#PNN In Other News

Here are some other local, state or national stories we are reading that may impact you, your practice or your patients.

Physician-led accountable care organizations outperform hospital-led counterparts | New data shows that physician-led accountable care organizations in the Medicare Shared Savings Program outperformed hospital-led ACOs — and not by a little, but by a significant margin. And according to the Avalere analysis, MSSP ACOs continue to achieve higher savings the longer they participate in the program. The MSSP is Medicare's largest alternative payment model, and seeks to transition Medicare away from fee-for-service payment into a new value-based framework. In 2018, 548 MSSP ACOs provided care to more than 10 million Medicare beneficiaries and reduced Medicare spending by $739 million. Under the Pathways to Success changes to the MSSP, CMS now classifies ACOs as "low revenue" or "high revenue." That's based on a threshold of Medicare Parts A and B revenue for ACO participants that is associated with the ACO's assigned beneficiaries. The distinction is made by CMS to classify ACOs as physician-led or hospital-led, respectively.

Google Health is finally opening up about its plans, and they’re all about search | Google hired David Feinberg from Geisinger Health, a system of hospitals based in Pennsylvania, toward the end of 2018 and put him in charge of a newly created division called Google Health. But the company has remained quiet about the division’s scope and goals. Now he’s beginning to talk publicly about his plans, and appeared on stage at HLTH, a health care conference in Las Vegas, this week [Oct. 27-30]. Feinberg, a doctor who describes himself as “no tech guy,” is focusing his efforts on Google’s core expertise in search, looking to make it easier for doctors to search medical records, and to improve the quality of health-related search results for consumers across Google and YouTube, according to his statements at HTLH and conversations with people familiar with his plans. Google has dabbled in health care for years, lured by the size of the opportunity. Health care represents a $3.5 trillion market, which still relies on a lot of manual processes. But the company has struggled with some of its early endeavors, such as its contact lens that aimed to measure blood glucose in tears and its Google Health medical record service, so the hire of Feinberg out of the traditional health sector is a recognition that the search giant will need to partner with the medical sector to have an impact.

Facebook Is Getting Into Healthcare. Is That A Good Idea? | On Oct. 28, Facebook announced it added a healthcare feature to its platform. This tool will take a user's age and gender and then provide preventative healthcare information, such as suggested checkups. "The tool allows people to mark when tests are completed, set reminders to schedule future tests and tell loved ones about the tool to increase awareness of preventive care. People can also learn more about each checkup and find affordable places to receive care," said Facebook in a press release. Facebook said the aim of this new feature is to help users become more proactive when it comes to their health. In the press release, the social media company said it realizes many people do not have health insurance and to help these users get affordable care, the preventative health feature helps users find nearby Federally Qualified Health Centers. Located in disadvantaged regions, the health centers offer care to everyone, even if they cannot pay for it. 

How Much Do Medicare Beneficiaries Spend Out of Pocket on Health Care? | Many policymakers and presidential candidates are discussing proposals to build on Medicare in order to expand insurance coverage and reduce health care costs, and improve financial protections and lower out-of-pocket costs for people currently covered by Medicare. More than 60 million people ages 65 and older and younger people with long-term disabilities currently rely on Medicare to help cover their costs for health care services, including hospitalizations, physician visits, prescription drugs, and post-acute care. However, Medicare beneficiaries face out-of-pocket costs for their insurance premiums, cost sharing for Medicare-covered services, and costs for services that are not covered by Medicare, such as dental care and long-term services and supports. In 2016, the average person with Medicare coverage spent $5,460 out of their own pocket for health care (Figure 1). This average includes spending by community residents and beneficiaries residing in long-term care facilities (5% of all beneficiaries in traditional Medicare). Among community residents alone, average out-of-pocket spending on premiums and health care services was $4,519 in 2016. But some groups of beneficiaries spent substantially more than others. Current Medicare-for-all proposals in Congress and from presidential candidates would largely eliminate out-of-pocket costs for premiums and patient cost sharing, including for people now covered under Medicare.

UPDATE: Santa Clara County approved Laura’s Law referral, youth e-cigarette ban | In just six weeks, Santa Clara County could adopt Laura’s Law, more than 17 years after the assisted outpatient treatment program was passed into state law. The Board of Supervisors on Tuesday [Nov. 5] unanimously approved a referral for administration to consider options for adoption, which will come back to the dais Dec. 17. The law would allow a court to compel services to mentally unstable individuals who refuse treatment, but would only apply to a specific group of people who have formerly been hospitalized or incarcerated as a result of their mental illness. Supervisors Cindy Chavez and Dave Cortese, who led the proposal, say they want to focus on helping this small population of residents – instead of alienating them. “We are not intending to criminalize people who are mentally ill,” Chavez said. “We’re really intending to figure out what are the best tools to serve those very, very hard to serve populations.” While she supported exploring adoption of the law, Supervisor Susan Ellenberg reminded her colleagues of programs already in place within the county’s Behavioral Health Department. “I think it’s critical to look at what we just put in place, and where we still have gaps and bottlenecks in accessing services,” Ellenberg said. Ellenberg added that she’d be interested in status reports on establishing a mental health triage center, as well as the feasibility of establishing a medical detox facility. Chavez agreed, thinking that a medical detox facility is still a missing link in services.

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