In the News: October 26–November 1

HHS Proposes State Flexibility for 2019 Public Exchanges

HHS released a proposed rule aimed at providing states greater flexibility in managing their public exchanges for the 2019 plan year. Most notably, the proposal would allow states to have a greater say in how essential health benefits are defined. Rather than accepting the national standard as defined by HHS, which has been the case since the passage of the Patient Protection and Affordable Care Act, states would have 3 options to redefine these benefits.

If finalized, Sg2 experts believe this is likely to increase the “underinsured” population and decrease demand for select preventive and disease management services in states that pursue these changes. 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.

Genome Sequencing Triumphs in the NICU

A Clinical CoLab Session at the American Society of Human Genetics Annual Meeting made headlines for its staggering findings on quality improvements and cost savings in neonatal and pediatric intensive care units (NICUs and PICUs). The research team’s “Rapid Whole Genome Interpretation for Genetic Diseases in NICU and PICU Patients” presentation reported reduced LOS by 31% and inpatient cost reduction by $1.8 million when rapid whole-genome sequencing was used.

Fast diagnoses allow for immediate indicated treatments, a decrease in LOS and the halting of unnecessary testing and procedures. Considering the expense of each day in an intensive care unit, these findings will be useful for overcoming insurer reimbursement challenges.

Whole genome sequencing is one of the innovative technologies Sg2 recommends for comprehensive pediatrics programs. Refer to the Sg2 STEP™ Technology Profile for whole genome sequencing key facts and strategic considerations.

Half of Hospital-Associated Medical Care Occurs in the ED

A study by researchers at the University of Maryland School of Medicine is the first to quantify the proportion of ED care from total US health care. Researchers found that EDs contributed an average of 47.7% of hospital-associated medical care delivered in the US from 1995 to 2010, with steady yearly increases and disproportionately high usage among minorities and women.

This statistic provides insight into how health care is delivered in the US and perhaps even the wants and needs of patients. The authors conclude change will be slow, given the current structure of the health care system, and recommend connecting ED care to care delivered by the rest of the system.

This concept is central to Sg2’s System of CARE—optimizing care at every step in your system will contribute to reductions in ED care proportions. Read the Sg2 Expert Insight: Sg2 Projects Flattening ED Demand Nationally, Despite Recent Increase in ED Use to review our unique methodology, as well as our forecasted ED projections.

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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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