Unbiased Analysis of Today's Healthcare Issues

Billionaires List

Written By: Jason Shafrin - Mar• 03•15

Forbes came out with its list of richest people in the world.  Bill Gates tops the list, but we don’t care about that here at the Healthcare Economist.  Which people in the healthcare industry are the richest?  The top 5 include:

  • 44. Dilip Shanghvi (India): $20 billion
  • 96. Patrick Soon-Shiong (US): $12.2 billion
  • 99. Stefano Pessina (Italy): $12.1 billion
  • 149. Ernesto Bertarelli (Switzerland): $8.8 billion
  • 174. Thomas Frist, Jr. (US): $7.6 billion

The full list is available here.

King v. Burwell

Written By: Jason Shafrin - Mar• 02•15

On Wednesday, the Supreme Court will begin hearing arguments in King v. Burwell.  The plaintiffs argue that the Affordable Care Act (i.e., Obamacare) does not permit subsidies to individuals if they receive health insurance from a federally-run health insurance exchange.

  • Why would they argue this?  Well, Section 1401(a)(2)of the law says that subsidies would go only to those who purchased coverage on “an exchange established by the state.” As Vox reports, there was no similar provision, or call out, for people who got their coverage on a marketplace that the federal government set up.
  • Will it affect a lot of people?  Yes.  Currently, there are only 14 state-run exchanges and 7 state partnership exchanges.  People living in the remaining 30 states with federally administered or federally supported exchanges  (including large states like Texas, Florida, Pennsylvania, Ohio, Georgia, North Carolina) would not be eligible for subsidies.
  • How much would premiums increase?  Overall, the affect on premiums is unclear.  However, the share of premiums for which consumers are responsible would rise “an average …of 255 percent…if the Court ultimately rules in favor of the plaintiffs in King v. Burwell.”
  • Did Congress really mean to may enrollees on federal exchanges ineligible for subsidies?  That is the crux of the issue that the supreme court will decide.
  • How did we get here? Vox has a nice overview of the history of King v. Burwell.  An excerpt is below.

“He had been talking about how states shouldn’t cooperate. And I responded to him with something like, ‘If they don’t create an exchange, they can’t get the tax credits,'” Adler recalls. “He said, ‘What?’ And I told him, ‘Read the statute.'”


Measles kills more kids that AIDS

Written By: Jason Shafrin - Mar• 01•15

Globally, measles is a significant killer of kids and the threat is growing in the US as vaccination rates decrease.  Citing a Global Burden of Disease study published in the Lancet, Wonk Blog reports that in 2013 measles killed over 82,000 children under age 5.  This puts measles as #7 on the list of the top causes of child death.




Friday Links

Written By: Jason Shafrin - Feb• 26•15

HWR is up

Written By: Jason Shafrin - Feb• 26•15

David Williams has posted Health Wonk Review: Happy 10th anniversary edition at Health Business Blog. It’s Health Business Blog’s 10 year anniversary so be sure to stop by to read David’s post and wish him well – 10 years Internet time is a veritable eon!


The end of wearables?

Written By: Jason Shafrin - Feb• 24•15

Wearable technology is all the rage.  There was even a recent paper in JAMA about wearable technology.  However, will wearables soon to be old news?  What is the future?  Joe Kvedar gives his thoughts on the topic:

Thus, we have plentiful pedometer apps…We’ve also solved how to run these apps in the background without disrupting the phone tasks or draining the battery. So, is it time to ask, “do we really need fitness wearables anymore?

I’d frame the question a different way. Is the future of patient-generated data migrating to the mobile phone (the proverbial digital Swiss Army Knife of life) or will it be migrating to the realm of micro-sized wearable seeds, ingestibles, injectables, bandaids and the like?  I was a fellow panelist with tech guru and futurist Nicholas Negroponte, and in an off-handed comment, he said that wearables are just a temporary fad and that the future is in ingestibles.

What is does an ingestible sensor look like? Take a look.

Narrow Networks

Written By: Jason Shafrin - Feb• 23•15

One of the ways health plans in the health insurance exchanges have been able to keep premiums down is through offering beneficiaries very narrow networks. By steering patients towards “efficient” doctors, premiums stay low. However, patients may worry that these “low cost” doctors are lower quality than those outside of the network. The tradeoff between cost and quality is one health policy wonks have wrestled with for many years.

In an attempt to ensure quality and access to care is adequate, CMS has instituted a number of checks on network adequacy. Tim Jost writes in the Health Affairs blog that qualified health plans (QHP) must:

…must meet network adequacy standards assessed, as in 2015, on a “reasonable access” standard. Insurers must submit detailed network provider data, including information on physicians, facilities, and pharmacies…A QHP insurer must publish a current, accurate, and complete provider directory including information regarding providers accepting new patients, the provider’s location, contact information, specialty, medical group, and any institutional affiliations.

In addition to ensuring that patients have up-to-date information on which providers are covered by their network, CMS is also mandating that QHPs cover some of the key providers in an area.

For 2016 as for 2015, QHP insurers must contract with at least 30 percent of available essential community providers (ECPs) in their service area, offer contracts in good faith to all available Indian health providers, and offer a contract in good faith to at least one ECP in each ECP category.

CMS will also monitor whether plans are attempting to restrict access to prescription drugs.

Drug formularies will also be monitored more closely for 2016. CMS will review formularies to identify outlier plans with unusually large numbers of drugs subject to prior authorization or step therapy. It will also review formularies to ensure access to clinically appropriate drugs for treatment of bipolar disorder, diabetes, rheumatoid arthritis, and schizophrenia. Other conditions, including HIV, may be considered for future reviews.

It is unclear whether the CMS initiatives will increase quality of care and access to care for patients; it is equally unclear whether these initiatives will drive up plan premiums. We’ll have to wait and see what happens.

Do Weight Loss Wellness Programs work?

Written By: Jason Shafrin - Feb• 22•15

In short, ‘no’.  At least that is the conclusion reached by a recent AJMC paper that looks at the evidence available for employer-sponsored wellness programs.  The authors write:

American corporations continue to expand wellness programs, which now reach an estimated 90% of workers in large organizations, yet no study has demonstrated that the main focus of these programs—weight control—has any positive effect. There is no published evidence that large-scale corporate attempts to control employee body weight through financial incentives and penalties have generated savings from long-term weight loss, or a reduction in inpatient admissions associated with obesity or even long-term weight loss itself. Other evidence contradicts the hypothesis that population obesity rates meaningfully retard economic growth or manufacturing productivity. Quite the contrary, overscreening and crash dieting can impact employee morale and even harm employee health. Therefore, the authors believe that corporations should disband or significantly reconfigure weight-oriented wellness programs, and that the Affordable Care Act should be amended to require such programs to conform to accepted guidelines for harm avoidance.

HT: Incidental Economist.

Friday Links

Written By: Jason Shafrin - Feb• 20•15

Coordinating Federal Efforts for Patients with Serious Mental Illness

Written By: Jason Shafrin - Feb• 18•15

Following up a December 2014 Government Accountability Office (GAO) report, testimony last week Linda T. Kohn, Director of Health Care at the GAO describes how fragmented the federal government provides very fragmented support services care for individuals with serious mental illness.  Coordinate across agencies is lacking and few agencies have conducted evaluations of their programs.

Agencies identified 112 federal programs that generally supported individuals with serious mental illness in fiscal year 2013. The majority of these programs addressed broad issues, such as individuals suffering from homelessness, which can include individuals with serious mental illness. The programs were spread across eight federal agencies: DOD, DOJ, DOL, Education, HHS, HUD, SSA, and VA….
Interagency coordination for programs supporting individuals with serious mental illness is lacking. HHS [the Department of Health and Human Services] is charged with leading the federal government’s public health efforts related to mental health, and SAMHSA [Substance Abuse and Mental Health Services Administration]  is required to promote coordination of programs relating to mental illness throughout the federal government…
Agencies completed few evaluations of the programs specifically targeting individuals with serious mental illness. As of September 2014, of the 30 programs specifically targeting individuals with serious mental illness, 9 programs had a completed program evaluation—7 by SAMHSA and 2 by DOD.

Ms. Kohn concludes with the following.

In conclusion, individuals with serious mental illness can face significant challenges getting the services they need. The public health, social, and economic impact of serious mental illness, coupled with the constrained fiscal environment of recent years, highlights the need to ensure that federal programs efficiently and effectively use their resources to support
the complex needs of individuals with serious mental illness

Below you can see a the types of SMI programs by agency.