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written by Dan Goldberg
MAPPING INSURANCE ENROLLMENT BY COUNTY — Check out this map from Brendan Cheney, which shows how many customers every insurer in New York enrolled in each county during the second year of the Affordable Care Act. Hover over a county to see the stats. What the map shows is that while some insurers performed well downstate, they were unable to enroll members in most of New York's upstate counties, where there appears to have been greater price sensitivity. Emblem Health, for example, captured 6 percent of the overall state market but in some counties only a handful of residents signed up. In Otsego County, only one person out of 1,150 enrollees chose Emblem, and in Saratoga County, only three people out of 4,114 chose Emblem. http://politi.co/1WR2HkI
…Other trends include the high uptake of out-of-network products, which is pointed out on the Health Care For All New York blog. “During the 2015 Open Enrollment period, carriers offered Qualified Health Plans (QHPs) through NYSOH with out-of-network coverage in 11 counties of the state: Albany, Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Rensselaer, Saratoga, and Wyoming counties. In these 11 counties, a whopping 21 percent of [private insurance] enrollees selected plans with an out-of-network benefit.” It’s notable that most of these counties are in more rural parts of the state where providers are harder to find. http://bit.ly/1U5bK2T
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ACO NUMBERS ARE IN — Montefiore Health System's Accountable Care Organization shaved 3.6 percent off its benchmark Medicare costs, saving taxpayers $18 million in 2014. Montefiore remained one of the highest performing ACO's in the bunch and will keep $8.4 million of the $18 million it saved the Medicare program.
NOW WE KNOW — New Yorker cartoons reveal attitudes toward parenting, according to a paper scheduled to be presented at the 110th annual meeting of the American Sociological Association. They found that during eras when child-rearing is considered harder, the cartoons show more ambivalence about the little bundles of joy. http://bit.ly/1U5ec9m
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PARTNERING — Montefiore Health System continues to expand into Westchester County, and announced Tuesday a strategic partnership with Burke Rehabilitation Hospital in which Montefiore will become the active parent. This is the latest in a series of moves by Montefiore and other health systems designed to vertically integrate their services so every part of a patient experience is under one system. http://politi.co/1NSXaUM [PRO]
MORE CONSOLIDATION — State officials have given final approval for Peconic Bay Medical Center to join North Shore-LIJ Health System. PBMC, a 200-bed community teaching hospital, had been part of the East End Health Alliance, which also included Southampton and Eastern Long Island Hospital. The other two members of the alliance have affiliated with Stony Brook University Hospital. PBMC becomes North Shore-LIJ's 21st hospital extending the health system's reach into Suffolk County. North Shore-LIJ also has Huntington Hospital, Southside Hospital in Bay Shore and South Oaks Hospital in Amityville.
TAKING ON SYNTHETIC MARIJUANA — The City Council will introduce legislation next month that would suspend or remove tobacco licenses from businesses caught selling synthetic marijuana, the New York Post reported. According to the report, sales of the synthetic drug, which is illegal and is known on the street as “K2” or “Spice,” would be punishable by up to a year in prison or a $5,000 fine followed by fines of up to $25,000. The bills, which will be introduced by Speaker Melissa Mark-Viverito and other members, come after law enforcement officials seized almost 8,000 bags in her East Harlem district. Read the report here: http://bit.ly/1JgN1xX
GRANT LAND — The University at Buffalo received a $2.5 million, four-year grant from the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health to study the toll police work takes on officers. “This research will provide important insights into how the stressful demands of police work impact the long-term health of officers, giving us valuable data from which to explore ways to improve the lives of those who choose this noble profession,” U.S. Rep Brian Higgins said in a press release from the school. http://bit.ly/1JtIsj4
REVOLVING DOOR — POLITICO reports: “Aryana Khalid, who served as Marilyn Tavenner’s chief of staff at CMS, will be joining her at the insurance industry’s top lobbying organization. Khalid’s departure from the federal government was announced at the same time as Tavenner’s in January. Khalid subsequently took a position as vice president for health care services strategy at CVS Health.”
SENTENCING — Oscar Huachillo, the former owner and operator of multiple HIV/AIDS clinics in New York City, was sentenced Tuesday in federal court in Manhattan to 87 months in prison for orchestrating a scheme to defraud Medicare out of more than $31 million. Huachillo, according to the criminal complaint, routinely billed Medicare for medications that were never provided or were provided at highly diluted doses, or were simply unnecessary. The scheme preyed on HIV/AIDS patients who were eligible for Medicare, according to the U.S. Attorney’s office. http://1.usa.gov/1U5b4dz
ACROSS THE RIVER — POLITICO New Jersey’s Katie Jennings reports that three New Jersey Democrats introduced a bill last week that would require a minimum staffing ratio in the state’s nursing homes. But it appears one key player was left out of the discussions: the trade association that represents nursing homes. The bill has the support of 1199 SEIU, the union that represents certified nursing assistants. But the Health Care Association of New Jersey, the trade association that represents the state’s nursing home facilities, said they were not involved in the discussions. http://politi.co/1WQZGRF
ALSO ACROSS THE RIVER — POLITICO New Jersey’s Ryan Hutchins looks at the battle to take over Saint Michael’s Medical Center in Newark. Prime Healthcare, the for-profit chain that showed interest in Long Island College Hospital, is still the front-runner but the Christie administration has refused to approve the sale. http://politi.co/1NSUXZw
PHARMA REPORT: Medtronic has agreed to acquire Twelve Inc., a company that develops valve replacement devices, for $458 million, according to The Wall Street Journal. The transaction, expected to close in October. http://on.wsj.com/1WR0Igg
… Jeanne Whalen explains how Medtronic is taking advantage of the tax benefits it gained after reincorporating overseas earlier this year. “Medtronic moved its headquarters to Dublin from Minneapolis after acquiring Dublin-based Covidien PLC for $43 billion. That move allowed the medical-device maker to spend more of its overseas cash in the U.S. without having to pay U.S. tax on it — a perk Chief Executive Omar Ishrak has said Medtronic would use to help it acquire U.S. technology.” http://on.wsj.com/1WR0Igg
WHAT WE’RE READING:
-THE OTHER ABORTION BATTLE — Charles Ornstein examines the latest front in the battle over abortions by looking at the fight over public records, which show how many abortions take place and the details surrounding those abortions. “Increasingly, abortion opponents are pursuing personal and medical information on women undergoing abortions and the doctors who perform them. They often file complaints with authorities based on what they learn.” Pro-life activists say they are trying to protect women from unscrupulous clinics, while pro-choice proponents say the intent is to intimidate women and doctors by using the loss of privacy as a weapon. http://bit.ly/1U5cJQn
-THE CADILLAC TAX — About one-quarter of employers will have to pay the Affordable Care Act’s Cadillac tax when it begins in 2018, according to a Kaiser Family Foundation report. http://bit.ly/1JvStAP
… Why does this matter? Because it means employers will likely look to cut benefits. For example, flexible spending accounts could disappear, according to Larry Levitt, a senior vice president at the foundation.
-EXPERTS AGREE — A panel of experts told the White House that federal and state Medicaid programs should widen access to the very expensive drugs that can cure Hepatitis C. States, including New York, are choosing to provide drugs such as Sovaldi and Harvoni only to the sickest patients because of their costs, but that is not sound medical practice, the experts say. The problem is that no one has any idea how the Medicaid program would pay for this expanded access. http://nyti.ms/1U5buk9
-THE PROBLEM WITH PATIENT ENGAGEMENT — Recent federal data show that fewer than a quarter of patients have ever tried to look at their electronic medical records. POLITICO’s Arthur Allen explains why that might be — including insufficient apps and technology that’s hardly user-friendly.
-ALARMING STAT — Alzheimer's Disease International says there is a new dementia case every 3.2 seconds. The global costs of dementia increased from $604 billion in 2010 to $818 billion in 2015 — now representing 1.09 percent of the world’s GDP. http://bit.ly/1NFxux1
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TODAY'S TIP — Comes from Montefiore Health System, which offers us “these tips to ease your fear of using public restrooms.” http://wb.md/1Uci3fE
-SOUND AND FURY — Researchers at NYU Langone Medical Center, writing in Nature Neuroscience, explain how even brief exposure to sudden sounds or mild trauma can form permanent, long-term brain connections, or memorie. The researchers looked at the locus coeruleus, which according to a press release from Langone, is the area responsible for releasing noradrenaline, the fight or flight hormone. "Our study gives us deeper insight into the functions of the locus coeruleus as a powerful amplifier in the brain, controlling how and where the brain stores and transforms sudden, traumatizing sounds and events into memories," senior study investigator and neuroscientist Robert Froemke, an assistant professor at NYU Langone and its Skirball Institute of Biomolecular Medicine, said in a press release from Langone. "Our findings, if confirmed by future studies in animals and people, should help us better understand how to improve hearing and memory abilities in those suffering from hearing loss or possibly even Alzheimer's disease, as well as how to alter or minimize memories involved in disorders like post-traumatic stress disorder." http://prn.to/1JtBmuT
-ROAD TO RECOVERY — Researchers at the Icahn School of Medicine at Mount Sinai, writing in the Proceedings of the National Academy of Sciences, explain how antidepressants can change the levels of a key signaling protein in the brain that processes both pain and mood. The study explains that the recovery from pain and depression are controlled by the gene RGS9 and the protein it codes for RGS92. Mice that lacked the gene responsible for encoding RGS9-2 responded much earlier to very low doses of antidepressants, showed significant improvement of sensory deficits and had no signs of depression-related behaviors, according to a press release from the school. “We don’t yet know if the typical pain-processing pathways in the spinal cord and the pathways we’ve identified in the brain reward center are directly linked, but we now know more about the cellular pathways that need to be activated in order to achieve pain relief and that effective therapeutics must target both pathways,” Venetia Zachariou, associate professor in the Fishberg Department of Neuroscience and the Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, said in the release. http://bit.ly/1JtIg3f
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