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In the News: November 23–29

US Scientists Try First Internal Gene Editing

For the first time, US scientists tried editing a gene inside a human body, attempting to change the patient’s DNA to cure a disease. As part of an experiment, a man with Hunter syndrome—an incurable metabolic disease where the body is unable to produce an enzyme that breaks down certain carbohydrates—was given a gene therapy that involves inserting billions of copies of a corrective gene and zinc finger nucleases, a gene-editing tool, into his liver cells. The zinc fingers cut the DNA in a precise location, allowing the new corrective gene to slip in and instruct the cell to produce the enzyme that the patient lacks. In 3 months, tests will show if the therapy was effective.

Sg2 believes that innovations in the constantly evolving field of precision medicine will change the way medicine is practiced, from screening and diagnostics to therapy. Register for the upcoming Disrupters to Watch in 2018 webinar to see the Sg2 Technology team discuss disrupters and key innovations for the coming year.


Retroactive Medicaid Rollbacks Impact Hospitals

With approval from the federal government, Arkansas, Indiana, New Hampshire and Iowa——all Medicaid expansion states—have eliminated retroactive coverage for some Medicaid populations, maintaining that this will encourage people to sign up for health insurance while they are healthy. The changes apply to varying groups across the states; most notably, Iowa rescinds retroactive eligibility to all groups except pregnant women and children under age 1.

Impacts of these policy decisions include increased likelihood of medical debt among the poor and increased uncompensated care, leaving hospitals to absorb the costs. The Medicaid program in Iowa is estimated to save $36 million from these cuts.

Medicaid waivers can dramatically impact revenue and pose confusion and uncertainty in hospitals and Systems of CARE. Register for the upcoming Payment and Policy Update 2017 webinar, where Sg2 policy experts will discuss various Medicaid waivers and their implications.


States Begin Enacting Contingency Plans for CHIP

States have begun to address projected funding shortfalls for the Children’s Health Insurance Program (CHIP), as federal funding ended on September 30. Some states have accessed unused federal funding to finance CHIP beyond this date; however, Minnesota has reportedly become the first state to exhaust those funds. As additional states are expected to also run out of federal funding in the coming months, the following contingency plans have been announced:

  • Redirecting State Funds: Several states have allocated additional funding to maintain coverage for all or some groups under CHIP; however, some state laws may not permit CHIP programs to continue without federal funding. In one such state, Arizona, the governor has stated that legislators are negotiating to lift this restriction.
  • Enrollment in Medicaid: Some states are planning enroll groups that otherwise qualify for Medicaid into the Medicaid program. Oregon projects that 40,000 children would be moved to Medicaid.
  • Ending CHIP Programs: States unable to maintain CHIP programs have begun notifying beneficiaries of projected termination dates. Colorado is sending informational letters to advise CHIP members to research alternatives in anticipation of the program’s end on January 31, 2018.

The House and Senate have notably taken up CHIP funding bills, but no consensus has been reached. Contingency plans vary by state, and providers should reach out to their state officials to be a part of the dialogue in navigating the difficult choices to mitigate impact. Check out the Sg2 FAQ, Impact of Policy Changes on Pediatrics, to examine the wide range of possibilities that have been discussed, with a specific focus on pediatrics.

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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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