The Rundown | Week of 9.23.2019

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MA Struggles to Address Social Determinants of Health

Despite increased flexibility around supplemental benefits, Medicare Advantage plans are not fully addressing the social determinants of health, according to a new study from the Urban Institute. Researchers based their assessment on interviews with five major MA insurers who collectively represent 38 percent of the MA market. The expansion of coverage is related to an April update from the Centers for Medicare & Medicaid Services (CMS), which would reimburse the insurers for services such as meal deliveries for chronically ill patients or transportation to doctor’s appointments. Insurers claimed they have not had enough time to update 2019 plans or to assess which benefits would positively impact the most MA beneficiaries.
>> Read More: Are Medicare Advantage Plans Using New Supplemental Benefit Flexibility to Address Enrollees’ Health-Related Social Needs?

Carcinogen Present in Tap Water

A recent report published in Heliyon identified 22 carcinogens regularly found in tap water that could result in as many as 100,000 cancer cases. Carcinogenic chemicals identified include arsenic, uranium, and byproducts of disinfectants. Researchers from Environmental Working Group, an environmental watchdog agency, noted that despite meeting legal standards, many contaminants are still unsafe at any level. The study analyzed nearly 50,000 community water systems that serve approximately 86 percent of Americans. While guidelines are set per chemical, researchers encouraged standards to account for the combined effects of multiple contaminants. “People are exposed to combinations of chemicals, so it is important that we start to assess health impacts by looking at the combined effects of multiple pollutants,” said Sydney Evans, the study’s lead author.
>> Read More: Cumulative Risk Analysis of Carcinogenic Contaminants in United States Drinking Water

Pelosi’s Plan to Lower Drug Prices

House Speaker Nancy Pelosi (D, CA) recently revealed a plan to lower drug prices for 250 medications by linking costs to an international index, similar to President Trump’s idea. Brand-name drugs without a generic or biosimilar competitor would have a price cap equal to 120 percent of the average price of the drug in Canada, France, Germany, Japan, Australia, and the U.K. The Department of Health and Human Services Secretary would be the designated price negotiator. Under Pelosi’s plan, these negotiated prices would apply to both Medicare and the commercial market, while Medicare Advantage and Part D insurers could lower costs further. However, experts anticipate impeachment hearings may halt the proposal’s progress.
>> Read More: Pelosi’s Drug Plan Would Let U.S. Negotiate Prices of 250 Medications

Average Family Premiums Exceed $20,000

According to a new report from the Kaiser Family Foundation (KFF), the average annual family premium for employer-sponsored insurance is now $20,576, a 4.9 percent increase from last year. Employees themselves pay for more than a quarter of this cost with employers paying the rest. This increase far outpaces both increases in earnings (3.4 percent) and national inflation (2 percent). KFF President and CEO Drew Altman said: “The single biggest issue in health care for most Americans is that their health costs are growing much faster than their wages are. Costs are prohibitive when workers making $25,000 a year have to shell out $7,000 a year just for their share of family premiums.”
>> Read More: 2019 Employer Health Benefits Survey

Watchdog Declares CMS Not Appropriately Tracking Quality Measures

A report from the U.S. Government Accountability Office (GAO) found CMS has large amounts of available funding — known as unobligated balances — for quality measurement activities from fiscal years 2010 through 2018.” These available funds could be used to monitor and assess quality measures more closely. However, CMS officials counter the funds were saved to “ensure there were no gaps in funding for future years.” Investigators noted CMS had no “procedures to ensure systematic assessments of quality measures … such as using a tool or standard methodology.” The GAO recommended CMS establish processes to align quality assessments with strategic objectives. Experts note that CMS’ measures are adopted by private payers, and thus refining these criteria is essential to the development of value-based care and alternative payment models.
>> Read More: CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives

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