Public Policy Weekly Clips: March 1, 2016

Every Tuesday NCQA gives a rundown of the best national, state and private sector health care articles from the week. Here are our picks for today’s Public Policy Weekly Clips:

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National:

GAO says CMS has taken a “passive approach” to fighting fraudulent Marketplace enrollment.

CMS will now require proof of eligibility for Marketplace sign-ups outside open enrollment.

70% of the uninsured got ACA penalty exemptions, largely because they could not afford coverage.

Readmissions dropped from 21.5-17.8% for ACA targeted conditions & from 15.3-13.1% for others.

Obama rejected the NGA’s bid to fight opioids by limiting how many painkillers can be prescribe at a time.

Average prescription drug costs for a year doubled to over $11K in just seven years.

Novartis signed value-based pricing deals with Aetna & Cigna for its CHF drug Entresto.

The 1% of patients with highest costs account for 21.5% of total health spending; the top 50% for 97%.

US obesity rate reached an all-time high of 30.4% in 2015, despite improved physical activity rates.

Mastectomies increased 36% from 2005-13 while breast cancer rates remained constant.

Cancer death disparities dropped from 47-24% for black vs white men & 19-14% for women since 1990.

Up to half of gay or bisexual African-American men are projected to contract HIV, vs 25% of Hispanics and less than 10% of whites.

Just 10.7% of privately insured patients get follow-up care after opioid-related hospitalizations.

Statins may lower cirrhosis & liver cancer risk in hepatitis C patients.

29 states & DC require insurers to cover telehealth at parity with in-person care, up from 11 in 2011.

The Senate confirmed new FDA head Robert Califf in an 89-4 vote.

AHRQ’s Rick Kronick is resigning to return to UCSD; Sharon Arnold will be acting director.

State:

Iowa got final CMS approval for moving to Medicaid managed care plans.

Kansas’ hospital association says lack of Medicaid expansion has cost the state over $1B.

Oregon’s ACA coop filed a class action lawsuit saying the feds owe up to $5B in risk corridor payment.

Private:

Employers worry that oncology clinics are linking with hospital outpatient departments to up costs.

Employers are focusing on chronic conditions since ~50% of adults have at least one.

Workplace stress contributes to at least 120K deaths each year and up to $190B in health costs.

A consultant says private exchanges don’t control costs, but let insurance companies retain more profit.

53% of employers have added new usage restrictions for specialty prescription drugs.

81% of employers say they offer telehealth to employees because they are cheaper than in-office visits.

Wellness efforts evolving to include behavioral health.

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