In the News: October 12–18

White House Announces End of CSR Payments to Insurers

On October 12, the White House announced that the administration will end federal cost-sharing reduction (CSR) payments to insurers. Previously, CSR payments had been made to reimburse insurers for reductions in cost sharing (eg, deductibles) for low-income enrollees in silver plans. While these reductions in cost sharing are required under the Patient Protection and Affordable Care Act (ACA), funds had not been explicitly appropriated for federal CSR payments to insurers.

In other words, insurers offering plans on the public exchange markets are directly impacted by this announcement. However, discerning the potential impact for enrollees and providers will be highly nuanced. For more information on how your state regulators are planning to respond, see this Health Affairs article and a group of bloggers’ state tracker. Finally, expect additional headlines as congressional leaders attempt to navigate a bipartisan solution.

As the policy landscape continues to evolve, Sg2 is excited to offer an interactive way for members to get their health care policy questions answered. Register now for the upcoming Experts Live: Q&A With Sg2’s Health Care Policy Team on December 7 for an open dialogue on the latest in health care policy.

High-Deductible Health Plans Reduce Health Care Cost and Utilization

A recent study in Health Affairs examined the impact of high-deductible health plans (HDHPs) on health service utilization and cost reduction. The study suggests that high-deductible health plans are associated with lower health care costs due to a reduction in enrollees’ use of health services, such as inappropriate care (eg, low-acuity ED visits). However, the study also showed a decrease in HDHP enrollees’ use of appropriate care, including necessary care, recommended preventive services (eg, cancer screenings) and medication adherence.

Given that the advent of HDHPs has shifted greater responsibility to the health care consumer, Sg2 believes that organizations have an opportunity to attract consumers through consumer-centric strategies focused on value and convenience. To learn more about engaging consumers in an evolving, value-based environment, read the Sg2 report: Reinventing the Patient Journey: A Consumerism Update and Outlook.

Increase in Obesity Rates Drives Market for Bariatric Surgery

The CDC recently released a report detailing obesity rate trends in the US. Obesity prevalence was 39.8% among adults and 18.5% among youth in the US in 2015–2016, up from 30.5% and 13.9% in 1999–2000, respectively.

The Sg2 report, Surgery Forecast 2017, details how the increasing obesity rate in the US has created a potentially large market for bariatric procedures, as a growing base of clinical evidence documenting the metabolic/hormonal benefits of bariatric interventions makes them an attractive option for obese individuals. To read more about this and other surgical trends, check out the 2017 forecast here.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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