What’s New in Health Care Reform: Sept. 27

The Week in Review provides an overview of the past week’s top health care content, including industry news and trends, Mayo Clinic and Mayo Medical Laboratories news, and upcoming events.

Washington's Reinsurance Signoff Sparks Fight to Save MinnesotaCare

State officials aren't sure how they'll cope with hundreds of millions of dollars in federal funding cuts for Minnesota's health care program for the working poor. The state got some good news last week as the federal government signed off on a new program to help lower insurance premiums for 2018. But it's also causing headaches: That approval was paired with an estimated $369 million cut in federal support for MinnesotaCare. Via AP.

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Feds Approve Minnesota Program for Lower Premiums

The federal government approved a state program to drive down health insurance premiums next year for people who buy coverage in the state's troubled market for individuals. Gov. Mark Dayton called the approval "very good news" on Friday, although it wasn't clear what impact the ruling might have on funding for the state's MinnesotaCare health insurance program. Called "reinsurance," the state program would reduce individual market premiums by an average 20% or more compared with what consumers might otherwise pay. Dayton blasted federal officials earlier this week for suggesting that as part of the reinsurance approval, the state would see a much larger hit in funding for MinnesotaCare. Via Star Tribune.

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Studying 1 Million People to End Cookie-Cutter Health Care

In a quest to end cookie-cutter health care, U.S. researchers are getting ready to recruit more than 1 million people for an unprecedented study to learn how our genes, environments, and lifestyles interact—and to finally customize ways to prevent and treat disease. Via AP.

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Three Ways to Make Proton Therapy Affordable

If cost was not an issue, proton therapy would be the treatment of choice for most patients with localized tumors. Yet most hospitals do not offer proton therapy. The equipment is huge and expensive. Now academics, private researchers and investors need to make proton-therapy systems even smaller and more competitive so that more patients can benefit. Via Nature.

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HHS Hints at Major Changes to Medicare That Could Mean Higher Costs for Patients

The Trump administration is signaling it will pursue significant changes to Medicare that could put beneficiaries on the hook for higher costs. In an informal proposal, federal health officials hinted at several new pilot programs it may implement in the months ahead. One idea would give doctors more latitude to enter into so-called private contracts to charge Medicare beneficiaries more for certain services, if the patients were willing to pay. Elsewhere in the document, officials indicated they might offer more incentives to encourage beneficiaries to join private Medicare plans, known as Medicare Advantage plans. Democrats and other experts said the language suggested interest in the controversial “premium support” model long favored by Republican policymakers. Via STAT.

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Narrow Networks Get Even Tighter When Shopping for Mental Health Specialists

If you’ve got a plan offered on the federal health law’s insurance marketplace and you’re looking for a therapist, you may have to look really hard: The average provider network includes only 11 percent of all the mental health care providers in a given market, according to a recent study. Via Kaiser Health News.

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CVS Tightens Restrictions on Opioid Prescriptions on Bid to Stanch Epidemic

CVS Health announced that it was limiting the amount and strength of prescription opioid painkillers it provides to patients taking the drugs for the first time, a step intended to help curb opioid abuse. Through its pharmacy benefit manager, CVS Caremark, which has 90 million plan members, the company will introduce three new policies, effective in February. First, patients new to opioids will only get seven days’ worth of medication. The program will also limit daily dosages and require that immediate-release formulations of drugs be given before extended-release versions are prescribed. Via STAT.

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America’s Opioid Epidemic Is So Bad It’s Causing Average Life Expectancy to Drop

The typical American was expected to die a little earlier in 2015 than 2014—and a dramatic rise in drug overdose deaths is largely to blame, according to a new study in JAMA. The study examined changes in life expectancy between 2000 and 2015. It found that, overall, life expectancy at birth increased by about two years in that time span. But drug overdose deaths made that number significantly lower than it would have been otherwise—by more than three months. And opioid overdoses in particular shaved about two and a half months from life expectancy at birth. Via Vox.

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Bemoaning Budget Cuts, Health Care Navigators Say Feds Don't Get It

The Trump administration says many of the organizations that help people enroll in health plans on the federal insurance marketplaces don't provide enough bang for the buck, sometimes costing thousands of dollars to sign up each customer. So it is cutting their funding, some by as much as 90%, the government told the groups last week. But the navigators, as they're called, say the government doesn't understand the time involved in the effort or the complexity of the enrollment challenge. Nor do federal officials appreciate the variety of tasks that navigators are asked to handle, they say. Via NPR.

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CMS Champions Innovation and Competition while Buoying Value-Based Care

The CMS issued a "request for information" from providers and patient advocacy groups on new ideas to bring to the Center for Medicare and Medicaid Innovation responsible for creating new payment models. The notice came after CMS Administrator Seema Verma wrote in a Wall Street Journal op-ed that the Innovation Center's old policies led to consolidation that has been widely blamed for growing overall health care costs. She also said the policies burdened providers. Via Modern Healthcare.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Clinic Laboratories.

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