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A Weekly Health Policy Round Up From Health Affairs            

**July 21, 2019**

HEALTH AFFAIRS EVENTS

HEALTH SPENDING:  MOVING FROM THEORY TO ACTION

Wednesday, September 11, 2019
9:00 am - 3:00 pm Eastern
National Press Club - Washington, DC
REGISTRATION NOW OPEN

Eighteen months ago, Health Affairs teamed with the National
Pharmaceutical Council and Anthem, Inc. to launch a multi-year project
to promote an evidence-based conversation about health spending. To
continue the discussion, Health Affairs and the National Pharmaceutical
Council are hosting a forum that will address:

* The pressures presented by soaring health costs on individuals,
employers, and government

* Strategies among payers and others to promote cost effective care

* Efforts currently underway to bring costs under control

Speakers include:

* Mandy Cohen, Secretary, North Carolina Department of Health and Human
Services

* Patrick Conway, President and CEO, Blue Cross and Blue Shield of North
Carolina

* Robert W. Dubois, Executive Vice President and Chief Science Officer,
National Pharmaceutical Council

* Christopher F. Koller, President, Milbank Memorial Fund

* Reed Tuckson, Managing Director, Tuckson Health Connections, LLC

* Alan Weil, Editor-in-Chief, Health Affairs

Be part of the conversation on September 11.
                                    
Getevent-specific emails
delivered directly to your inbox.

THIS WEEK ON THE BLOG

FOLLOWING THE ACA

New 1332 Resources; Rhode Island 1332 Waiver Deemed Complete

By Katie Keith (7/18/19)

On July 15, 2019, CMS released new resources to support states in
pursuing waivers under Section 1332 of the ACA. In addition, CMS
informed Rhode Island that its application to develop a state-based
reinsurance program under Section 1332 was complete.
Read More >>

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Third Circuit Blocks Trump Contraceptive Rules

By Katie Keith (7/16/19)

As a result of this ruling, a nationwide injunction remains in effect.
With those rules enjoined, the Obama-era accommodations process had
remained in place. Read More >>

MEDICARE

More ACOs Taking Accountability Under MSSP Through 'Pathways To
Success'

By Seema Verma (7/17/19)

The Trump Administration is finding new ways to lower costs, improve
efficiency and quality, and protect the Medicare program for future
generations. We appreciate health care providers joining us in this
effort and embarking on a new model of care delivery. Together we can
move towards a health care system that rewards high quality at a low
cost, to generate more value for patients and improve health outcomes.
Read More >>

BEHAVIORAL HEALTH CARE

After School Shootings, Children And Communities Struggle To Heal

By Ariella Iancu, Lisa Jaycox, Joie D. Acosta, Frank G. Straub, Samantha
Iovan, Christopher Nelson, and Mahshid Abir (7/19/19)

Building community resilience, implementing evidence-based mental health
support early, and providing access for survivors and the community
immediately post-incident and in the long term could help promote
healing and prevent more tragedy. Read More >>

PHARMACEUTICALS AND MEDICAL TECHNOLOGY

Biosimilar Approvals And The BPCIA: Too Soon To Give Up

By Jonathan J. Darrow (7/19/19)

If biosimilars prove to be reasonable substitutes for their reference
products, skepticism of prescribers and patients will wane just as it
has with respect to small-molecule drugs over the past several decades.
Although it is unclear to what extent the BPCIA will ultimately prove a
success, its abandonment would be premature. Read More >>

PAYMENT

Rep. Ruiz's Arbitration Proposal For Surprise Billing (H.R. 3502)
Would Lead To Much Higher Costs And Deficits

By Loren Adler, Erin Duffy, Paul B. Ginsburg, Mark Hall, Erin Trish, and
Christen Linke Young (7/16/19)

The new legislation introduced by Rep. Ruiz would, like other proposals,
prohibit balance billing for surprise out-of-network services and limit
patient cost-sharing to standard in-network amounts. Read More >>

Successfully Splitting The Baby: Design Considerations For Federal
Balance Billing Legislation

By Sabrina Corlette, Jack Hoadley, and Kevin Lucia (7/15/19)

As congressional leaders craft balance billing protections that can gain
support-or at least the absence of opposition-from health industry
stakeholders, some state legislatures have charted potential paths
forward. Read More >>

V-BID X: Creating A Value-Based Insurance Design Plan For The Exchange
Market

By Haley Richardson, Michael Budros, MPP Michael Chernew, and A. Mark
Fendrick (7/15/19)

Value-Based Insurance Design (V-BID), which aligns patients'
out-of-pocket costs with the value of services, offers a route to
mitigating the negative impacts of increased cost sharing, namely the
underutilization of evidence-based, high-value care. Read More >>

WORKFORCE IN THE COMMUNITY

A Backstory To Michael Ogg's Narrative Matters Essay: Why He Needed To
Leave PACE

By Lisa I. Iezzoni (7/18/19)

This blog post joins an emotionally laden niche genre written by people
with long experience as clinicians, health policy researchers, or
putative health care experts who describe feeling frustrated, baffled,
buffeted, and sometimes ultimately helpless to rescue a loved one or
friend from a dysfunctional and even dangerous health care system. Read
More >>

MATERNAL AND CHILD HEALTH

To Help Fix The Maternal Health Crisis, Look To Value-Based Payment

By Clare Pierce-Wrobel and Katie Green (7/16/19)

The health care system can and should be held accountable for reducing
disparities in outcomes as a part of an outcomes-driven maternity
payment model. Read More >>

ACCESS TO CARE

Autistic Perspectives Needed: Community Participation Services And
Research Are At A Critical Juncture

By Lindsay Shea, Whitney Schott, Julia Bascom, and Amy R. Pettit
(7/17/19)

Autistic voices and perspectives will be critical to shape a service
system that can effectively meet their needs, but it remains unclear
whether states' public comment periods and feedback processes have
included effective mechanisms for this group to be heard.
Read More >>

IN THE JOURNAL

DISPARITIES

The Role Of Social Risk Factors In Dialysis Facility Ratings And
Penalties Under A Medicare Quality Incentive Program

By Andrew C. Qi, Anne M. Butler, and Karen E. Joynt Maddox

Andrew Qi and coauthors find that dialysis facilities in low-income
areas and with high proportions of patients who are black or dually
eligible for Medicaid performed worse and were penalized more under the
End Stage Renal Disease Quality Incentive Program.
Read More >>

Racial And Ethnic Disparities In Care Following The New York State
Sepsis Initiative

By Keith Corl, Mitchell Levy, Gary Phillips, Kathleen Terry, Marcus
Friedrich, and Amal N. Trivedi

In 2013 New York State undertook a major initiative that required
hospitals to adopt an evidence-based protocol for sepsis care. Keith
Corl and coauthors find overall improvements in care and no evidence of
racial disparities in treatment within hospitals. However, because
hospitals primarily serving black patients had smaller improvements, the
initiative widened the sepsis care quality gap between blacks and
whites. Read More >>

THE PRACTICE OF MEDICINE

Accuracy Of The Relative Value Scale Update Committee's Time Estimates
And Physician Fee Schedule For Joint Replacement

By John W. Urwin, Emily Gudbranson, Danielle Graham, Dawei Xie, Eric
Hume, and Ezekiel J. Emanuel

John Urwin and coauthors use EHR time-stamp data from the University of
Pennsylvania Health System to examine physicians' time spent
conducting knee and hip replacements. They find that the time estimates
used by Medicare to set the physician relative value fee schedule, based
on physician surveys, are greatly overstated, including by 50 percent or
more for revision procedures. Read More >>

This article appears in Health Affairs' series on The Practice of
Medicine
.

AGING & HEALTH

A National Examination Of Long-Term Care Setting, Outcomes, And
Disparities Among Elderly Dual Eligibles

By Rebecca J. Gorges, Prachi Sanghavi, and R. Tamara Konetzka

Rebecca Gorges and coauthors find that, on average, home and community
spending is higher for non-Hispanic whites than for blacks or Hispanics
of any race and that blacks have the highest rates of hospitalization,
including those that are potentially avoidable.
Read More >>

This article appears in Health Affairs' series on Aging & Health
.

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MEDICAID

Growth Of Public Coverage Among Working Families In The Private Sector

By Douglas Strane, Genevieve P. Kanter, Meredith Matone, Ahaviah Glaser,
and David M. Rubin

Douglas Strane and coauthors examine enrollment of children in working
families in Medicaid or CHIP in the period 2008-16. They find that
among low-income families, children's public health insurance coverage
was highest for those with parents employed at small private firms. Read
More >>

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NARRATIVE MATTERS

Dying To Access Methadone

By Jessica L. Gregg

A cancer patient who uses heroin can't gain reasonable access to
methadone to treat his disorder until he qualifies for hospice.
Read More >>

Listen to the podcast here
.

Call For Submissions: Narrative Matters Poetry Contest 2019

The Narrative Matters section of Health Affairs is seeking poetry
submissions for an upcoming issue of the journal.

We are holding a poetry contest, from July 1 to August 31, looking for
well-crafted poems that touch on topics related to health and health
policy. Three winning poems will be announced in September. Winning
poets will receive a monetary prize-$500 for first place, $300 for
second, and $100 for third-as well as publication in Health Affairs,
and two copies of the issue containing the winning poem.

All entries will be read and judged by Health Affairs staff.

* Limit 3 poems submitted per person. Each poem-in pdf or word doc
format-should be submitted as a separate entry through our submission
portal here .

* Poems must be no longer than a single-spaced page, with double spaces
between stanzas

* Font size no smaller than 11 point.

* Poems must be written in English.

* Poems must be previously unpublished.

* Poems themselves should contain no personal identifiers.

You can read some earlier poems published by

**Health Affairs**, including the winners of the 2015 Narrative Matters
poetry contest
,
poems by patients and consumers
,
poems on vulnerable populations
,
and poems on the cancer experience
.

We look forward to reading your submissions!

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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
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
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Today , and Health Affairs
Sunday Update .  

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

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814, United States

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