Trinity Health to expand risk-based care with Heritage Provider Network
Bob Herman for Modern Healthcare
“Intriguing partnership between two healthcare providers to provide bundled healthcare services to payers and employers. We will see far more partnerships such as this in 2015 than outright M&A activity in the provider market.” – John

High Health-Care Prices: More Talk Than Action
Drew Altman for The Wall Street Journal
“We agree with this editorial by Kaiser Family Foundation’s president. While efforts at price transparency are important, they’re not enough on their own to bring down exorbitant rates charged for procedures. Altman hits the nail on the head when he states that special interests (profit) are simply too strong. The next question is – now that we know this, who can/will do something about it?” – Naveen

Skilled Nursing facilities: steps for reducing FCA liability
William McDermott, et al for The Association of Corporate Counsel
“Upcoding can be found anywhere apparently. This piece talks about how SNFs bills CMS for therapy services under Medicare Part A. Care provided is characterized in resource utilization groups (RUGs). The article contains the following observation, “…the minimum minutes for a RUG level are often perceived as maximum minutes and that some providers might implement internal rules that prohibit clinicians from providing therapy above RUG level minimums contrary to their professional medical judgment.” It goes on to outline instances of unneeded care (waste) and unprovided care.” – Brian

Survey: Healthcare Finance, Reform Top Issues Confronting Hospitals in 2014
American College of Healthcare Executives Survey
“ACHE survey of hospital executives challenges and priorities. There wasn’t any big changes from 2013 to 2014 although it is interesting to note that population health and patient satisfaction still remain as somewhat lower priorities despite all of the attention that they have received in the past year.” – Matt

Biotech’s Price Wars Are Just Beginning
Robert Langreth for Bloomberg
“Pharmaceutical/biotech spending growth has been fairly tepid in the U.S. compared to historical norms but is poised to notably increase as more biologics (notable ‘$1,000 day mark for the new Hep C treatments) get introduced. Most recently Anthem announced a deal with a drug firm as health insurers are starting to negotiate directly with pharmaceutical firms for preferred pricing discounts on expensive specialty drugs. As the article states there are limited disease states for which this approach can be taken. Much of the early focus at the JPMorgan Healthcare Conference this week has been on this very topic including a fairly scathing keynote presentation by Ezekiel Emanuel on the the cost efficiency of new drugs especially new cancer drugs.” – Matt

Why Drugs Cost So Much
Peter B. Bach for The New York Times
“A new survey by the Commonwealth Fund points to progress of the ACA, along with a number of deeper challenges that persist when it comes to access and affordability of care. The good news according to the survey is that fewer people are reporting delaying needed medical care (test, treatment, Rx refill) dropped by nearly a third, while those reporting problems paying their medical bills dropped by a quarter. Yet results also show that these gains are still developing inequitably, with those from lower SES reporting less progress. Another sign of potential problems is the inflation of the average employer-sponsored deductible, which has grown by nearly 50% over the last 5 years. Important to remember that as much as industry stakeholders laud the era of “consumer-directed health,” high deductibles can discourage people from getting needed care, defeating the purpose of having insurance in the first place.” – Naveen

Health-Law Test To Cut Readmissions Lacks Early Results
Jay Hancock for Kaiser Health News
“Initial evaluation results of the Community-based Care Transitions Program (from May 2014) by Econmetrica were disclosed last week on the CMS website. The initial results seem disappointing (only 4 of the 48 agencies significantly cut readmissions compared to their control group) but it was only a year and half into the evaluation. Additionally, the issue of having the proper IT infrastructure for communication/case management/data tracking and access to the hospital EHR record by partner hospitals wasn’t looked at in great detail.” – Matt

Fewer Americans delayed needed medical care in 2014, survey says
Noam N. Levy for The LA Times
“A new survey by the Commonwealth Fund points to progress of the ACA, along with a number of deeper challenges that persist when it comes to access and affordability of care. The good news according to the survey is that fewer people are reporting delaying needed medical care (test, treatment, Rx refill) dropped by nearly a third, while those reporting problems paying their medical bills dropped by a quarter. Yet results also show that these gains are still developing inequitably, with those from lower SES reporting less progress. Another sign of potential problems is the inflation of the average employer-sponsored deductible, which has grown by nearly 50% over the last 5 years. Important to remember that as much as industry stakeholders laud the era of “consumer-directed health,” high deductibles can discourage people from getting needed care, defeating the purpose of having insurance in the first place.” – Naveen

Letting Go: Gradual withdrawal of care may make end-of-life decisions easier
Ravi Parikh for Slate
“Continuing problems with affordability and access to the healthcare system stand in stark contrast to this anecdote. Here a physician talks about how, for certain patients, the default response of the payment system is more treatment when it is clear that more is not better. Families and physicians engage in a set of factual but essentially oblique conversations around the fact that no one lives forever. If less oblique conversations about lifestyle, diet, and exercise occurred earlier in life, perhaps the course of end-of-life treatment could be improved.” – Brian