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POLITICO New York Health Care, presented by PhRMA: De Blasio to announce new health centers; the managed care move

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

DE BLASIO’S NEW HEALTH CENTERS — Mayor Bill de Blasio will announce his plan to expand primary care access for thousands of low-income New Yorkers on Thursday, partially fulfilling a campaign promise. Dubbed the Caring Neighborhoods initiative, the new program will spend $20 million over the next two years to build 13 new community health centers and expand several others. The bulk of the money will go to the city's Health and Hospitals Corporation, which will receive $12 million to create five new health centers and expand six others. The New York City Economic Development Corporation will award an additional $8 million in grants to help identify eight new health center sites in underserved neighborhoods. These sites might include city-owned buildings that can be repurposed, according to the de Blasio administration.

The de Blasio strategy reflects the reality that real estate in New York City is too expensive — even in low-income neighborhoods — to build new community health centers.

...During de Blasio's 2013 campaign, the mayor promised to create 16 new community health centers that would serve 500,000 more New Yorkers by 2018. This plan promises only to serve an additional 100,000 New Yorkers. A spokeswoman for the administration said this is only one piece of their strategy to bring health care to underserved neighborhoods. Read my full story here: http://politi.co/1OJt4a5

SHARE ME: Like this newsletter? Please tell a friend to sign up. Give them this link: http://politi.co/1gMLiJV

AND MAKE SURE YOU FOLLOW Josefa and me on Twitter @J__Velasquez & @DanCGoldberg. And for all New Jersey health news, check out @katiedjennings

IS THIS A GOOD IDEA? — Representatives for state agencies, mental health organizations and health plans convened in Albany Wednesday to weigh how the transition to the Medicaid managed care model is affecting individuals receiving mental health and substance abuse services. The state said it’s going well. But legislators questioned how the state knew the new model would deliver services more effectively while saving money. “I was disappointed that they couldn’t provide me any data which would serve as the basis for their general conclusion that this is a better way to go from the point to view of service and the point of view of saving money,”Assemblyman Tom Abinanti said. POLITICO New York’s Josefa Velasquez has more: http://politi.co/1OJrqFF [PRO]

NOW WE KNOW — People who watch ‘Law & Order’ have a better understanding of what sexual consent means than those who watch ‘CSI’ or ‘NCIS,’ according to a study in the Journal of Health Communication. The researchers concluded that watching a show with sexual predators gives people a good idea of what is not acceptable behavior. "One of the marked differences between 'Law & Order' and other crime dramas is its focus on the criminals' trials," Stacey Hust, lead researcher, said in a press release accompanying the article. "Viewers of Law & Order not only see the criminal act taking place, but they typically see the criminal punished for the crime. This judicial sentencing is rarely seen in other crime dramas." And those courtroom scenes are opportunities, said co-author Emily Garrigues Marett. "For example, the process of preparing a case for prosecution frequently requires establishing whether consent was present,” she said. “This provides a valuable opportunity to clarify misperceptions around this issue." http://bit.ly/1XjT79x

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.

** A message from PhRMA: In 2013 alone, the biopharmaceutical industry invested more than $553 million dollars in clinical trials in New York. Learn more about the economic impact of clinical trials in our communities at http://bit.ly/1O64IWa **

WOMEN’S EQUALITY LAW — Gov. Andrew Cuomo signed into law a series of long-anticipated bills dealing with women’s issues on Wednesday. Cuomo, who created the Women’s Equality Party last year to draw attention to the issues, signed eight bills passed by the Legislature this past session with little fanfare at Hunter College in Manhattan. The bills deal with pay equity, sexual harassment, discrimination, strengthening order of protection laws, as well as human trafficking laws, and pregnancy discrimination. Notably absent from the signings was an abortion plank. For Senate Republicans, the abortion provision, which would have made New York law consistent with Roe v. Wade, was a non-starter. Republicans argued that the abortion measure would increase abortions.

DUAL TROUBLE — The Centers for Medicare and Medicaid Services knows that New York State’s dual eligible program, known as FIDA, is not performing well. “The experience we've had … gives us a lot of reason to think about how this policy has played out in real life,” Engelhardt said, according to Modern Healthcare. “The challenge of delivering a truly integrated product, in which we prioritize care coordination for a beneficiary, can easily be undermined by (constant) movement back and forth across plans.” http://bit.ly/1GqVDX9

DIFFERENT MODEL — Crain’s profiles Cure Urgent Care, which is opening up two new sites in Brooklyn — in Coney Island and Bedford-Stuyvesant. “Cure’s chief executive Elan Katz said he wants to target low-income areas that are considered medically underserved, with a shortage of doctors. … What changed is that Katz started signing contracts with insurers that enroll Medicaid beneficiaries. In the past, Medicaid managed care plans urged members to see their assigned primary care doctors. But those insurers' attitudes toward urgent care centers are starting to change, Katz said. New contracts with Medicaid managed care plans have helped boost the number of Medicaid visitors at Katz’s clinics to about 32 percent today from about 12 percent at the end of 2014.” http://bit.ly/1jBSU39

INSURANCE REPORT — POLITICO reports that insurers have stepped up their lobbying efforts just as they announced mergers that are causing new federal scrutiny. “Anthem, which is planning to acquire Cigna, spent $2.3 million this quarter, which was up from $1.1 million during the same quarter in 2014. Cigna spent $1.4 million, compared to $500,000 in the same period last year. Aetna, which is seeking approval for its acquisition of Humana, spent $690,000 on lobbying during the third quarter, with seven firms paid to help press the insurer's agenda on Capitol Hill. That was up from $430,000 spent by Aetna during last year's third quarter. UnitedHealth Group spent $590,000 on lobbying during the third quarter, the first since it dropped out of America's Health Insurance Plans, the primary industry group. That was actually less money than UnitedHealth spent in each of the first two quarters of the year, though on par with what it spent in the third quarter last year.”

PHARMA REPORT — The Wall Street Journal reports: “Biogen Inc., whose share price has tumbled this year amid slowing revenue growth, said it would cut 11 percent of its workforce by year-end as the biopharmaceutical firm retrenches.” http://on.wsj.com/1GqzCrw

-EBOLA DRUG — Gilead confirmed that it is working on an Ebola drug and has given it to a nurse in England sickened with the disease. http://on.wsj.com/1GqUX3W

WHAT WE’RE READING:

-THERANOS RESPONSE
— Elizabeth Holmes, the embattled CEO of Theranos, told The New York Times she plans to release “a 16-page point-by-point rebuttal of the [Wall Street Journal] articles, a document that concludes by accusing the articles’ author of having an agenda that considered Theranos “a target to be taken down.” But she also said her company has “no immediate plans to do what skeptics say would most persuade them: publish data in peer-reviewed medical journals showing that its test results were as accurate as those of more established laboratories.” http://nyti.ms/1QVvkc1

-THE COST OF REPEAL — The Congressional Budget Office and Joint Committee on Taxation report that rescinding the so-called Cadillac Tax, the 40 percent excise tax on pricey health care benefits, would reduce projected revenues by $109 billion over the next decade while also cutting anticipated spending by $18 billion. For those keeping score, that’s $91 billion added to the national deficit. Read the report here: http://1.usa.gov/1jBQZvu

-IS THIS WORKING?
— On Wednesday, I wrote about another failed Accountable Care Organization. Kaiser Health News asked several experts if three years in, the ACO program is working. http://bit.ly/1XjT7Gs

-THIS WILL BE HARDER THAN YOU THINK — Aaron Carroll explains why it will be hard to implement the new mammography guidelines recommended by the American Cancer Society. The new guidelines call for women to receive fewer mammograms and begin receiving them later in life. “Many studies have shown that once physicians become conditioned to be more invasive, it’s hard for them to reverse course. … Once physicians believe they are doing good, it is hard to get them to change their minds. Others think that doing more protects them from lawsuits, although that’s most likely untrue. Some have seen screening pick up diseases, leading to treatment and positive outcomes, and have assumed that it was the screening that made the difference (although evidence refutes this). And, yes, some are probably influenced, overtly or subtly, by financial incentives that still lean toward everyone being more invasive.

But in this case, it will most likely be even harder to change the public’s expectations. For decades, we’ve been told, over and over, that more screening is better, that early detection is the key to a cure. That’s true, up to a point. We seem to have passed that point, though, and more and more experts are trying to reverse course.” http://nyti.ms/1jBPAVR

...In a letter to the Daily News, Dr. Jiyon Lee, a breast radiologist at NYU Langone Medical Center’s Laura and Isaac Perlmutter Cancer Center, writes that one-fifth of women diagnosed with invasive cancer are in their 40s. “Relaxing the screening guidelines is sabotaging the test and directly perpetuating what is already a common criticism that mammography has been ‘oversold.’” http://nydn.us/1QVrNKL

-PUSHBACK — Health plans are pushing back against Hillary Clinton's criticism of two mergers that could reshape the insurance industry. "Contrary to the political claims, the reality is that health plans are operating in one of the most competitive and highly regulated environments in the country," Clare Krusing, press secretary for America's Health Insurance Plans, said in a statement. "If the goal is to make health care more affordable and to provide greater choices for consumers, then policymakers should focus on addressing the real cost challenges facing patients -- the soaring prices of prescription drugs and medical services."

-GRANT LAND — POLITICO reports: “More than $2.2 billion in Ryan White HIV/AIDS Program grants were awarded in fiscal 2015, HHS Secretary Sylvia Mathews Burwell announced today. This included more than $600 million to 53 metropolitan areas for core medical and support services for people living with the disease and approximately $1.3 billion in grants to states and territories for medical and support and the AIDS Drug Assistance Program. Other funding went toward the education and training of health care professionals, community organizations that provide family-centered care for women, infants and young children, and to programs targeted at minorities.” For a full list of awarded grants see: http://1.usa.gov/1LEYZmf

TODAY'S TIP — Comes from North Shore-LIJ: “Change your cancer destiny by incorporating these cancer-preventing foods into your diet.” http://bit.ly/1jywMXl

STUDY THIS:

-QUESTIONING THE PREVAILING WISDOM
— Researchers at Mount Sinai are questioning the commonly held belief that mental health screenings for children should be routine. Dr. Eyal Shemesh, writing in The Journal of Pediatrics, says children who live with food allergies go through a unique struggle in life – one where they may feel stigmatized. This could have an effect on their mental health. “We’ve shown that within a highly-specialized program that ensures support for mental health needs, screening for mental health problems such as anxiety, bullying, and reduced quality of life does not result in a better rate of successful referrals for evaluation and treatment,” Shemesh said in a press release accompanying the article. “The unexpected finding from this study is that it is probably better to refocus our efforts towards making sure these children have access to behavioral health services when they need them, rather than spend some of those resources on screening.”

-BRONX V. PUERTO RICO FOR RISK TAKING — Researchers at Columbia University’s Mailman School of Public Health, Columbia University’s Department of Psychiatry and the University of Puerto Rico School of Medicine, show that U.S. children were more likely to seek out new and risky behaviors than their Puerto Rican counterparts. The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, found that sensation-seeking behaviors don’t follow the same trajectory from childhood to adolescence in all populations. Context matters, according to a press release from Columbia. Rates of sensation-seeking were consistently higher in the South Bronx than Puerto Rico, and youth in the South Bronx generally reported sensation-seeking at an earlier age, the release stated. “Children born into families of migrants scored higher in sensation-seeking either because they inherited a ‘novelty-seeking’ trait from their parents,” first author Dr. Silvia Martins, associate professor of Epidemiology, said in the release, “or because they were exposed to family environments and different parenting practices that promoted certain behaviors.” http://bit.ly/1NVpvNZ

-HOW WE MULTITASK — Researchers at NYU Langone Medical Center have added to evidence that the thalamic reticular nucleus, a shell-shaped region in the center of the brain, is likely responsible for the ability to multitask, according to a press release from Langone. The neurons, they say, act like a switchboard that shift focus, according to the article, which appeared in Nature. “Our latest research findings support a newly emerging model of how the brain focuses attention on a particular task, using neurons in the thalamic reticular nucleus as a switchboard to control the amount of information the brain receives, limiting and filtering out sensory information that we don’t want to pay attention to,” senior study investigator and neuroscientist Dr. Michael Halassa, said in the release. “Filtering out distracting or irrelevant information is a vital function. People need to be able to focus on one thing and suppress other distractions to perform everyday functions such as driving, talking on the phone, and socializing.” http://bit.ly/1jBRO7E

** A message from PhRMA: Every day in New York, countless people fight life-threatening diseases. Their bravery inspires countless researchers and scientists across the country in their quest to develop medicines that help patients live longer, healthier lives. Here in New York, the biopharmaceutical industry has invested more than $553 million during the 2,476 clinical trials that took place in 2013 alone. Each step brings us closer to a cure. To learn more, please visit http://bit.ly/1O64IWa **

MISSED A ROUNDUP? Get caught up here: 10/21, 10/20, 10/19, 10/16, 10/15

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