Friday, December 05, 2014


The FEHBlog had a routine doctor's visit yesterday. His doctor, an internist, railed against the fact that Medicare Part B has not given internists a raise in 12 years. Point taken. His comment illustrates the fact the Medicare's low reimbursement rates force doctors to jack up prices to me and other patients under age 65.  He also complained about the lack of interoperability of electronic medical records systems. He explained that unrelated EMRs currently rely on faxes to communicate between providers, 1980s style. That's sad. The federal government has spent almost $30 billion on these systems. You can't solve a problem by throwing money at it. The FEHBlog hopes that the private sector can resolve this very serious lack of interoperability problem without a new law.

The Hill reports on a biosimilars conference held on Capitol Hill yesterday.  The FEHBlog got a kick out of this exchange:
Though healthcare professionals are hailing biosimilars for their potential to cut patient costs, the head of the National Association of Medicaid Directors raised concerns about whether the nation’s biggest healthcare provider will be able to afford the biological copycat drug.
Medicaid as a payer is not equipped to pay the types of prices we’re seeing out there,” Matt Salo said. “Not just with the drugs to treat hepatitis C or cystic fibrosis, I’m talking about what’s in the pipeline.”
But Lori Reilly, executive vice president for policy and research at Pharmaceutical Research and Manufacturers of America (PhRMA), said the notion that Medicaid prescription drug costs break the budget is misleading.
“Medicaid gets the best price in the market minus a 23 percent statutory discount and in most cases a supplemental rebate on top of that,” she said. 
If Medicaid is complaining out the prices, the root cause is that the prices are just too dam* high.

But it's Friday so let's end on a bit of good news. The New Hampshire Business Review reports on a new plan called ElevateHealth that was formed by two large health care providers and an insurer. The Review interviewed ElevateHealth's CEO
Q. What makes ElevateHealth different?
A. ElevateHealth is a joint venture between two hospital systems and a payer. It’s sort of the first in the country to have a model like this. By sharing data, by integrating and having each entity doing what they are best at, instead of often duplicating efforts, there is an opportunity to reduce costs and improve care.
A lot of health care is struggling because of misaligned incentives, and that is one thing we address immediately by jointly owning ElevateHealth.
Q. How does that address it?
A. Typically in health care, the incentives are for a provider to do a lot of tests, to really increase their revenues through volume. The goal of a payer is to try to reduce their rate of patients. We are trying to address that volume incentive by having the providers be joint owners.
This is not the only such consortium, The number is bound to grow.

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