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POLITICO New York Health Care: A DSRIP Concern; Health Republic winding down

Dear readers: POLITICO New York Pro subscribers receive this email at 5:30 a.m. each weekday. If you'd like to receive it at that time, along with a customized real-time news feed of New York health care policy news throughout the day, please contact us at lenglander@politico.com and we'll set you up for trial access.

written by Dan Goldberg

A DSRIP CONCERN — The state’s Delivery System Reform Incentive Payment program is supposed to herald unprecedented collaboration between large health systems and so-called downstream providers such as Federally Qualified Health Centers and other community based organizations. The problem is these are groups that tend not always to see eye to eye. DSRIP is structured so that the PPS lead — most often hospitals — will decide how to spend the more than $7 billion that New York and the federal government have devoted to these projects. Thousands of providers and community-based organizations of varying size and strength are vying for a finite pot of money, a struggle bound to cause lots of internal battles among the very groups needed to make the state's ambitious reform a success. These battles can only be avoided if DSRIP is seen not as a reform of the delivery system, its name notwithstanding, but as a bridge loan to a world of value-based contracts. Read my full story here: http://politi.co/1KGUOVw

...Arthur Gianelli, who is leading Mount Sinai’s PPS, points out that DSRIP is a bridge to a system that relies more heavily on value-based contracts. This is where the downstream providers, and the health systems, can realize their dividends. “All of us may not make as much money as we’d like through DSRIP but we are making investments that are enduring,” Gianelli said. “We are laying the foundation for value-based purchasing.”

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FRIDAY’S BIG NEWS — Health Republic Insurance of New York, the nation's largest co-op, is being ordered to wind down its business, becoming the fourth co-op created by the Affordable Care Act to fold. The company, which has policies for more than 200,000 New Yorkers and owes the federal government more than a quarter billion dollars, will cover its members until the end of the year, but it won't write any new policies for 2016 and will be removed from the state's health insurance marketplace. Health Republic offered one of the lowest premiums of any insurer on the exchange, and still provided a relatively broad network of providers. Its success may have been its undoing. The insurer's low premiums attracted roughly 20 percent of the New York market, but the company never had the reserves to cover all those members. Read my full story here: http://politi.co/1Fsp9vn

...Why did this happen? Co-ops were created by the Affordable Care Act, in part to inject competition into the marketplace and keep insurers honest. It wasn’t the “public option” that many liberals wanted but it was a government-funded start-up. The problem is that it’s really hard to get into the insurance business. It takes enormous capital. The Affordable Care Act had set up a $6 billion pot of money for co-ops to use for startup costs and as a solvency fund that would, in theory, buffer them against bad times. But Congress cut off the funding after the first $2.4 billion went to 23 co-ops, which meant Health Republic never had enough in its rainy-day fund to stay solvent. Other co-ops are suffering the same fate. It doesn’t help that these new companies had to outsource almost everything, leading to massive inefficiencies, and unreliable claims data from which to build a network or create a benefits package.

...Where’s my tax money? Health Republic borrowed $265 million from the federal government? It’s not clear how, or if, that will be repaid. The company is owed roughly $147 million in 2014 risk corridor payments. That’s in addition to whatever they’ll be owed in 2015. That might end up equaling or surpassing the $265 million they borrowed. Would the feds call it a wash?

NOW WE KNOW — Sitting in front of the tube playing video games is not good exercise regardless of whether you’re a man or a woman. But it’s only women who seem to pack on the pounds, according to a study in the journal BMC Public Health. Researchers studied 2,500 Swedish women in their 20s who played at least one hour of video games per day and found they were more likely to become overweight. Play more than two hours a day, and a young women can expect to put on 8 pounds. http://bit.ly/1FskNVd

WE'D LOVE TO HEAR FROM YOU: This roundup is for you, so please tell us how we can make it even better. Send tips, news, ideas, calendar items, releases, promotions, job postings, birthdays, congratulations, criticisms and corrections to dgoldberg@politico.com.

DE BLASIO ANNOUNCES MAJOR PUSH IN CUTTING BUILDING EMISSIONS — POLITICO New York's David Giambusso: Mayor Bill de Blasio will announce a multi-faceted push by City Hall today to jumpstart his plan to cut greenhouse gas emissions in private buildings, including hospitals, 80 percent by the year 2050. The mayor will roll out a retrofit accelerator — a free one-stop shop for private landlords to refurbish buildings for energy efficiency, clean energy and water conservation. http://politi.co/1LW7vN9

NEW CAMPAIGN — As New York State readies for the Affordable Care Act's third open enrollment season, the state health department has come up with a new slogan — "You'd Be Surprised ..." The marketing campaign intends to tell the roughly 900,000 New Yorkers who remain uninsured that they'd be surprised that there are quality health plans that fit their budgets, and surprised at how easy it is to sign up. The state will also be heavily marketing its new Basic Health Plan. The plan offers New Yorkers with income at or below 150 percent of the federal poverty level ($17,655 for a household of one; $36,375 for a household of four) insurance with no monthly premium. Those with incomes up to 200 percent of the federal poverty level ($23,540 for a household of one; $48,500 for a household of four) will pay $20 per month.

AUDIT — Riaz Ahmad, a New York City internist hasn't met the minimum standards to support his Medicaid claims, an audit by state Comptroller Tom DiNapoli found. DiNapoli's audit also found that due to Ahmad's deficient record-keeping, there wasn't enough of a guarantee that he had provided the appropriate medical care to warrant $1.04 million in Medicaid payments. The comptroller's office also questioned whether pharmacy claims totaling $15 million were all necessary. Read the audit here: http://bit.ly/1O2IoOK

THE LONG READ — John Leland spent six months following around six New Yorkers over the age 85. He chronicles the trials of trying to care for aging. “The Rand Corporation estimated last year that Americans spend 30 billion hours annually caring for older relatives and friends, with most of them juggling caregiving along with jobs, families and other demands on their time.

In New York City, where residents over 85 are among the fastest-growing age groups, the pressures on these families have grown accordingly. Caregiving goes along with higher rates of depression, stress, high blood pressure and heart disease, which worries city officials.” http://nyti.ms/1h1rz8t

IF AT FIRST YOU DON’T SUCCEED — Jill Furillo, executive director of the New York State Nurses Association, writes in City & State that hospitals need more nurses to ensure safe patient care. “When the state Legislature reconvenes, NYSNA nurses will be advocating that lawmakers pass the Safe Staffing for Quality Care Act, which would guarantee enough nurses for all patients, wherever they are in New York.” http://bit.ly/1FsmqSC

SPEAKING OF NYSNA — POLITICO New Jersey’s Katie Jennings writes NYSNA is threatening to strike at Shore Medical Center in South Jersey. The notice of the strike, which would begin Oct. 8, comes after nearly a year of bargaining. The union represents all of the hospital's more than 340 registered nurses. Earlier this week, New Jersey State Senate President, and potential gubernatorial candidate Steve Sweeney gave the nurses his support in a statement. “Nurses are the ones who tend to our sick and vulnerable all day, every day,” Sweeney said. “That is why I am standing with Shore Medical nurses — because they stand with those who try to create better working conditions and services for patients. It is never acceptable to have the quality of healthcare be driven by the bottom line.”

ALLIED POWERS — Columbia Memorial Hospital wants Albany Medical Center as its parent, according to the Albany Times-Union. The state’s Public Health and Health Planning Council, will consider the issue at its Oct. 8 meeting. “Columbia Memorial lost $2.2 million in 2013, $550,000 in 2014 and nearly $400,000 in the first half of this year, according to Health Department documents. Albany Med had operating income of $10 million in 2013 and $34.7 million in 2014. … Saratoga and Glens Falls hospitals also announced last year that they were talking about potential ways to collaborate, Albany-based St. 's Health Partners and Schenectady-based Ellis Medicine — each the result of previous hospital mergers — last year created a ‘clinically integrated network’ to recruit doctors and compete as one unit for new types of contracts with public and private insurers.” http://bit.ly/1FsnJB4

PHARMA REPORT: Stephen J. Ubl will become president and chief executive of Pharmaceutical Research and Manufacturers of America, according to The New York Times. The move comes as the pharma industry is facing new criticisms over pricing. http://nyti.ms/1h0vx0U

WHAT WE’RE READING:

RIGHT TO TRY = YET TO WORK — POLITICO’s Sarah Karlin says “right to try” laws are, so far, having little actual effect. “Half the states have passed right to try laws since early 2014 to help patients with life-threatening illness gain access to experimental medicines. It's an unusually fast-moving wave of state legislation - but even the measures' main proponent acknowledges the laws have not yet benefited a single person. … Critics say the right to try movement is selling false hopes. The state laws make it easier for people to request investigational drugs from the manufacturers - but they don't require the drugmakers to hand them out. And the drug companies don't want to broadly distribute experimental drugs, which could undermine clinical trials.” http://politico.pro/1KGPzoQ [PRO]

PRIMARY SUPPORT — The New York Times reports: “Supported by one of the world’s leading philanthropies, a new partnership was announced Saturday during a United Nations development meeting aimed at improving health in poor and middle-income countries by helping to strengthen their primary care providers.” http://nyti.ms/1VjuUNL

JOHN BOEHNER’S HEALTH CARE LEGACY — John Boehner’s most significant contribution to health care will likely be his effort to repeal the sustainable growth rate, writes Paul Demko for POLITICO. “Boehner and Minority Leader Nancy Pelosi surprised veteran health care policy watchers earlier this year. ... They then shepherded the package through both chambers with large bipartisan support despite grumbling from key senators cut out of the deal-making and conservative complaints that the package wasn't fully paid for. The legislation also included a clean two-year extension of the Children's Health Insurance Program, which has enjoyed broad, bipartisan support. But Republicans had hoped to overhaul with controversial conservative reforms.”

TODAY'S TIP — Comes from the state health department, which reminds us, “delaying vaccines puts kids at risk for dangerous diseases. Follow the recommended schedule.” http://on.ny.gov/1h0wPcf

STUDY THIS:

-GENDER GAP — The good news is the number of female anesthesiologists is on the rise. The bad news is the are still paid less than their male peers, according to a RAND Corporation study. Marital status was the most important factor — even more so than children — in determining how many hours a female anesthesiologist worked. The study found 40 percent of anesthesiologists under the age of 36 were female as compared to 26 percent in 2007. But the men earned 29 percent more: $403,616 as compared to $313,074. That’s larger than the national wage gap, which stands at 23 percent. http://bit.ly/1FsluxE

-LADIES’ SPECIAL — Women who drink beer once or twice a week have a 30 percent less chance of heart attack, compared to heavy drinkers and women who never drink beer, according to a study in the Scandinavian Journal of Primary Health Care. This particular study was unable to confirm if wine had the same effect. http://bit.ly/1Fsm12t

-RACIAL GAP — The Los Angeles Times reports on a study that found when African Americans and whites are given the same care, African Americans do significantly better. “Over a nine-year period, researchers found that the adjusted mortality rate of African Americans was 24 percent lower than that of whites, according to a study published this month in the journal Circulation. ‘We thought we were going to show they do the same if the same care is offered to both groups,’ said senior author Dr. Kamyar Kalantar-Zadeh, a nephrologist and epidemiologist at UC Irvine. ‘But we found blacks do even better.’” http://lat.ms/1FsodHp

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