A quick roundup of the issues driving the healthcare reform conversation.
Week in Review
CONSOLIDATION A closer look at how hospital consolidation impacts prices and quality.
Quick takeaway: When a large hospital system acquires an independent facility, not only do prices go up, but quality may also be impacted.
Digging deeper: According to a new study, after an independent hospital is acquired by a corporatized hospital system, profitability goes up, partly because prices are increased, but primarily as a result of staffing cuts. Those reductions led to an increase in readmission rates, an indicator of decreasing quality.
What it means: Reduced costs don’t automatically translate into greater affordability, as these savings only matter if they actually benefit health plans and consumers, which the research fails to establish.
FEES Patients still getting blindsided by hidden charges.
Quick takeaway: Hospitals continue to charge “hospital facility fees” for routine services delivered in non-hospital settings.
Digging deeper: Hospitals argue that facility fees are necessary in order to cover the cost of operating full-service, 24/7 facilities, including staff, equipment, utilities, maintenance, and security.
Increasingly, though, these same systems have been tacking on facility fees for services at smaller clinics and outpatient centers they own, which usually aren’t located close to the main hospital campus.
What it means: Consumers are already facing higher prices for services delivered at hospital-owned outpatient departments. The burden is only worsened as large hospital systems keep acquiring smaller clinics, physician groups, urgent care facilities, and imaging centers.
WEIGHT-LOSS Rx PBMs help patients navigate the weight-loss drug journey.
Quick takeaway: The exploding market for breakthrough weight-loss drugs threatens to overwhelm our healthcare system.
Digging deeper: As previously covered, stakeholders across the healthcare spectrum have been raising the alarm over what the cost of covering expensive GLP-1 drugs for weight loss threatens to do to healthcare spending in this country.
The combination of unprecedented demand, high prices, and lack of competition for these drugs, presents numerous challenges for consumers. But, thanks to where they sit in the drug supply chain, pharmacy benefit managers (PBMs) are uniquely positioned to help consumers better manage these challenges.
What it means: PBMs leverage their expertise to actively support health plans, employers, and government programs that cover GLP-1 drugs for weight loss. For instance, making available behavioral support programs aimed at helping patients make permanent lifestyle changes related to obesity, while providing clients with options for coverage, financial predictability, and clinical care solutions to help ensure appropriate use of treatments.
By offering comprehensive programs to ensure the right patients access GLP-1 drugs for weight loss, in addition to supplemental services that help optimize health outcomes, PBMs are able to better meet the diverse needs of the customers they serve.
MATERNAL HEALTH Late Medicaid enrollment during pregnancy increases the risk of adverse maternal health outcomes.
Quick takeaway: Having continuous access to care is critical for timely prenatal care and diagnosis of conditions to promote healthy delivery, birth, and postpartum outcomes.
Digging deeper: A new study from Elevance Health’s Public Policy Institute details the important role that Medicaid plays in maternal and infant health. Specifically, the study looks at the impact of enrollment timing in the program during pregnancy on maternal health outcomes in addition to risk of mortality after birth.
The findings suggest that delayed enrollment in a Medicaid managed care plan (third trimester vs. first trimester enrollment) is associated with a greater risk of all-cause maternal and infant mortality, despite third trimester enrollees appearing healthier during pregnancy.
Overall, earlier enrollment in a Medicaid plan can support diagnosis and care management for conditions associated with the risk of adverse outcomes during pregnancy and delivery.
Other research has shown that an estimated 60 percent of pregnancy-related maternal deaths are preventable, with access to prenatal care being a contributing factor. Additionally, that lack of prenatal care is also associated with higher infant mortality rates.
What it means: Stakeholders have been highlighting the importance of a strong Medicaid program in meeting the unique and diverse needs of millions of Americans, including expectant mothers.
Spotlight
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