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Care Delivery

 

Group market insurance plans had premiums increase by an average of 3 percent this year, the sixth consecutive year of a single-digit hike and well below the 20 percent jump in non-group market premiums, while employers continue to search for ways to cut costs through different sites of care and wellness programs.

Just a month earlier, Anthem had announced it wouldn’t offer ACA exchange coverage in the state, blaming “continued uncertainty” surrounding the law.

Sixty-three cities and counties and more than 70,000 enrollees in Virginia are now at risk of having no insurer participating in their Affordable Care Act (ACA) exchange for 2018, a problem which had appeared to be solved in other parts of the country just two weeks prior.

Ground has been broken on a $270 million medical campus in Frisco, Texas, that will be jointly operated by Texas Health Resources and the University of Texas Southwestern Medical Center.

In the first three months of this year, 8.8 percent of the U.S. population lacked health insurance, a slight decrease from the final 2016 numbers as the big gains in coverage from the Affordable Care Act appear to have ended.

 

Recent Headlines

Telehealth increases utilization instead of replacing office visits

Using direct-to-consumer telehealth, where a patient was direct access to a physician on the phone or through videoconferencing, may be a tool to increase access to care. According to a study published in the March 2017 issue of Health Affairs, it also increases utilization and spending. 

Need for real-world evidence in value-based care could be advantage for pharma

With more physicians employed in larger organizations than private practices, and those larger groups being more likely to be reimbursed through models which involve financial risk, more physicians are looking to real-world evidence to inform their clinical decisions—a shift which could be beneficial for pharmaceutical companies.

New Jersey law limits initial opioid prescriptions to five days

New Jersey has enacted what its governor calls the strictest anti-opioid law in the country, affecting how long the length of initial prescriptions and waiving prior authorization requirements for those seeking treatment for addiction.

Uninsured rate at 8.8 percent; high-deductible plans on the rise

The latest National Health Interview Survey figures on health coverage show the number of people without health insurance fell to a new low through the first nine months of 2016.

California insurers reported inaccurate provider info to regulators

According to a review released by the California Department of Managed Health Care (DMHC), 90 percent of California insurer reports on which providers were in their network contained inaccurate information.

Lower wages change utilization, even in employer-sponsored insurance plans

Workers who make $24,000 or less annually, but still have employer-sponsored health insurance, have higher hospital and emergency department admissions rates and lower utilization of preventive care compared to higher-paid coworkers.

Physicians warn Trump immigration order will worsen doctor shortage, affect care

Two University of Pennsylvania Medical Center physicians said suspending immigration from seven Muslim-majority countries will have a negative impact on graduate medical education (GME) and the U.S. healthcare system as a whole.

Major organizations aim to change prior authorization requirements

A coalition of medical organizations led by the American Medical Association has released a 21-point plan to change when health insurers require pre-approval before patients can receive certain treatments, drugs or devices.

Illinois governor proposing new pharmacy rules after risky drug combinations go unnoticed

In response to a Chicago Tribune investigation, Illinois Gov. Bruce Rauner is a backing of series of changes to the state’s oversight of pharmacies, including sending “mystery shoppers” to make sure pharmacists are warning customers when their prescriptions may have adverse effects when taken together. 

Anthem ending opioid treatment preauthorization nationwide

Anthem has reached a settlement with New York Attorney General Eric Schneiderman to end its policy requiring prior authorization for medication-assisted treatment (MAT) for opioid addiction.

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