Navvis Right Now: Issue 18 – April 6, 2019

April 6, 2019

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CMS Finalizes Medicare Advantage 2020 Rule

CMS finalized a rule on Monday giving Medicare Advantage plans a 2.53% pay raise in 2020, which is higher than the 1.59% raise CMS originally signaled. But Advantage plans’ payments will also be based on 50% of patient “encounter data,” increased from 25% that health insurers fought hard to avoid. Medicare Advantage plans will have more flexibility to offer supplemental benefits to patients with chronic illnesses that aren’t necessarily going to cure their conditions but will address the social and environmental factors that can harm health. Plans will also be able to tailor benefits or reduce cost-sharing to meet certain members’ needs. For instance, Verma said a Medicare Advantage plan could pay for home air filters or carpet shampooing for a patient with asthma or pay for heart-healthy meals for a beneficiary with heart disease. The agency also said it is encouraging plans to take advantage of the flexibilities to offer targeted benefits to patients with chronic pain or those undergoing addiction treatment. CMS also said it is moving ahead with plans to adjust payments to reflect patients’ total number of medical conditions, in addition to viewing each condition individually. (This change is required by the 21st Century Cures Act.) The CMS said it will implement what it called the “alternative payment condition count model,” which accounts for some additional diagnoses, including dementia and ulcers. Insurers had supported the alternative model in their comments to the CMS.

Takeaway: The expansion of supplemental benefits is significant. In 2019, CMS said supplemental benefits had to be “primarily health related” whereas in 2020 CMS has now said “have a reasonable expectation of improving or maintaining the heath or overall function.” CMS Administrator Seema Verma said, “The plans can tailor these offerings to individuals, and the offerings could increase competition between plans” which I fully agree. (Although beneficiaries have a very low rate of switching plans, supplemental benefit design can be the missing lever to prompt change.) The final payment increase of 2.53% was higher than forecasted, which is positive for plans. Plans fought hard to prevent CMS from finalizing risk adjustment moving to a split of 50% encounter data and 50% RAPs data that can be sent after the visit but lost because of inaccuracies in the data. There is significant profit margin in Medicare Advantage for a well-managed plan and the largest payers are United Health Group, Humana, CVS since it acquired Aetna, and WellCare. Currently there are 20 million members enrolled in Medicare Advantage with a significant growth trajectory, so these changes mean increased competition across payers to growth their memberships.

Trump Predicts New Health Care Law After 2020

President Trump on Monday put forward a timeline for a new health care plan to replace Obamacare, indicating legislation would be brought up for a vote after the election in 2020. “Vote will be taken right after the Election when Republicans hold the Senate & win back the House,” he tweeted. “It will be truly great HealthCare that will work for America,” he promised. “Also, Republicans will always support Pre-Existing Conditions.” The Trump administration last week began a new push to invalidate former President Obama’s signature health care law when the Justice Department argued in a new court filing that the entire law should be ruled unconstitutional. White House aides have indicated that the administration is working on replacement legislation to submit to Congress sometime this year.

Takeaway: Overall this announcement is a way for Trump to ensure the Republican party can keep healthcare as a focus and winning topic for 2020. Becker’s reported Trump named Rick Scott architect of the new GOP health plan, along with two other senators who will lead the effort to design a Republican healthcare plan. In an NPR interviewMonday, Mr. Scott said he is focused on making incremental improvements to the existing healthcare system, such as lowering drug prices. Scott has extensive experience with healthcare from his former role as CEO of Columbia/HCA 22 years ago where he oversaw 340 hospitals, 135 surgery centers and 550 home-health locations. (Later HCA was found guilty of Medicare and Medicaid fraud and HCA was fined more than $1.7 billion in criminal fines, civil damages and penalties so support for Senator Scott is mixed.)

Amazon’s Alexa is Now HIPAA Compliant

Amazon unveiled software for its voice assistant Alexa that allows healthcare organizations to transmit and receive patients’ protected health information, according to a company blog post this week. Consumers can now use Alexa-enabled devices for tasks such as scheduling medical appoints, checking on the status of prescriptions and accessing hospital post-discharge instructions. Alexa’s skills are HIPAA-compliant and can be accessed by healthcare providers, payers, pharmacy benefit managers and digital health companies as part of an invite-only program. Amazon has partnered with the following six healthcare organizations: Livongo, Renton, Wash.-based Providence St. Joseph Health, Boston Children’s Hospital, Atrium Health in Charlotte, N.C., Express Scripts and Cigna.   “Voice is going to be a big part of the future in all areas of our lives, including health and healthcare,” Providence St. Joseph Health Chief Digital Officer Aaron Martin. “We’re excited to be one of the first health systems in the U.S. to build Alexa skills that help our patients connect to our providers and get faster access to care.” To use the new Alexa skills at Providence St. Joseph, patients can simply ask Alexa to open Providence’s health app, and Alexa will suggest appointment times within the next day at a clinic closest to the patient’s home. Individuals can also cancel appointments through the new Alexa skill.

Takeaway: Amazon’s move to make Alexa HIPAA compliant is not only a smart move, but it’s also a move that partners Amazon more closely with health systems and healthcare, which is the company’s goal along with increasing reoccurring revenue streams. Alexa is currently being used and tested at patient’s bedsides by hospitals in LA, at Cedars-Sinai and Boston Children’s Hospital to name a few. The goal of Livongo’s partnership is for consumers to ask Alexa to read their latest blood sugar reading and blood sugar measurement trends as well as provide health insights personally individualized for the user to manage their chronic disease. This is only the tip of the iceberg for the potential uses for virtual voice enabled assistants in healthcare.

Express Scripts Takes Steps to Cut Insulin’s Price to Patients

Cigna’s Express Scripts announced Wednesday it will take steps by the end of the year to help limit the drug’s cost to consumers. Express Scripts, which manages prescription drug insurance for more than 80 million people, is launching a “patient assurance program” that Steve Miller, Cigna’s chief clinical officer, says “caps the copay for a patient at $25 a month for their insulin — no matter what.” Insulin has become a major focus. A Minnesota man died last year, according to his mother, when he tried to ration his insulin because he couldn’t afford the $1,300 monthly cost. Though the drug has been in use for more than a century, its price in the U.S. is 10 times higher than it was 20 years ago, according to a report by the House of Representatives released last week. “What we’re hoping is that we’re going to see more diabetics taking more insulin, [fewer] complications for those patients, and hopefully lower health care costs,” Miller tells Shots. Express Scripts covers 1.4 million people who take insulin, Miller says. Under the discount program, patients who haven’t met their deductible and normally would have to pay the full retail price for their insulin would pay $25. The same goes for those whose normal copayment is a percentage of that retail price. Miller says on average patients pay about $40 a month for insulin copayments — but the price can vary widely month to month, depending on the design of a patient’s prescription drug plan.

Takeaway: The move by Express Scripts comes as lawmakers are focused on high drug prices and listening to stories about patients who can’t afford their medication and ahead of the PBM hearings that start next week. (Express Scripts and four other PBMs are testifying.) Type 1 diabetes is a fatal disease without insulin treatment. However, the price of this life-sustaining drug doubledbetween 2012 and 2016. A recent Yale study found that about a quarter of people with diabetes skip doses to save money or use less of the medication than prescribed. “Patients who rationed insulin were more likely to have poor control of their blood sugars,” Dr. Kasia Lipska, an endocrinologist and assistant professor at Yale, testified. She said patients who don’t maintain good control of their blood sugar run the risk of amputations, blindness and other diabetes complications.

Virtual Simulations Offer a Cure to Doctors’ Poor Bedside Manner

The bedside manner of doctors, nurses and other caregivers is getting a boost from an unexpected source: artificial intelligence (AI). Virtual simulations that incorporate AI are making their way into medical training programs across the country, placing caregivers in the role of patients or having them interact in their real-life roles with virtual patients. The simulations aim to help train health-care workers to be more empathetic and improve difficult conversations with patients suffering from a wide range of conditions including Alzheimer’s, cancer and substance addictions. “If health-care workers can virtually stand in the shoes of patients as they interact with doctors, nurses and their families, they have a tremendous opportunity to improve the care they deliver,” says Daryl Cady, chief executive of the Hospice of Southern Maine, which has used a virtual-reality training module with nearly a hundred employees, as well as dozens of health-care workers at nearby hospitals and physicians’ offices.  “Empathic communication is actually very challenging to teach,” says Fred Kron, an adjunct professor at the University of Michigan Medical School and founder of Medical Cyberworlds. With virtual patients, students and practitioners can practice with many more patients in many more medical situations than the traditional training methods—which typically use lectures and role playing. They get real-time feedback, and they can repeat challenging situations and see how the encounter with the patient changes depending on their choices.

Takeaway: Empathy and end of life discussions are not taught in medical school and yet there is a call for doctors to provide more ‘compassionate care.’ Many physicians struggle with how to have these conversations, because they were taught how to save lives. New programs are being introduced to help teach empathy and provide simulations to practice difficult conversations.  Embodied Labs introduced virtual experience, 30-minute simulation places users in the role of “Clay,” a 66-year old lung cancer patient in the need of hospice care and the discussions with family and providers where the user experiences initial symptoms that progress to Clay’s life ends. Embodied Labs and other experts say the VR effects are “surprisingly poignant.” There are customized assessment questions to be answered before and after staff and students sample a VR scenario that provide qualitative and quantitative data. The data can be used to provide new insights, on the part of professionals, into things such as how conversations about end-of-life are carried out. Belmont University also started including training nursing students on how to handle death in response to surveys showing anxiety about death among young nurses.


Disclaimer: This blog includes content gathered from other published sources, not authored by Navvis, and is presented as information only. As with any news story, this information may have changed since its publication date. Commentary included with the information is the opinion of its authors, and is not indented to provide legal or regulatory advice or guidance to the reader. Navvis does not represent the accuracy of or assume liability for the content presented herein.