obamacare’s subsidies (tax credits) to health insurers. Plaintiffs argue that in the 36 states with federal Obamacare exchanges, subsidies cannot be paid legally. If no subsidies can be paid, neither the individual mandate to buy health insurance nor the employer mandate to offer insurance can be enforced.

Few people would voluntarily buy health insurance from an Obamacare exchange if health insurers on the exchanges did not receive subsidies to enroll people. The premiums would be too high otherwise. Experts expect that the Supreme Court might decide on King v. Burwell in July, in which case Obamacare will end with a bang.

However, even if the Supreme Court allows the Administration to continue to unilaterally re-write the law, Obamacare’s exchanges – both state and federal – will likely end with a whimper in 2015 or soon after. Just look at how quickly the Administration began to roll back expectations for enrollment, immediately after the election.

Read the entire column at Forbes.

Tuesday, November 11, 2014

Hiring in Outpatient Clinics Froze Last Month

Hiring in health care continued its moderate pace in October. As noted in September, the rapid hiring in the health sector, especially in outpatient services, has slowed dramatically. Health care hired about 25,000 workers in October, increasing employment by 0.17 percent. Non-farm payrolls, excluding health care increased 0.15 percent. So, job growth in health care has settled down to a rate similar to the overall economy.

However, hospitals have picked up their hiring, adding 7,000 workers for growth of 0.13 percent, as shown in table 1. Hospital hiring had lagged other health hiring for months. Home health added a lot of employees, while nursing homes actually shed jobs. Outpatient clinics froze hiring in October.

Read the entire column at NCPA's Health Policy Blog.

Monday, November 10, 2014

Obamacare's Most Popular "Patient Protection" Is Why Patients Can't Get Paid For Saving The System Money

Last Monday, I posed the rhetorical question “Why Can’t Patients Get Paid for Saving the System Money?” and gave some examples, such as Medicare’s competitive bidding for durable medical equipment and incentives offered by Medicare Advantage plans, demonstrating how rules inhibit patients’ ability to participate more fully in forming prices and controlling costs.

The primary reason for such rules is to compensate for Obamacare’s most popular provision: Prohibition against medical underwriting, so that sick and healthy patients of the same age pay the same premiums.

Read the entire column at NCPA's Health Policy Blog.

Real Health Spending Remains Moderate, Inflation Increasing

For a while now, I’ve been surprised at how optimistic investors are about healthcare companies. Obamacare, the stock market tells us, is good for business. However, data on health spending does not support that story without qualification.

It looks like the discrepancy is between real versus nominal data. A survey reported in nominal dollars indicated a big hospital spending boom. On the other hand, the Gross Domestic Product (GDP) estimates indicate that real spending growth on health care is moderate.

Read the entire column at NCPA's Health Policy Blog.

Drug Patent Litigation is Robust

You may have heard the stories about brand-name drug-makers and generic competitors quietly doing deals called “pay for delay” with each other. “Pay for delay” consists of a brand-name drug-makers which has a drug coming off patent paying a generic competitor not to challenge the patent and enter the market.

It sounds pretty bad, although it may actually be an efficient way to resolve a patent dispute. In fact, generic drug makers are attacking patents more aggressively than they have in years, according to research by Lex Machina. They file faster and more often. As a result, the patented medicines being challenged are younger – only five years old, versus ten in 2010.

Read the entire column at NCPA's Health Policy Blog.

Say It Ain't So! The Medical Device Excise Tax Doesn't Hurt?

The medical-device excise tax, part of Obamacare, is a universally reviled 2.3 percent levy on medical devices. Many people think that it will finally be repealed, with Republicans in charge of both chambers.

Now, along comes the Congressional Research Service to pour cold water on the idea that the tax is a job killer. The writers agree that the tax makes no economic sense:
Viewed from the perspective of traditional economic and tax theory, however, the tax is challenging to justify. In general, tax policy is more efficient when differential excise taxes are not imposed. It is generally more efficient to raise revenue from a broad tax base. Therefore excise taxes are usually based on specific objectives such as discouraging undesirable activities (e.g., tobacco taxes) or funding closely related government spending (e.g., gasoline taxes to finance highway construction). These justifications do not apply, other than weakly, to the medical device case. The tax also imposes administrative and compliance costs that may be disproportionate to revenue.
However, they dispute the argument that it will harm device makers:
The estimates in this report suggest fairly minor effects, with output and employment in the industry falling by no more than two-tenths of 1%. This limited effect is due to the small tax rate, the exemption of approximately half of output, and the relatively insensitive demand for health services.
So, all is well? Not at all:

Read the entire column at NCPA's Health Policy Blog.

Corporate Digital Health Deals Are Exploding

A recent blog entry discussed a spate of reports, which demonstrated that investors are flooding into digital health, and less interested in traditional medical devices and pharmaceuticals.

A new report from CB Insights focuses on corporate investments in digital health, noting that “corporate investors from Google to Merck to BlueCross BlueShield are actively getting into the fray.”

This blog has started to discuss the emerging evidence base supporting digital health technologies, including telehealth. Despite Obamacare, many of these investments are likely to result in products and services that bend the curve of health spending.

Read the entire column at NCPA's Health Policy Blog.

Friday, November 7, 2014

Third Parties Control 83 Percent of Prescription Drug Spending, Up From 52 Percent in 1993

Adam J. Fein of Drug Channels has written a short article describing the evolution of payment for prescription drugs. In just twenty years, patients’ share of payments dropped from almost half of the spending to just 17 percent. Even worse, Fein forecasts, the share will drop to 12 percent by 2023.

Red the entire column at NCPA's Health Policy Blog.

83 Percent of Physician Practices Say Medicare's Quality Reporting Does Not Improve Quality

The Medical Group Management Association (MGMA) has produced another painful report about the experience of being a physician or physician executive:
More than 83% of physician practices stated they did not believe current Medicare physician quality reporting programs enhanced their physicians’ ability to provide high-quality patient care. In addition to the lack of effectiveness, physician practices reported significant challenges in complying with Medicare quality reporting requirements. More than 70% rated Medicare’s quality reporting requirements as “very” or “extremely” complex. In addition, a significant majority of respondents indicated these programs negatively affected practice efficiency, support staff time, and clinician morale.
Read the entire column at NCPA's Health Policy Blog.

Wednesday, November 5, 2014

Obamacare's Twilight: Health Reform In The Next Congress

Republican candidates won a decisive victory at the voting booth on Tuesday, in all races: House, Senate, governorships, and state legislatures. The future of Obamacare has never looked more bleak.

The next battle is more daunting: the Republican Party needs to avoid shooting itself in the foot, govern in a way that achieves results rather than perpetuates partisan bickering, and continue to develop patient-centered health reform for the post-Obamacare future. Although Obamacare itself will not be repealed until January 2017, Republican success yesterday gives depth, resilience, and energy to the post-Obamacare health reform movement.

Read the entire column at Forbes.

One Percent of Patients Account for 23 Percent of Health Spending

The Agency for Healthcare Research and Quality (AHRQ) has updated its estimate of the concentration of medical expenditures, previously reported as of 1996. In 2012:

  • Total medical spending was $1.35 trillion;
  • One percent of people accounted for 22.7 percent of total health expenditures, with an annual mean expenditure of $97,956;
  • Five percent of people accounted for 50.0 percent of the total, with an annual mean expenditure of $43,058; Ten percent of people accounted for 66.0 of the total, with a mean annual expenditure of $28,468;
  • Fifty percent of people accounted for 97.7 percent of the total; and Fifty percent of the people accounted for only 2.3 percent of the total.
Read the entire article at NCPA's Health Policy Blog.

Number of FDA's Regulatory Requirements Increased 15 Percent, 2000-2012

The Regulatory Affairs Professionals Society (RAPS), using data from our friends at the Mercatus Center, have concluded that the Food and Drug Administration’s regulatory requirements have increased 15 percent in just over a decade:
While regulatory professionals working with FDA needed to know just 16,329 requirements in 2000, they needed to know 18,777 in 2012, according to the data.
The analysis uses two measurements of regulatory burden: “Requirements”, defined as any instance in the U.S. Code of Federal Regulations containing the words “shall”, “must”, “may not”, “prohibited” or “required”; and the number of words in the regulations. Both grew at about the same rate.

Read the entire column at NCPA's Health Policy Blog.

Tuesday, November 4, 2014

John R. Graham: Shouldn't Healthcare Be Fair?




A new video from the Independent Institute.

Administration Continues to Stonewall on Obamacare Enrollment

Back in May, the U.S. Department of Health and Humans Services (HHS) suddenly stopped issuing monthly reports on enrollment in Obamacare’s exchanges. These reports had been used by the Administration to ramp up the cheer-leading to Obamacare’s “successful” recruiting of 8.1 million people by the end of the first open enrollment on March 31 (or, actually, sometime in mid-April due to omnipresent technical glitches).

On Halloween, HHS issued a report that looks exactly like the reports that it published through May 1. So, one might reasonably expect that if the Administration could produce a report on May 1 that announced enrollment as of March 31, the next report that it issued on October 31 could announce the numbers enrolled as of September 30.

No such luck.

Read the entire column at NCPA's Health Policy Blog.

Monday, November 3, 2014

Top Wall Street Analyst: Insurers' Bailout Assumptions "Make Us Nervous"

Citibank’s Carl McDonald, one of Wall Street’s top sell-side analysts covering health insurers, suspects that the firms which he covers are being too optimistic about the money they’ll receive from Obamacare’s risk corridors.

Read the entire column at NCPA's Health Policy Blog.

Why Can't Patients Get Paid for Saving the System Money?

Back in 2008, I met Michael Leavitt in his capacity as U.S. Secretary of Health and Human Services for President George W. Bush. Secretary Leavitt was trying to implement a new way for Medicare to buy some medical supplies, categorized as durable medical equipment (DME), through competitive bidding.

At the time, DME was bought using the same, Soviet-style fixed-fee schedules that Medicare uses for doctors and hospitals today. Competitive bidding for DME had actually been legislated in the Medicare Modernization Act of 2003. In 2014, we know that competitive bidding has saved hundreds of millions of dollars.

And yet, it took years for the Administration to overcome the suppliers’ lobby. Why? I suggest that it is because Medicare beneficiaries themselves did not share in the savings.

Read the entire column at NCPA's Health Policy Blog.

Saturday, November 1, 2014

Employer-Based Benefits: Spending Up 3.9 Percent

The Health Care Cost Institute, a collaboration of four major insurers, has published its 2013 Health Care Cost and Utilization Report and companion Out of Pocket Spending Trends 2013, which discusses cost trends for people with employer-sponsored insurance (ESI):
In 2013, health care spending for the national ESI population grew 3.9%. This growth rate was similar to the rates observed in 2011 (4.0%) and 2012 (3.7%). Spending growth for 2013 was driven mainly by rising prices rather than by utilization, as use of many services declined.
That is mixed news.

Read the entire column at NCPA's Health Policy Blog.

Medicare Part D Responsible for 60 Percent of Medicare Spending Slowdown

When Medicare added Part D, the prescription-drug benefit, via the Medicare Modernization Act (2003), its framers decided that every beneficiary would receive the benefit from a private plan, not from the government directly.

The benefits of this design continue to show themselves. In Health Affairs, Loren Adler and Alex Rosenberg conclude that the Part D benefit is responsible for 60 percent of the reduction in the rate of Medicare spending since 2011.

Read the entire column at NCPA's Health Policy Blog.

Government Buries Evidence of Poor Access to Care Under Obamacare

Thank providence for USA Today, which has given us yet another story describing how poor access to health care is under Obamacare.

People who fell for navigators’ sales pitches and signed up for Obamacare are discovering that it is junk insurance.

Read the entire column at NCPA's Health Policy Blog.

Obamacare Premiums Increased Dramatically For Every Age Group in 2014

HealthPocket, an online insurance broker, has measured the increase in premiums for every age group in Obamacare versus the pre-Obamacare individual market. Their conclusion: Premiums increased by double digits for every age group.

What I find really surprising is the increase in rates for 63-year olds: 37.5 percent for women and 22.7 percent for men. Recall that Obamacare forbids actuarially accurate underwriting by age.

Read the entire column at NCPA's Health Policy Blog.