Research Roundup: Impact Of GOP Lawsuit; Co-Ops’ Failures; Plan Choices For Patients With HIV

Each week, KHN compiles a selection of recently released health policy studies and briefs.

State Highlights: Bill Would Let Californians Know About Unreasonable Rate Hikes; Va. Mental Health Advocates Push For Reforms

News outlets report on health care developments in California, Virginia, Minnesota, North Carolina, Connecticut and Florida.

State Highlights: Montana Averts Financial Headache Over State Employee Health Plan; Chronic Disease In Minnesota

News outlets report on health care developments in Montana, Minnesota, Maryland, Kansas, Ohio, Louisiana, Florida, Georgia, California, South Carolina, Washington and Wisconsin.

Viewpoints: Hospitals And Preventable Harm; How Medicaid Expansion Is Playing In Iowa, New Hampshire

A selection of opinions on health care from around the country.

Iowa Will Be Ready For Medicaid Privatization Switch, State Official Says

Iowa Medicaid Director Mikki Stier says she is "very confident" that the state will be ready to transfer its Medicaid program to private management starting March 1. Meanwhile in Kansas, an audit finds that new computer system for Medicaid enrollment will save far less than the $300 million that was estimated.

In California, Hearing On HealthNet-Centene Merger Triggers Tough Questions

Meanwhile, Centene also discloses that six hard drives with information belonging to about 950,000 members are "unaccounted for." Also in the news, Modern Healthcare reports on Marilyn Tavenner's view of how AHIP moves forward. And news outlets detail high-deductible health plans and limited coverage plans.

Markey Blocking Vote On FDA Nominee Until Agency Addresses Opioid Concerns

Sen. Ed Markey, D-Mass., the second lawmaker to place a hold on the nomination, says, "The FDA needs to commit to shift the way it approaches and evaluates addiction before I can support Dr. Califf's nomination." Elsewhere on Capitol Hill, Republicans are likely to use a new Congressional Budget Office analysis of booming health care costs to propose deep funding cuts. Also, lawmakers reschedule their hearing on drug prices.

State Highlights: Rural Hospital Crisis Continues; Utahns Want More Open Talk About Health Care Plan

News outlets report on health care developments in Georgia, South Carolina, Utah, Maryland, New York, West Virginia, Virginia, Massachusetts and Kansas.

Research Roundup: Marketplace Competition; Rural Health IT; HIV Testing; Abortion Coverage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Viewpoints: Sanders’ Health Plan Draws Concerns; Gov.’s ‘Bizarre Attack’ On Ky. Reform

A selection of opinions on health care from around the country.

State Highlights: Calif. Releases End-Of-Life Prescription Guidelines; Pa. Regulator Takes Aim At Costly ‘Surprise’ Bills

News outlets report on health care developments in California, Pennsylvania, Florida, Nebraska, Arizona, Alabama, Minnesota, Kansas and Illinois.

McCaskill Calls For Treatment Centers, Monitoring Program To Fight Opioid Abuse

Sen. Claire McCaskill, at a field hearing in Jefferson City on Tuesday, called on lawmakers to rectify the lack of a drug monitoring program in Missouri. Elsewhere, Ohio announces new guidelines for prescribing painkillers, and New York extends its rebate for naloxone, an antidote for heroin and other opioid overdoses.

Relatives More Likely To Rank End-Of-Life Care Excellent When Patient Was In Hospice, At Home

A new study in JAMA surveys family members of terminally ill cancer patients, and found that they were more likely to rate the care as excellent when the patient was not in an intensive care unit. Another study in the same journal examines how treatment of terminal patients in the United States compares to other countries.

For Hospitals, Treating Violence Beyond The ER Is Good Medicine And Good Business

BALTIMORE — Ask David Ross to describe an average day on the job. He says it doesn’t exist.

Ross is a violence intervention specialist at the University of Maryland Medical Center. Though he isn’t a doctor, he’s been working at the hospital as part of its Violence Prevention Program for close to 10 years. His team works with patients who are victims of violent injuries — stabbings, gunshots or physical assaults — and who physicians flag as candidates for the program’s assistance.

His challenge is to figure out the factors in their lives that put them at risk of violence. The work he does is time-consuming, and the relationships he builds with these patients can last months and even years.

This KHN story also ran in The Washington Post. It can be republished for free (details).

Do you feel safe at home? Do you have health insurance? A high school diploma? A stable job? Having health insurance or a diploma is no guarantee against violence, but Ross and his colleagues ask such questions to help the team connect patients with programs that might improve their lives and insulate them from the violence that put them in the hospital.

“Some days, it can be emotional. Or it can be gratifying,” Ross said. “I spoke to a patient the other day, and he almost had me crying.”

Sometimes that kind of emotion comes from the devastating things patients have seen, whether it's the result of a dysfunctional living situation, substance abuse, poverty or other social ills. Other times, it's because "you thought you made progress — and then there's a setback."

Maryland is a pioneer in this type of coordinated effort, having launched its anti-violence program in 1998. Now, about 30 hospitals across the country — from the Children’s Hospital of Philadelphia to the University of Rochester Medical Center in New York — have developed similar initiatives. They follow Maryland’s “wraparound” approach, which involves following up with patients after they leave the hospital, and providing medical and social support to keep them out of harm’s way — by, for example, getting them into drug rehab or education classes for people who have not finished high school. The hospitals are acting on the notion that keeping violent injury from recurring will ultimately reduce their expenses and improve people’s long-term health. In other words, they increasingly view violence prevention programs as both good medicine and good business.

On this particular day, Ross visited seven hospital patients who were being treated for violent injuries. Ross's job isn't just to identify the trouble spots in a patient's life; it also involves moving with the person through the legal and medical systems, sometimes acting as an advocate. The day before, for instance, he had accompanied a mentally ill client to court to make sure the man's condition was understood by authorities. On such days, he dresses in a suit instead of his hospital uniform: pink scrubs, an outfit that shows that while he doesn't stitch wounds or prescribe pills, he's part of a team dedicated to keeping patients healthy.

As experts increasingly view violence as a medical concern, hospitals see it as an opportunity. “There’s been a groundswell of professionals understanding that this is a public health issue,” said Rochelle Dicker, a trauma surgeon and professor at the University of California, San Francisco, who directs the UCSF Medical Center’s violence prevention program.

And the 2010 federal health law supports that interest. It says nonprofit hospitals have to work harder if they want to maintain their tax-exempt status: Among other requirements, they have to formally measure their surrounding community’s health needs at least every three years and implement a strategy to address them.

To this end, a growing number of hospitals, especially those located in areas with high rates of violent crime, are partnering with local organizations to try to reduce neighborhood violence, said Jonathan Purtle, an assistant professor at Drexel University who researches hospitals and violence prevention.

The Department of Justice has been supportive, too. In a 2012 report, it recommended that hospitals become more involved in violence prevention, through counseling patients directly or connecting them with education, gang diversion programs, substance abuse treatment and other social services.

Research shows that, if someone comes in suffering from a gunshot or stab wound and then, after leaving the hospital, returns to the same environment, there are good odds they will be back in the emergency department. In addition, trends and anecdotal evidence suggest people at higher risk for violent injury are likely to face issues such as domestic violence, mental illness or substance abuse. They also often deal with other stressors, like poverty or bad housing. These challenges can result in health problems including lead poisoning and poor nutrition, which the hospital can work to address. Even if they can't change, for instance, a neighborhood's crime rate or drug culture, they can help someone get into rehab or find somewhere new to live.

Much of the growth in such hospital interventions has happened in the past five years, Dicker said.

“It’s becoming a more established understanding that this kind of violence is preventable,” said Rebecca Cunningham, an emergency medicine professor at the University of Michigan and associate director of its youth violence prevention center. “And we can have programs that can prevent it, and the hospital and emergency department are really critical locations for this.”

Michigan’s center doesn’t do that same level of outreach and case management as Maryland’s. All patients between the ages of 14 and 20 and from neighborhoods where violence is more prevalent are approached for a counseling session — what Cunningham called a “preventive” intervention.

So far, there isn’t much research measuring these programs’ effectiveness. But the findings available show promise. UCSF found that people who had come to the hospital with a gunshot or stab wound and then participated in the intervention program were far less likely to get injured again after leaving. The number of patients returning with another violent injury dropped from 16 percent to 4.5 percent. And in a paper published last year, researchers estimated that program would save the hospital half a million dollars annually.

That’s crucial. “It’s very important to be able to talk about cost effectiveness” as hospitals look to curb unnecessary expenses, Dicker said.

The University of Maryland‘s statistics are similarly encouraging. Research found victims of violent injury who went through the program were 83 percent less likely to return because of another violent event when compared with those who didn’t participate, said Tara Reed Carlson, who directs the university’s Center for Injury Prevention and Policy. Those who had participated in the program were more likely to have a job and less likely to be involved in criminal activity.

Ross said the work he does — and the change he sees — underscores the value of intensive outreach. The before-and-after contrast is striking. “I’m talking about young guys who haven’t had any guidance,” he said. “That’s rewarding.”

Often, he said, patients stop by to visit, years after they’ve gone through the program. They share new successes, like buying a home or getting married.

“It makes you feel good,” he said. “You’re doing something that’s needed.”

Viewpoints: Talking About Drug Prices; How Big Data Could Focus The Cancer ‘Moonshot’

A selection of opinions on health care from around the country.

State Highlights: A Tuberculosis Outbreak In Rural Alabama; In California, Alzheimer’s Caregivers Have Limited Options For Aid

News outlets report on health care developments in Alabama, California, Ohio and Florida.

Survey: 40 Percent Of Physicians Report Bias Toward Certain Patients

Doctors reported that factors such as emotional problems, weight, intelligence, language barriers and attractiveness determined how they viewed a patient. Other media outlets examine if a yearly physical is necessary, a new procedure for cataract blindness, and organ transplant numbers.

Drug Makers: Most People Don’t Pay Retail

Executives are pushing back against the recent outcry over high drug costs, saying media outlets are focusing on the list prices rather than the discounted ones they say consumers are actually paying. In other pharmaceutical news, Merck settles a class action lawsuit over a painkiller it pulled from the market, and the costs of targeted cancer drugs is growing.

As Enrollment Period Nears Close, Advocates Ponder Why Texas Sign-Ups Lag

The Dallas Morning News examines why Texas is not as successful as Florida in signing up people for health insurance. Also in the news is a look at hospitals' efforts to get into insurance networks and a reminder to consumers that penalties for not having a plan will rise in 2016.

Barbs Fly At Debate As Clinton, Sanders Battle Over Health Care

In the last Democratic faceoff before the Iowa caucuses, Hillary Clinton and Bernie Sanders' heated words underscore the ever-narrowing race between the two. In a series of pointed exchanges, Clinton continued her attack on Sanders' newly released "Medicare for all" health plan, while Sanders went after her ties to Wall Street.

Viewpoints: Gaming Special Enrollment Periods; Hillary Clinton’s Attack On Bernie Sanders’ Single-Payer Plan

A selection of opinions on health care from around the country.

Viewpoints: Kentucky’s Obamacare Escape Route; What Are The GOP Replacement Plans?

A selection of opinions on health care from around the country.

Viewpoints: Joe Biden Takes Aim At Cancer; Obamacare As A Pay Cut

A selection of opinions on health care from around the country.

Anthem Reports Higher-Than-Expected Enrollment Numbers

Anthem's strong 2016 forecast has given a boost to its peer group, with the four largest insurers seeing a bump in market value. In other news from the industry, the CEO of Aetna predicts the Humana deal will close this year and says he will not withdraw from the public health exchange market.

Executives: Outrage Over Pharma Profiteering Is ‘Perversion Of Reality’

The drug makers defended their products as life saving, and dismissed concerns over prices as "more of a campaign issue than an actual issue." In other pharmaceutical news, a California cost transparency bill is shelved and the Pfizer and Allergan CEOs tout plans to boost medicine production.

Viewpoints: Is Obama A ‘Transformational President’?; The Burden Of Medical Debt

A selection of opinions on health care from around the country.

State Highlights: Calif. Health Regulator To Pay Fine For Helping Kaiser Permanente During Audit; Ind. Prisoners Sue State Over Tuberculosis Cases

News outlets report on health care developments in California, Indiana, Pennsylvania, South Carolina, Minnesota, Oregon, Ohio, Kansas and Arizona.

Scrutiny On Insurance Mergers Intensifies As 15 State AGs Join Justice Department Probe

The group will look at Aetna's plan to buy Humana and Anthem's bid for Cigna. Elsewhere, the health care insurers providing individual plan coverage in Delaware are fined over regulation violations.

Shire-Baxalta $32B Merger Would Create Powerhouse Rare-Disease Drugmaker

Big companies used to steer clear of rare-disease drugs because there aren't enough patients to make them profitable, but that has changed as the market has sustained high prices. In other pharmaceutical news, drug companies launch a cooperative effort to fight cancer, the Supreme Court lets a ruling on deceptive marketing of an anti-psychotic drug stand, and states look at ways to combat high prices.

Viewpoint: GOP’s Repeal Bill Could Be A Test-Run; Another Side Effect Of High Deductibles

A selection of opinions on health care from around the country.

What’s Ahead For The Health Care Sector In 2016?

Bloomberg offers a series of charts to aid in understanding the market forces at work in the health industry in the year ahead. Meanwhile, a large shareholder sells off its stake in a giant hospital physician staffing company while a startup focused on cancer blood tests raises $100 million. Also, why insurers are enjoying this year's mild winter.

Research Roundup: Readmission Rates At Safety Net Hospitals; Asthma Cases; Cataract Surgery

Each week, KHN compiles a selection of recently released health policy studies and briefs.

State Highlights: Backers Of An Ohio Drug Pricing Initiative File Suit To Force Action; Kansas Lawmakers Mull Physician Assistant Limits

News outlets report on health care developments in Ohio, Kansas, Louisiana, North Carolina, Illinois, Colorado, California and Georgia.

Partners In Proposed Tennessee Merger Pledge $450M In Community Benefit If Deal Goes Forward

Also in Tennessee, Community Health Systems announces that its spinoff of 38 small-market hospitals into a new company will take place by the end of June, rather than its initial March target date. News outlets also report hospital news from Massachusetts, Illinois, Kansas and Florida.

FTC Sends Message On Patient Data Protection With $250,000 Settlement

The Federal Trade Commission has settled with Henry Schein Practice Solutions, a company that supplies products and services to dental, medical and animal health providers, over allegations that it "falsely advertised the level of encryption it provided to protect patient data.” In other technology news, business leaders and lawmakers in Massachusetts want to create a digital health care hub.

Viewpoints: Jeb Bush On His Family’s Addiction Crisis; Don’t Penalize Doctors For Prostate Tests

A selection of opinions on health care from around the country.

Viewpoints: GOP’s Repeal Vote Is Not ‘Pointless’; Medicaid Expansion Debates Rev Up Again

A selection of opinions on health care from around the country.

State Highlights: N.H. Heroin, Opioid Task Force To Take Proposals To State House; Conn. Grapples With Cost Transparency Law

News outlets report on health care developments in New Hampshire, Connecticut, Missouri, Ohio, Washington, Delaware and Maryland.

Debate On Kidney Transplants: Should Donors Be Paid?

The Washington Post offered a variety of opinions from experts about how to increase the number of kidney donors.