Welcome to The Donut Hole’s weekly summary. The news doesn’t stop. Lucky for you, we are here to help you take in the week that was in the business of healthcare.
GoodRx inks deal with Surescripts to provide information on cash prices for drugs
Emerging health tech giant GoodRx has partnered with e-prescribing leader Surescripts to deliver drug discount price information to prescribers when they are prescribing medications for uninsured patients and patients whose price information isn’t already available from their pharmacy benefit manager (PBM) or health plan. By improving price transparency at the point of care, the companies hope clinicians can have more informed conversations with their patients and ensure they can afford the treatment they need before arriving at the pharmacy counter.
About 1/3 of Americans say they have skipped filling a prescription for a chronic condition one or more times because of the cost, according to an internal GoodRx survey.
Commentary: We’ve talked about medication non-adherence and no-fill rates before (including here), so we are encouraged by the partnership and hope that it will actually help the uninsured and underinsured access the medications they need. We’ll be following this one closely to see what impact it actually has in the real world. We suspect those of you who help manage and support individuals with chronic conditions feel the same way.
As an aside, a really interesting expansion of the partnership would be automating enrollment for patient support programs (what we talked about in last week’s issue with Pfizer’s lawsuit). Combining GoodRx’s access to discounted prices and copay and coinsurance relief from support programs could materially increase fill rates, adherence, and, presumably, outcomes.
Medicare-reliant hospitals perform worse financially, more likely to face closure or acquisition: Health Affairs
In news that is unlikely to surprise anyone, a new study from Health Affairs finds that hospitals with a higher share of Medicare patients had lower profits and were more likely to be acquired or close compared with hospitals less dependent on Medicare. Medicare pays lower rates than commercial payors, so that makes sense. What is interesting is that the study throws cold water on the theory that hospitals tend to raise commercial prices to make up for lower reimbursement from Medicare and Medicaid (i.e. cost shifting). Rather, Health Affairs argues for “consolidation-induced cost shifting,” which attributes higher commercial prices to provider consolidation as the hospitals that rely more on Medicare and Medicaid are forced to close or sell to more financially stable health systems. Those remaining health systems, with the competition eliminated, can then flex their muscle and negotiate higher reimbursement rates from commercial plans.
Hospitals with higher Medicare discharges were more likely to be nonteaching facilities in rural areas with fewer beds. They were also more likely to be in counties with an older and slower-growing population. In terms of policy implications, the researchers warn that "reductions in public prices must be undertaken cautiously. Mechanisms to limit closure- or acquisition-induced increases in commercial hospital prices may be important."
Commentary: For those of you with a background or interest in policy and population health, this is a very interest piece with a clear application to rural healthcare in particular. We need strategies in place to ensure the viability of our rural care settings. Otherwise, Americans living in those areas will continue to face serious access challenges and / or exorbitant commercial pricing.
Primary care docs, facing 'existential' threat, fear for profession's future
A recent survey from the Larry A. Green Center and Primary Care Collaborative painted a dire picture for the future of primary care. 40% of clinicians worry primary care will be gone in just five years, and 21% say they expect to leave primary care within 3 years. The survey also included policy proposals from the clinicians to strengthen primary care. Responses included:
Protect primary care as a "common good" - available to anyone regardless of ability to pay
Change how primary care is financed so that it is not in direct competition with specialty care
Change how primary care is paid, moving away from majority fee-for-service to value-based payment models
Improve health data infrastructure to streamline health information exchange
Allow for more professional autonomy and decision-making power
Revamp electronic medical records to capture patient narratives & care delivery process
The survey also touched on the ongoing challenge of COVID for PCPs. A large majority practices now say they have enough vaccine supply or have vaccine partnerships in place with government groups, but vaccine hesitancy and misinformation is weighting on providers and leading to burnout. Per one clinician in Illinois, “Vaccine hesitancy requires at least 5-10 minutes of counseling for a less than 30% success rate.” Another in Tennessee noted, “I am exhausted from trying to counter the myths about COVID and the vaccine.”
Commentary: We’ve consistently written about the slow but steady shift to value-based care. This survey highlights that the pace may not be fast enough, especially in the Commercial and Medicaid markets. One item to think about for those of you in primary care, the shift to value may enable you to have more control over your patients’ care plans and increase reimbursement, but it will also require more robust quality metrics reporting to plans and more care coordination with other providers. Practices will need to invest in better workflow tools. Otherwise, there will be an even greater administrative and documentation burden on already burned-out providers.
Other news you may like:
U.S. ranks last among 10 other countries in new study on healthcare systems
Boston Scientific, Stryker get extra year of add-on payments as CMS adjusts to pandemic
Telehealth waivers wind down, restricting some providers from delivering care across state lines
CMS axes hospital price transparency mandate from 2022 inpatient payment rule
Democrats reintroduce legislation to create Medicaid-based public option
JPM venture arm Morgan Health invests $50M in value-based primary care player Vera
Honor Acquires Home Instead to Transform Care Experience for Caregivers and Older Adults
Altoida's Alzheimer's-predicting smartphone app snags FDA breakthrough status
Nanox offers up to $200M to pool digital X-ray technology in Zebra Medical merger
'Damning assessment' finds few ties between physicians' MIPS scores and stronger surgical outcomes
One Medical Employees Say Concierge Care Provider Is Putting Profits Over Patients
Average signing bonuses for 5 most recruited medical specialties
Have a great week!
— Hannah and Caleb Bank, Co-founders
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