A proposed CMS rule aims to ensure payers will receive 2018 risk adjustment payments, why healthcare is a key issue for midterm election voters, and more.
1. Sedentary behavior may be the largest and most controllable factor in children developing obesity, a new American Heart Association Science Advisory suggests. Reuters reports that the AHA Obesity Committee believes TVs and other screens in bedrooms should be removed, in addition to “excluding them from meal times, creating daily ‘device-free’ time, encouraging outdoor play and for parents to enforce appropriate screen time by modeling these behaviors themselves.” According to the Centers for Disease Control and Prevention, one in six U.S. children and adolescents are obese. Furthermore, while it is recommended that screen time is limited to less than two hours per day, this is difficult to achieve in today’s society with screens used both at home and at school. Tracie Barnett of the National Institute of Scientific Research and lead author commented, “We’ve seen such dramatic changes in the nature of screen-based recreational devices in the last 10 years, and our behaviors are quite different, too.” In addition, the advisory authors note in the journal Circulation that, “Increased sedentary time, including screen time and sitting time, is associated with an increased risk of heart disease, diabetes and obesity.”
2. The top eight insurers in the U.S. brought in $285.2 billion in revenue for the first half of 2018, compared to the $264 billion in revenue at this same point last year. Fierce Healthcare also reports that they increased total earnings from the first half of 2017 to the first six months of 2018 with an increase from $13.4 billion to $16.6 billion. UnitedHealth Group was the top-earning insurer for both years, but the rest of the list is not as stagnant. Aetna is listed in second in 2018 with a net income total of $2.4 billion- an increase from its fifth-place spot in 2017 with a total of $1.59 billion. Molina also gained on the competition this year with $309 million in net income, bouncing back from a $153 million loss last year; however, it is complicated how the insurer achieved this since it only increased revenue by $26 million from last year. With two firings of its CEO and CFO, along with removing itself from two states’ ACA marketplaces last year, Molina made a comeback. “Per-member per-month premiums increased 41% over the same six-month period last year, and medical costs declined to the point where the company is no longer meeting its 80% medical loss ratio threshold required by the ACA.” Joseph Zubretsky, the company’s new CEO, commented, “This company had inconsistent processes. It had, in some cases, poor execution in some of our local health plans and by a rigorous performance management process, leading indicators that identify the number of authorizations that are going in, so that we can head off high acuity inpatient trends that are emerging, all of these are contributing to the very favorable medical care ratios that we’re experiencing in the first half.”
3. Scientists at MIT discovered a way to use artificial intelligence to optimize chemo and radiation therapy doses to treat patients with glioblastoma, a painful form of brain cancer. The research, outlined by MedGadget, will be presented at Stanford University’s 2018 Machine Learning for Healthcare conference. Per MedGadget,“Their software, which uses a technique called reinforced learning, assesses different data points about a given patient, and uses information obtained from thousands of previous similar cases to produce a treatment plan that is better optimized than existing regimens.” Tests have only been done in silico on 50 virtual patients, but results seem promising. The article notes that “The dosage levels were frequently reduced by half or more, and therapy sessions were often significantly reduced in their frequency.” Lead researcher, Pratik Shah, said, “We kept the goal, where we have to help patients by reducing tumor sizes but, at the same time, we want to make sure the quality of life — the dosing toxicity — doesn’t lead to overwhelming sickness and harmful side effects.”
4. A new CMS proposed rule aims to ensure payers will receive 2018 risk adjustment payments by resolving legal issues over the matter, HealthPayer Intelligence explains. The article states, “The proposed rule will implement CMS’s statewide premium methodology to calculate payment rates and provides a clarifying statement on how the 2018 payments are issued.” A ruling in February 2018 by the U.S. District Court of New Mexico resulted in “the suspension of the statewide premium to calculate risk adjustment payments.” However, the CMS resolution only explained its payments calculation methodology for 2017 and did not address this for future years. “Today’s proposed rule continues our effort to help stabilize the individual and small group markets,” CMS Administrator Seema Verma said. “Our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health coverage options.”
5. The November 2018 midterm elections are approaching and healthcare is the number one issue on potential voters’ minds, according to a new poll conducted by NBC News and The Wall Street Journal. This begs the question of which specific healthcare issue matters the most to voters. Forbes contributor, Robert Pearl, M.D., investigated this by surveying his monthly newsletter readers. The top four results all are related to money — prescription drug pricing led as the top healthcare issue for 58 percent, universal and single-payer coverage was second with 57 percent, Medicare funding followed with 50 percent, and Medicaid funding was ranked the top healthcare issue by 40 percent of respondents. Pearl explained that “healthcare consumes 18% of the gross domestic product (GDP) and that national healthcare spending now exceeds $3.4 trillion annually.” A Commonwealth Fund Report also found that among the 11 wealthiest nations, the U.S. has the lowest life expectancy and highest childhood mortality rate. General healthcare inflation and price constraints composed by Medicare are two high-cost factors that are contributing to this issue of rising insurance premiums, according to Pearl. Many companies are raising deductibles to combat this and placing the burden on their employees instead. The political debate on the topic does not help either with Republicans and Democrats arguing for their own side. Pearl believes that “amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all healthcare system will produce large increases in utilization and cost.