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A Weekly Health Policy Round Up From Health Affairs            

**July 26, 2020**

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FAST TRACK AHEAD OF PRINT

COVID-19

Designing Pull Funding For A COVID-19 Vaccine

By Christopher M. Snyder, Kendall Hoyt, Dimitrios Gouglas, Thomas
Johnston,
and James Robinson

Christopher Snyder and coauthors propose a "pull" program that
incentivizes late-stage development for COVID-19 vaccines by awarding
advance purchase commitments to bidding firms. According to the
authors' model, the optimal pull program should spend more than $100
billion to induce virtually all serious vaccine candidates to
participate, scaling up capacity at risk to provide an average of 2.2
billion doses in 2021 across simulations, generating net social benefits
of $2.8 trillion. Read More >>

EYE ON HEALTH REFORM

Contraceptive Mandate, ACA Final Rules, And COVID-19

By Katie Keith

Katie Keith reviews several key Supreme Court decisions pertaining to
the Affordable Care Act (ACA). These include the court's 7-2
decision in Little Sisters of the Poor Saints Peter and Paul Home v.
Pennsylvania, upholding two Trump-era rules that broadly exempt
employers from complying with the contraceptive mandate of the ACA when
they object for religious or moral reasons. In addition, Keith notes new
federal guidance on the ACA, identifying ACA requirements that are now
being delayed as a result of COVID-19.
Read More >>

IN THE JOURNAL

CONSIDERING HEALTH SPENDING
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Lessons From The Impact Of Price Regulation On The Pricing Of Anticancer
Drugs In Germany

By Victoria D. Lauenroth, Aaron S. Kesselheim, Ameet Sarpatwari, and
Ariel D. Stern

Under the 2011 German Pharmaceutical Market Restructuring Act,
manufacturers set the prices of newly authorized drugs during their
first year on the market. Benefit assessments are carried out during
this year and then used in price negotiations between manufacturers and
representatives of the country's statutory health insurers. Using data
on fifty-seven anticancer drugs launched in Germany from 2002 to 2017,
Victoria Lauenroth and coauthors found that implementation of the act
was associated with drug prices being more closely aligned with clinical
benefit. Read More >>

See our Considering Health Spendin
g page for more on this
series topic.

DISPARITIES

EMS Access Constraints And Response Time Delays For Deprived Critically
Ill Patients Near Paris, France

By Matthieu Heidet, Thierry Da Cunha, Elise Brami, Eric Mermet, Michel
Dru, Béatrice Simonnard, Eric Lecarpentier, Charlotte Chollet-Xémard,
Corinne Bergeron, Mohamed Khalid, Brian Grunau, Jean Marty, and Etienne
Audureau

Increased emergency medical services (EMS) response times and areas of
low socioeconomic status are both associated with poorer outcomes for
several time-sensitive medical conditions attended to by medical
personnel before a patient is hospitalized. We evaluated the association
between EMS response times, area deprivation level, and on-scene access
constraints encountered by EMS in a large urban area in France.
Read More >>

MEDICAID

A Medicaid Alternative Payment Model Program In Oregon Led To Reduced
Volume Of Imaging Services

By Stephan Lindner, Menolly R. Kaufman, Miguel Marino, Jean O'Malley,
Heather Angier, Erika K. Cottrell, K. John McConnell, Jennifer E. DeVoe,
and John R. Heintzman

In 2013 Oregon's Medicaid program changed its reimbursement of
traditional primary care services for selected community health centers
(CHCs) from a per visit to a per patient rate. Using Oregon claims data,
Stephan Lindner and coauthors analyzed the price-weighted volume of care
for five service areas: traditional primary care services, including
imaging, tests, and procedures; other services provided by CHCs that
were carved out from the payment reform; emergency department visits;
inpatient services; and other services of non-CHC providers. Read More
>>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Abandoning List Prices In Medicaid Drug Reimbursement Did Not Affect
Spending

By Benedic Ippolito, Joseph F. Levy, and Gerard F. Anderson

State fee-for-service Medicaid programs have traditionally based
payments to pharmacies for drugs on a percentage of the drugs' list
price. Because list prices have increased more quickly than the prices
actually paid by pharmacies, estimating appropriate reimbursements has
become challenging. In recent years most states have switched to models
where payments were based instead on results from a survey of pharmacy
invoices. Benedic Ippolito and coauthors examined how this changed
fee-for-service Medicaid drug spending. Read More >>

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****

In 1999, at the urging of President Clinton's Advisory Commission on
Consumer Protection and Quality in the Healthcare Industry, the National
Quality Forum was formed to promote health care quality through
measurement and public reporting.

Twenty years later, with America in the grips of COVID 19, the work of
NQF continues and is more important than ever. A new report from the
National Quality Task Force, entitled, "The Care We Need: Driving Better
Health Outcomes for People and Communities" provides a roadmap to
consistent and predictable high quality care for every person by 2030.
The Task Force consists of nearly 100 leaders and diverse stakeholders
from across the health care system.

At an online forum on July 30, Health Affairs Editor-in-Chief Alan Weil
(who was a member of the Advisory Commission) will host leaders of the
quality movement for a discussion of the report and its recommendations
for improving the health and safety of all Americans.

Date: Thursday, July 30, 2020
Time: 2:00 p.m. - 3:15 p.m. (Eastern)
Place: Online details to come after you've registered

Speakers to include:

* Shantanu Agrawal, President and CEO, National Quality Forum

* Carolyn Clancy, Deputy Under Secretary for Discovery, Education and
Affiliate Networks, Veterans Health Administration, US Department of
Veteran's Affairs; Former Director, Agency for Healthcare Research and
Quality

* Kenneth W. Kizer, Chief Healthcare Transformation Officer and Senior
Executive Vice President, Atlas Research; Founding President and CEO,
National Quality Forum

* Mary Wakefield, Visiting Distinguished Professor, Practice of Health
Care, Georgetown University; Member, President Clinton's Advisory
Commission on Consumer Protection and Quality in the Health Care
Industry

* Alan Weil, Editor in Chief, Health Affairs

RSVP TO ATTEND

THIS WEEK ON THE BLOG

COVID-19
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The Day After Tomorrow Must Include Independent Primary Care

By Azalea Kim, Scott Heiser, Leslie McKinney, Robert Overman, and Rahul
Rajkumar (7/23/20)

We now have a unique opportunity to revisit how we value and pay for
health care. The choices we make today in responding to the crisis faced
by independent primary care providers during the pandemic will shape the
delivery system we have the day after tomorrow, when COVID-19 is behind
us. Read More >>

The Pharmacist's Role In COVID-19 Response Efforts

By Richard Hughes IV, Daniel Nam, Nick Diamond, Colleen Hopkins, Neil
Rosacker, and Manuel Aviña (7/23/20)

Direct patient care by pharmacists has been shown to potentially improve
various patient outcomes during a public health emergency. As
pharmacists play a larger role in COVID-19 response efforts, the
question remains whether states and the federal government will expand
legal scope of practice and reimbursement beyond this public health
emergency. Read More >>

Ten Actions For Better Post-Pandemic Health Care In The United States

By David Beier, Robert Kocher, and Avik Roy (7/23/20)

The 1918 influenza pandemic-the worst viral pandemic of the twentieth
century-led to few meaningful health care reforms. Let's not make
the same mistake again. Here are ten actions that will lead to better
health care after the current pandemic. Read More >>

Paying Their Fair Share: States Should Require Increased Medicaid Health
Plan Payments To Support Safety-Net Providers In The Age Of COVID-19

By Jacob Wallace, Julia E. Smith, and Timothy J. Layton (7/22/20)

States must act quickly and leverage the options available to prevent
catastrophic losses for safety-net providers while ensuring that
Medicaid managed care plans pay their fair share.
Read More >>

A Regionalized Public Health Model To Combat COVID-19: Lessons From
Japan

By Ryoko Hamaguchi, Kay Negishi, Masaya Higuchi, Masafumi Funato,
June-Ho Kim, and Asaf Bitton (7/22/20)

With public health centers as its crux, Japan's unique regionalized
public health model appears to have been one of the drivers of Japan's
success in weathering the COVID-19 crisis. Japan provides an example for
countries looking to employ locally responsive public health centers to
lead regional coordination, surveillance, and triage during a pandemic.
Read More >>

Caring For Kids In The COVID-19 Era: Addressing Social Drivers And
Paying For Health

By R. Lawrence Moss, Charlene A. Wong, Daniella Gratale, and Mark B.
McClellan (7/21/20)

The road to recovery from COVID-19 is through transforming our health
care and social service systems to address underlying social factors
impacting the health of children and families, with a goal of promoting
health equity. Read More >>

Addressing Racial Health Disparities In The COVID-19 Pandemic: Immediate
And Long-Term Policy Solutions

By Leana S. Wen and Nakisa B. Sadeghi (7/20/20)

As states begin to reopen, and we look ahead to the next stage of the
COVID-19 pandemic, policy makers, health systems, and public health
authorities should turn attention to concrete steps that can be taken to
ensure that recurring patterns of health disparities do not repeat
themselves. It is not sufficient to advance policy or strategy without
an explicit focus on equity. Read More >>

FOLLOWING THE ACA

ACA Litigation Round-Up: Part I

By Katie Keith (7/20/20)

This post summarizes the recent Affordable Care Act (ACA)-related
Supreme Court decisions and the latest in California v. Texas. A second
post will discuss the status of long-standing ACA-related lawsuits and
highlight newer lawsuits over ACA implementation. A third post will
focus on the resolution of lawsuits over unpaid risk corridors payments.

Read More >>

ACA Litigation Round-Up: Part II

By Katie Keith (7/21/20)

This post discusses the status of long-standing ACA-related lawsuits and
highlights newer lawsuits over ACA implementation. A prior post
summarized the implications of recent Supreme Court decisions and
California v. Texas. A third post will focus on the resolution of
lawsuits over the risk corridors program. Read More >>

ACA Litigation Round-Up: Part III

By Katie Keith (7/22/20)

In April 2020, the Supreme Court ruled that insurers were entitled to
more than $12.2 billion in unpaid risk corridors payments. This post
summarizes the latest on risk corridors litigation in the wake of that
ruling. Two prior posts focused on other recent ACA-related Supreme
Court decisions and ACA lawsuits in the lower courts. Read More >>

PHARMACEUTICALS & MEDICAL TECHNOLOGY

Who Is Sowing Seeds Of Confusion About The QALY?

By Jennifer C. Chen and Anna Kaltenboeck (7/24/20)

Industry-sponsored patient advocacy groups say that they find fault in
the quality-adjusted life year (QALY) for technical reasons. But their
stance also benefits pharmaceutical manufacturers that fund them and
have an interest in disrupting efforts at value assessment. Read More >>

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About Health Affairs

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at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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