‘Hotspotting’ Study Raises Questions About Social Determinants of Health

January 21, 2020

A newly published study suggests that efforts to improve care and lower costs associated with health care “superutilizers” — typically patients with complex medical and social challenges —aren’t always as effective as they’re heralded to be.

The subject of the study in question is the Camden Coalition of Healthcare Providers, which convened health systems, primary care officers, community organizations and other stakeholders in a bid to test whether short-term, intensive care management would help reduce the cost of caring for some of the hardest-to-treat patients after they’re discharged from the hospital.

By Leslie Small

A newly published study suggests that efforts to improve care and lower costs associated with health care “superutilizers” — typically patients with complex medical and social challenges —aren’t always as effective as they’re heralded to be.

The subject of the study in question is the Camden Coalition of Healthcare Providers, which convened health systems, primary care officers, community organizations and other stakeholders in a bid to test whether short-term, intensive care management would help reduce the cost of caring for some of the hardest-to-treat patients after they’re discharged from the hospital.

For the study, researchers randomly assigned 800 hospitalized patients with medically and socially complex conditions to the Camden Coalition’s care-transition program or to usual care. Medicare was the primary payer for 48% of the trial population, and Medicaid was the primary payer for 45% of the population. The study found that the 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group.

“I think that navigation and coordination is totally necessary, but it’s insufficient to solve the problem,” says Jeffrey Brenner, M.D., who founded the program, and is now senior vice president of integrated health and social services at UnitedHealthcare’s Community & State division. “In many instances we found we were navigating patients to nowhere,” he adds.

Brian Castrucci, CEO of the de Beaumont Foundation, says that the Camden Coalition experiment underscores how the health care industry is thinking about social determinants of health in the wrong way.

While it’s good that “we finally understood that there are social conditions that impact our health,” Castrucci says, “instead of dealing with those social conditions, we’re still trying to do it from an individual basis.”

“You don’t clean the fish tank by focusing on the fish. What this study has shown is that the context that people live [in] is a lot harder to deal with than just signing them up for a social worker, referring to housing — because when you refer someone to housing, it assumes that there is housing for them to be placed into,” he says.

Datapoint: Cigna, Oscar Health Partner to Launch New Small Business Plans

January 20, 2020

Cigna, the fourth-largest health insurer in the United States, and health care startup Oscar Health last week said they will join forces to offer new fully insured commercial products for the small group market. The new plans, set to launch sometime this year, will integrate primary medical, behavioral health and pharmacy benefits, as well as a 24/7 telemedicine service, according to both companies. About 12.3 million people are currently enrolled in small group plans, with Cigna and Oscar both holding relatively small shares of the market, at 34,619 and 18,371 lives, respectively.

Cigna, the fourth-largest health insurer in the United States, and health care startup Oscar Health last week said they will join forces to offer new fully insured commercial products for the small group market. The new plans, set to launch sometime this year, will integrate primary medical, behavioral health and pharmacy benefits, as well as a 24/7 telemedicine service, according to both companies. About 12.3 million people are currently enrolled in small group plans, with Cigna and Oscar both holding relatively small shares of the market, at 34,619 and 18,371 lives, respectively.

Source: AIS’s Directory of Health Plans

Kansas Works Out Medicaid Expansion Deal

January 20, 2020

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers.

By Lauren Flynn Kelly

Kansas Gov. Laura Kelly (D) and Republican Senate Majority Leader Jim Denning on Jan. 9 said they’d reached a compromise proposal to extend Medicaid coverage to an estimated 130,000 more low-income Kansans.

If approved, Kansas will pursue a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 funding match. The state will also seek Section 1332 waiver approval to establish a reinsurance program and Section 1115 waiver approval to transition individuals whose incomes fall between 100% and 138% of the FPL from Medicaid to the exchange no later than Jan. 1, 2022, although expansion is not dependent on those waivers. If CMS denies either waiver, full Medicaid expansion will be implemented on Jan. 1, 2021, according to a summary of the pending legislation.

Kansas would be the 37th state to expand Medicaid. Ballot initiatives are pending in Missouri and Oklahoma, while voters in Nebraska and Utah have already approved expansion. The 10 remaining non-expansion states are largely concentrated in the South.

According to a summary of the pending Kansas legislation, the compromise proposal would feature a “robust work referral program,” “modest” premiums of up to $25 per month for an individual (or $100 per family) and no lockout provisions. But the expansion deal does not include work requirements.

Compared with other states that have attempted to require able-bodied expansion enrollees to seek work or other volunteer activities or risk losing their Medicaid coverage, the Kansas tactic is “a kinder, gentler approach to work,” remarks Jerry Vitti, founder and CEO of Healthcare Financial, Inc.

In a Jan. 9 research note from Evercore ISI, securities analyst Michael Newshel noted that if the approximately 130,000 additional lives that would be covered by expansion were split evenly among the state’s three contracted MCOs — which are units of Centene Corp., CVS Health Corp.-owned Aetna and UnitedHealthcare — they would each gain roughly $250 million in annual revenues.

People on the Move

January 17, 2020

Nearly 500 Medications See Price Hikes in New Year

January 17, 2020

After only one week into the new year, drug manufacturers have raised the list prices of almost 500 medications. On average, prices on 491 drugs have increased 5.2%, according to GoodRx, a company that tracks the cost of more than 3,000 medications. Neos Therapeutics, Inc.’s attention deficit hyperactivity disorder treatment, Cotempla XR, saw a price jump of 13.2%, the largest increase so far in 2020. Merck & Co., Novartis International AG and Allergan plc are among the companies that raised prices on several of their products, Reuters reports, citing a 3 Axis Advisors analysis.

by Jinghong Chen

After only one week into the new year, drug manufacturers have raised the list prices of almost 500 medications. On average, prices on 491 drugs have increased 5.2%, according to GoodRx, a company that tracks the cost of more than 3,000 medications. Neos Therapeutics, Inc.’s attention deficit hyperactivity disorder treatment, Cotempla XR, saw a price jump of 13.2%, the largest increase so far in 2020. Merck & Co., Novartis International AG and Allergan plc are among the companies that raised prices on several of their products, Reuters reports, citing a 3 Axis Advisors analysis. Novartis increased prices on nearly 30 drugs, including one of the most commonly prescribed medications, Cosentyx, which treats moderate to severe plaque psoriasis, ankylosing spondylitis and psoriatic arthritis. Pfizer Inc.’s Diazepam, a treatment for anxiety disorders, alcohol withdrawal symptoms and muscle spasms, saw a price increase of 7.8%.