Revealing the secret prices insurers pay can save health care

A bold proposal to publish tightly held secrets about health care prices could unleash the power of markets to lower health care costs.

The Department of Health and Human Services has released a request for information on a proposal to create public access to real price information in health care under the regulatory framework of the Health Insurance Portability and Accountability Act (HIPAA). Unlike the mandate earlier this year from the Centers for Medicare and Medicaid Services that requires hospitals to publish their so-called chargemaster prices, the HHS proposal would shed light on the secret negotiated prices insurance companies pay.

Making these prices public would infuse much-needed competition into health care’s bloated $3.5 trillion market.

The full STAT article can be viewed at this link.  

Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis

We have found consistent evidence from high-income countries that low socioeconomic position (SEP) is a risk factor across several components of service use at the end of life, including dying in hospital rather than at home, receiving acute hospital-based care in the last 3 months of life, and not receiving specialist palliative care in the last year of life. We also found evidence of a pervasive social gradient in place of death and use of specialist palliative care. These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life. We recommend that all research on care received towards the end of life should attempt to account for SEP, end-of-life care interventions should be analysed for their different effects across the social strata, and the planning and provision of end-of-life care services should consider SEP in local populations.

The full article can be downloaded below.  

Three Years Down the Road: The Aftermath of the CDC Guideline for Prescribing Opioids for Chronic Pain

The 2016 CDC guidelines for opioid prescribing by primary care physicians have exposed some shortfalls in our thinking about opioid use and stranded many chronic pain patients with inadequate analgesia. Opioid prescribing rates started to decline in 2012, but still remain high. The response from providers to the 2016 guidelines have led to unintended consequences. Some of the CDC guidance seems arbitrary and not supported by evidence (the 90 MME per day cutoff). Patient and prescriber education, the role of buprenorphine (an atypical Schedule III opioid), and abuse-deterrent opioids are not mentioned at all but could play crucial roles in reducing abuse. Opioid use disorder (OUD) is not defined by the guidance which calls on primary care physicians to recognize and treat it. Opioid withdrawal syndrome is not mentioned and tapering plans, although advised, are not described in a practical way. While the morbidity and mortality associated with OUD are public health crises, so is untreated pain. Chronic pain patients deserve consideration, yet emerge as the silent epidemic within the opioid crisis. To be sure, there is much good in the CDC guidance or any guidelines that urge caution and care in opioid prescribing. Pain specialists must speak out to advocate for patients dealing with pain, to educate patients and prescribers about analgesic options, and to make sure that pain is adequately treated particularly in vulnerable populations.

The full commentary can be downloaded below.  

Priorities and challenges for health leadership and workforce management globally: a rapid review

Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers.

A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified.

Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers.

Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.

The full article can be downloaded below.  

Opioids and Cancer Pain: Patients’ Needs and Access Challenges

Opioids are a mainstay in the treatment of cancer-related pain and end-of-life symptoms. This class of medications, long used by oncologists, is facing new scrutiny and restrictions as medication and illicit drug abuse in the United States has steadily increased, creating in recent years what has now been termed an “opioid epidemic.” Oncologists experience the opioid epidemic on several fronts: (1) treating patients who have legitimate pain needs in addition to their own addiction issues; (2) seeing patients suffer the repeated heartaches of having a family member struggling with addiction; and (3) now more commonly, facing barriers, restrictions, and hurdles to ensuring that an individual with cancer or cancer treatment– related pain is able to obtain adequate pain control.

The full article can be downloaded below.  

BEST PRACTICES AND GUIDELINES FOR JAIL-BASED MEDICATION-ASSISTED TREATMENT

Medication-assisted treatment (MAT)—utilizing the FDA-approved medications methadone, buprenorphine, or naltrexone—is considered a central component of the contemporary standard of care for the treatment of individuals with opioid use disorders.

Best Practices

• Determine enrollment - Individuals should be clinically assessed for substance abuse disorders and recommended treatments.
• Determine the correct treatment - Shared decision making and regular testing should be used to inform treatment.  
• Consider pregnant women - Pregnant women require specialized treatment.
• Partnerships and support services - Couple MAT with other services and collaborative relationships.
• Have the right program components - Assemble the right team, safeguards, protocols, and structure for success.
• Client screening - Client screening is important for addressing treatment continuation, withdrawal, and relapse.  
• Facilitate health care coverage - Engage Medicaid and postrelease financial assistance.

The full resource can be downloaded below.  

Caring for the mental health of the medical workforce: Best Practices

This report marks the first stage of the project and provides a summary of findings from a large-scale survey of both doctors and medical students. The survey, which was open to BMA members and non-members across the UK from 10 to 31 October 2018, received over 4,300 responses including around 1,400 medical students. The survey provides a quantitative overview of experiences and attitudes to mental health and offers a starting point for the next stage of our project which is a more in-depth qualitative study.

Best Practices

• Building a supportive culture - Valuing the workforce, preventing the cause of ill-health, raising mental health awareness, using innovation, and offering support are all means to improve in this area.
• Enhancing access to support - Improving awareness of services, meeting service user needs, and providing spaces to rest can improve this area.  
• Encouraging self-care and peer support - Valuing and maintaining one's mental health, and offering support to colleagues can improve this area.  

The full article can be downloaded below.  

County Jails Struggle With A New Role As America's Prime Centers For Opioid Detox

Faced with a flood of addicted inmates and challenged by lawsuits, America's county jails are struggling to adjust to an opioid health crisis that has turned many of the jails into their area's largest drug treatment centers.

In an effort to get a handle on the problem, more jails are adding some form of medication-assisted treatment, or MAT, to help inmates safely detox from opioids and stay clean behind bars and after release.

But there are deep concerns about potential abuse of the treatment drugs, as well as worries about the efficacy and costs of programs that jails just weren't designed or built for.

The full NPR article can be viewed at this link.  

US Healthcare Trends and Contradictions in 2019

Over the past several years, many healthcare trends have been identified as micro rather than macro as incremental year-to-year changes dominated the US healthcare market. Looking at 2019 and toward 2020, the shift to macro-level trends returns, reflecting market transformation during the Trump administration. For example, many 2017 and 2018 trends were a continuation of micro themes, such as benefit design offerings, care delivery initiatives, contracting, or early technologies for monitoring personal health status.

Now, structural and broader market changes are part of a bigger economic transformation that includes healthcare as a major beneficiary. As a result, in 2019 many trends are macro-focused, in addition to some continuing micro aspects, all of which are being transformed in parallel. Much of the innovation efforts to date have led to trends that move us from micro to macro perspectives on change.

The forecasted trends identified in this article focus on the macro and micro levels that may emerge or are just emerging, depending on your perspective. Furthermore, some trends may be opposing to other trends, which reflects the uncertainty along with the diversity of change in healthcare, globally and nationally.

The full article can be downloaded below.