In the News: Nov 30–Dec 6

CVS Health to Buy Aetna for $69 Billion

On Sunday, CVS Health announced it had agreed to buy Aetna for about $69 billion. A combined CVS-Aetna could position itself as a formidable figure in health care as the companies touch most of the basic health services that people regularly use. However, critics are worried about how this deal could limit customer choice if people covered by Aetna are forced to go to CVS for much of their care.

The merger of a drugstore giant with one of the largest health insurers in the US comes at a time of great uncertainty in the industry. Register now for the Sg2 webinar, 2018: The Year Ahead, where Sg2 experts will highlight key trends to watch and potential wildcards for the coming year.

Value-Based Benefit Designs Impact Elective Health Care Services Usage

A recent Health Affairs study compared the effects of reference-pricing and centers-of-excellence value-based benefit designs on the utilization and prices of elective health care services, finding that both designs prompted patients to choose their plans’ designated high-value providers to avoid higher out-of-pocket spending at nondesignated facilities.

However, reference-pricing design (where designated facilities accept charging up to a reference price for certain elective procedures) reduced payments per case but not utilization rates, whereas the centers-of-excellence design (where health maintenance organization enrollees are required to use a designated facility to receive coverage) lowered utilization rates but did not reduce average payments per case. This suggests that reference-pricing design is more suitable for reducing price variation, while the centers-of-excellence design is more suitable for addressing variation in use.

As insurers continue to offer novel value-based benefit designs, Sg2 believes that health systems have the ability to shape their strategic direction toward value-based care. To learn more about how value-based care models are evolving in different markets, read the Sg2 report: The Race to Risk—Tracking Markets’ Evolution Toward Value-Based Care.

Mortality Rate Is Rising in Opioid-Driven Hospitalizations

By utilizing the National Inpatient Sample, researchers revealed that opioid-driven hospitalization mortality increased from 0.43% before 2000 to 2.02% in 2014, while hospitalization mortality from other drugs was unchanged.

Volumes have shifted from opioid dependence or abuse diagnoses to opioid or heroin poisoning, and the higher-case fatality rate in poisoning drives the increasing mortality rate seen in hospitals. The study also found that patients admitted for opioid/heroin poisoning are more likely to be white, aged 50–64, Medicare beneficiaries with disabilities and residents of lower-income areas.

Efforts to battle the opioid epidemic have centered around treatment and community rescue outside of a hospital. For a true System of CARE approach that includes crisis stabilization and detox within the inpatient setting, watch the on-demand Sg2 webinar, Behavioral Health Update: Addiction and Chemical Dependency Landscape.

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