Scan this code to subscribe!

12/01/2016

Upcoming Podcast: Former President Obama and Clinton Health Policy Adviser Chris Jennings Discusses What Now? (December 5th)

Chris Jennings, Founder and President of Jennings Policy Strategies, will discuss what strategies Congressional Democrats will adopt to defend and/or reform the Affordable Care Act.      

The Pros and Cons (or Imperfections) in Rating Hospital Care Quality: A Conversation with Consumer Reports' Doris Peter (November 30th)

Listen Now

Though comparatively late to adopt quality ratings, many health care products and services are today quality rated.  For example, CMS rates hospital, nursing home and home health care care quality along with Medicare Advantage insurance and prescription drug, or Part D plans.  Quality performance is a factor in calculating rewards and penalties in Medicare pay for performance agreements, for example, in scoring earned shared savings for Accountable Care Organizations.   Though today common, rating care quality is not without criticism.  For example, researchers question the validity of how component or domain scores are weighted or clustered, the absence or inadequacy of risk adjustment, meaningfulness to patients, patient literacy/numeracy limitations and unintended negative consequences.     

During this 21 minute conversation, Dr. Peter discusses why Consumer Reports rates hospital care quality, the methodology used in scoring hospital care quality, specifically types of care quality, for example prevalence of hospital-acquired infections, the response to ratings by hospitals, use by patients or consumers, the imperfections or limitations in rating hospital care quality, unintended negative consequences and how Consumer Reports intends to improve upon its work in the near term.

Dr. Doris Peter is the Director of Consumer Reports Health Ratings Center, a part of the nonprofit organization, Consumer Doris Peter Reports.   Beyond hospitals her team rates other health care services including physicians and insurance plans and as well health care products, e.g., drugs.  Dr. Peter is also the Principal Investigator of a grant from the Consumer and Prescriber Education Grant Project that helps consumers understand safety, effectiveness and the cost of prescription and over-the-counter medications.  Prior to joining Consumer Reports Dr. Peter was an editor and then publisher of the nonprofit organization, The Medical Letter, and then North American editor for an international evidence-based medicine journal.  Dr Peter is a neurobiologist by training, earning her Ph.D. at UCLA.  She completed a postdoctoral fellowship in cellular biophysics at Rockefeller University.

For more on Consumer Reports hospital quality ratings efforts go to: http://www.consumerreports.org/cro/health/doctors-and-hospitals/index.htm

 

11/17/2016

What Explains the Opioid Epidemic? Dr. Anna Lembke Discusses Her Recent Work, "Drug Dealer, MD" (November 16th)

Listen Now

As has been widely reported the US has faced an opioid addiction epidemic over the past decade.  Opioid-related overdose deaths have quadrupled in recent years.  (Drug overdose deaths, in sum, now equal or exceed auto accident fatalities.)   What explains the dramatic increase use and addiction to these medicines?  In Drug Dealer, MD, recently published by Johns Hopkins University Press, Dr. Anna Lembke presents a nuanced explanation of what is a highly complex problem. 

The 30 minute conversation begins with Dr. Lembke briefly explaining work's title, Drug Dealer, MD: How Doctors Were Duped, Patients Got Hooked and Why It's So Hard to Stop.  Moreover, Dr. Lembke discusses several of the numerous reasons that explain the opioid addiction epidemic, i.e., patient and prescribing physician behavior, organized medicine's contribution, pharmaceutical industry marketing strategies and market forces that all contribute to fostering the epidemic.

Dr. Anna Lembke is an Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University.  She is also a faculty Lembkemember at the Stanford University School of Medicine, Program Director for the Sanford University Addiction Medicine Fellowship and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic.  She is also a Diplomate of the American Board of Psychiatry and Neurology and a Diplomate of the American Board of Addiction Medicine.  Dr. Lembke has published over 50 peer-reviewed articles, chapters and commentaries in numerous journals including the New England Journal of Medicine and the Journal of the American Medical Association and the Journal of General Internal Medicine and Addiction. Dr. Lembke recieved her undergraduate degree in Humanities from Yale University and her medical degree from Stanford. 

For more information on Dr. Lembke's work go to: https://jhupbooks.press.jhu.edu/content/drug-dealer-md

 

11/01/2016

Review of Hatcher's "The Poverty Industry," (November 1st)

If you've not had a chance to listen to my September 22nd interview with Daniel Hatcher regarding is recent work, "The Poverty Industry, The Exploitation of America's Most Vulnerable Citizens," here is a review I wrote in preparation for my discussion with Professor Hatcher.

http://thehealthcareblog.com/blog/2016/10/31/the-perversion-of-fiscal-federalism-daniel-l-hatchers-the-poverty-industry-the-exploitation-of-americas-most-vulnerable-citizens/

 

10/24/2016

The ACA's Little Discussed But Very Intriguing State Innovation Waiver Provision: A Conversation with Stuart Butler (October 24th)

Listen Now

Section 1332 of the Affordable Car Act allows states to propose Affordable Care Act-comparable state insurance programs.   Programs would need to meet certain criteria in order to win federal waiver authority.   One state currently considering a wavier is Colorado, i.e., Colorado voters will be asked to approve a state constitutional amendment that would create in part, a financing plan that would provide universal health care to all eligible Colorado residents.       

During this 20 minute conversation Dr. Butler discusses the genesis of Section 1332, why states (blue and red) would be motivated to submit a waiver, the benefits of such waivers, how the next administration might revise current 1332 regulations and state efforts to date, for example, Colorado under its ColoradoCare initiative. 

Dr. Stuart Butler is a Senior Fellow in economic studies at the Brookings Institution.   He is also currently an Adjunct
Professor at Georgetown, a Visiting Fellow at the Convergence Center for Policy Resolution, a member of the editorial board Butler headshot jpegof Health Affairs, a member of the Board on Health Care Services of the Institute of Medicine and of the Advisory Group for the Academy of Medicine's Culture of Health program.   Prior to Dr. Butler spent 35 years at the Heritage Foundation.   Among other previous positions he was an Institute of Politics Fellow at Harvard and a member of Housing Secretary Jack Kemp's Advisory Commission on Regulatory Barriers to Affordable Housing.  Dr. Butler was educated at St. Andrews University in Scotland where he received his undergraduate degree in physics and mathematics, his Masters of Arts in economics and history and his Ph.D. in American economic history.  

Dr. Butler's JAMA Forum essay, noted during this conversation, is at: https://newsatjama.jama.com/2016/09/14/jama-forum-action-on-the-aca-next-year-maybe/

See also Dr. Butler's most recent November 30th JAMA Forum essay titled, "Repeal and Replace Obamacare: What Could it Mean?"  At: https://newsatjama.jama.com/2016/11/30/jama-forum-repeal-and-replace-obamacare-what-could-it-mean/.

 

10/15/2016

Methods to Stabilize the State Health Insurance Marketplaces: A Conversation with Jack Hoadley (October 13th)

Listen Now

UnitedHealth Group and other major health care insurers' participation in state health insurance marketplaces has caused increasing concern Affordable Care Act-created state marketplaces are becoming unstable.  Moreover, this means health care insurance consumers will have little or possibly no choice in selecting an insurance provider.  For example, in 2016 30 percent of counties throughout the US had only two insurers participating in state marketplaces (10 percent of counties had one). Beyond consumer choice, the absence of marketplace competitors threatens premium affordability.   Creating new and stable insurance marketplaces, that is by definition challenging to accomplish, has been made additionally difficult by Congressional Republican opposition to the ACA's risk corridor program, that along with risk adjustment and reinsurance, is designed to mitigate unavoidable plan financial losses in trying to appropriately price premiums for a population with an unknown health history.             

During this 25 minute conversation Professor Hoadley discusses contributing factors to state marketplace instability and
moreover four methods by which the insurance marketplaces can be stabilized: a "fall back plan;" state participation requirements; extending risk corridors and reinsurance; and, methods to improve marketplace enrollment. 

Dr. Jack Hoadley is a Research Professor at Georgetown University's Health Policy Institute where he studies health financing Hoadley portrait 1 topics including drug pricing, out-of-pocket costs and the dynamics of insurance making decisions.   In 2015 Professor Hoadley was reappointed to a second, three-year term as a Medicare Payment Advisory Commissioner (MedPAC) member.  Prior to his work at Georgetown, Dr. Hoadley held staff positions at DHHS, i.e., within the Assistant Secretary for Planning and Evaluation (ASPE) office, at MedPAC, the Physician Payment Review Commission and at the National Health Policy Forum.   Professor Hoadley has published widely on health care financing and pharmaco-economics topics and has provided testimony to numerous federal Congressional and other government panels.  He earned his Ph.D. in political science. 

Jack Hoadley and Sabrina Corlette's August 2016 paper, "Strategies to Stabalize the Affordable Care Act Marketplaces: Lessons from Medicare," is at: http://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html.

10/02/2016

"ACO Performance Year Three: What Happened And What Does It Mean?" (October 1st)

Listeners may recall last October 26th I posted a summary of Accountable Care Organization (ACO) performance year two (PY2) results that was published by Health Affairs on their blog.  This essay, that appears on "The Health Care Blog," summarizes ACO performance year three (PY3) results.  PY3 results were not much different than PY2, e.g., 29% of ACOs in 2015 (v. 26% in 2014) earned shared savings, success was again largely due to comparatively higher financial benchmarks and there was again no correlation between quality performance and financial success.  

The essay is at: http://thehealthcareblog.com/blog/2016/10/01/aco-performance-year-three-what-happened-and-what-does-it-mean/

 

09/23/2016

"The Poverty Industry, The Exploitation of America's Most Vulnerable Citizens," A Conversation with the Author, Daniel L. Hatcher (September 22nd)

Listen Now

For this, my 101st interview, I discuss with the author, Daniel L. Hatcher, his new work, "The Poverty Industry, The Exploitation of America's Most Vulnerable Citizens."  The work is aptly summarized by Columbia University Professor Jane Spinak.  She notes on the book's dust jacket, "In the tradition of great muckracking, Hatcher has exposed how states and localities misdirected and misused public funds envisioned to benefit the most vulnerable among us." 

During this 26 minute conversation Professor Hatcher discusses his motivations for writing the book, defines "poverty's iron triangle," explains how state foster care and Medicaid agencies, with the help of private contractors, monetize poverty for state financial gain, explains how states attempt to reason this behavior and offers solutions for how this malfeasance can be "reeled in."  

Daniel L. Hatcher is Professor of Law at the University of Baltimore School of Law, teaching a civil advocacy clinic and other Hatcherclasses.  Before joining the faculty in 2004, Hatcher was with the Maryland Legal Aid Bureau, serving as the assistant director of advocacy for public benefits and economic stability.  He previously worked as a staff attorney for Legal Aid representing abused and neglected children, and he represented adult clients all poverty law matters – including public benefits, housing, consumer and family law issues.  He was also a senior staff attorney with the Children's Defense Fund.  Hatcher has testified before Congress, the Maryland General Assembly and in other governmental proceedings regarding several issues affecting children and low-income individuals and families.  Professor earned his law degree at the University of Virginia and his undergraduate degree at the University of Texas at Arlington. 

For more on Hatcher's work go to: https://www.amazon.com/Poverty-Industry-Exploitation-Americas-Vulnerable/dp/1479874728

09/14/2016

How Providers Will Respond to MACRA Implementation (September 14th)

For those interested in how providers will likely respond to MACRA, today the Better Medicare Alliance posted my essay, "How Will Providers Respond to MACRA and What Does It Mean for Provider Participation in Medicare Advantage?"  The essay is at: http://bettermedicarealliance.org/perspectives/how-will-providers-respond-macra-and-what-does-it-mean-provider-participation-medicare.

The proposed MACRA (the Medicare Access and CHIP Reauthorization Act) rule was the subject of my June 14th interview with CAPG's Mara McDermott on June 14th. 

08/16/2016

Medicare Advantage Program Reforms Within and Beyond MACRA: A Conversation with Molly Turco (August 15th)

Listen Now

Since the passage of the Affordable Care Act in 2010 CMS has been working to reform Medicare reimbursements from "fee for service" to "fee for value."  (Earlier this year Secretary Burwell noted 30% of traditional or "fee for service" Medicare reimbursements are now tied to quality or value.)  The Medicare Access and CHIP Reauthorization Act (MACRA) passed in 2015 accelerates this transition by incenting Medicare providers to participate in "fee of value" or pay for performance agreements, termed Alternative Payment Models (APMs) under MACRA, with a 5% annual bonus.  To date, commercial Medicare Advantage (MA) plans (Medicare Part D) have been immune from these reforms.   However, under MACRA beginning in performance year 2019 MA plan providers can potentially count their MA reimbursements and MA beneficiaries toward qualifying for the 5% MACRA APM bonus - if they meet the financial risk and other qualifying MACRA APM criteria.  To what extent MA plans, that now account for nearly one-third of all Medicare beneficiaries, will work with their provider partners to meet the MACRA APM qualifying criteria is unknown.      

During this 23 minute conversation Ms. Turco discusses expectations for MA plan participation under MACRA as qualifying APMs, how MA stakeholders are thinking about moving the program outside of MACRA toward improved value or reduced spending growth, CMS's MA Value Based Insurance Design (VBID) demonstration scheduled to begin in January and anticipated MA reforms under a new White House administration next year.   

Ms. Molly Turco is presently Director of Policy and Research at the Better Medicare.  Previously, Ms. Turco was a Senior Healthcare Policy Analyst with the Marwood Group.  Turco Ms. Turco also worked as a Healthcare Policy Researcher in the State of Vermont Office of Health Reform, within the University of Pennsylvania Health System and at Dartmouth Hitchcock Medical Center and the Geisel School of Medicine at Dartmouth.  Ms. Turco holds a MPH from the Dartmouth Institute for Health Policy and Clinical Practice and a BA from Middlebury College.