Last Week in Healthcare Reform: August 23rd, 2021

Momentum builds to hold Big Pharma accountable for rising drug prices; the vast majority of hospitals fail to comply with price transparency rules; Medicare Advantage plans continue to focus on beneficiaries’ health-related social needs; and, a new survey details how telehealth saves patients a trip to the ER.

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Item of the Week

Week in Review

Rx Accountability: If it feels like rising prescription drug prices have dominated so much of the healthcare costs conversation the past few years, you’re not far off.  The unrelenting trajectory of these increasing costs have led some to call Big Pharma our healthcare system’s worst pre-existing condition.  Stakeholders have maintained a steady drumbeat, attacking the pharmaceutical industry’s dishonest attempts to distract from the issue of astronomical prices and anticompetitive practices by pointing fingers.  For their part, pharmacy benefit managers (PBMs), who’ve borne the brunt of drugmakers’ scapegoating tactics, have offered up a path forward to reduce prescription drug costs.  Meanwhile, momentum continues to build amongst lawmakers who’re increasingly looking to hold Big Pharma accountable.

Hospital Prices: Earlier this year, reports surfaced of hospitals using sophisticated programming code to hide pricing data that new federal rules had mandated must be made available to consumers going forward.  Newly-published data now puts a finer point on just how pervasive the issue of hospitals’ noncompliance with federal transparency rules continues to be.  According to the analysis released by Patient Rights Advocate, an estimated 94.4 percent of all hospitals are failing to comply with the new requirements.  Perhaps this should come as no surprise, as a separate body of research released in late spring found that most of the country’s top hospitals charged more than a five times markup for their services.  This analysis only added to the growing body of evidence highlighting this practice, such as the data from earlier this year in which hospitals were found to mark up drug prices by an average of 250 percent.  And, lest we assume that this practice is limited to a specific geography, new research released just this month shows that the prices charged by hospitals for colonoscopies are all over the place. 

Medicare Advantage Focus: With its dedicated focus on connecting vulnerable seniors to an enhanced package of benefits resulting in better health outcomes and higher satisfaction rates than traditional Medicare fee-for-service, the Medicare Advantage (MA) program continues to drive value for beneficiaries and our healthcare system.  It’s this holistic approach to whole-person health that’s enabled MA plans to so seamlessly integrate health-related social needs into the program’s structure and care delivery model.  This emphasis on non-medical social factors and their collective influence on health outcomes has rapidly reshaped just about every aspect of our entire approach to healthcare design.  However, this change has not been without its challenges, specifically in the Medicare Advantage space, where technological limitations have proven to be something of a barrier in health-related social needs interventions.

Telehealth: A new survey highlights the importance of the growing role that telehealth is playing in how and when and where people are seeking out low acuity care.  Conducted by the Bipartisan Policy Center, the study found that about one-in-seven people (14 percent) who used telehealth would have otherwise sought care in an emergency department setting or urgent care center.  Additionally, more than half of those who reported using telehealth to receive care had their primary health issue resolved.  Experts point to this shift in care delivery as an indicator of telehealth’s potential to take non-emergency cases out of emergency settings.


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