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POLITICO New York Health Care, presented by the NYeC Gala & PATH Awards: Mounting anxiety of Health Republic demise; Taub takes the stand against Silver

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

LOOMING TROUBLE — Last week, the state authorities announced that Health Republic Insurance of New York would not be able to stay in business beyond Nov. 30, an unprecedented failure predicated on the company's finances being "substantially worse" than what was reported in its filings. The effect, since then, has been mounting anxiety among consumers uncertain what to do next, and other health providers over the prospect of the unraveling of what had been a model of a functioning state health care exchange. The Department of Financial Services, in a press release, instructed Health Republic's 200,000 customers to choose a new plan from the state-based exchange by Nov. 15 if they want health insurance in December. But no one appears to have checked with New York's other insurers who are wondering how they will handle the logistics of enrolling a population for which they had not planned. Read my full story here: http://politi.co/1MiOWaj

...Rep. Chris Gibson, a Republican and possible gubernatorial candidate, is holding conference call today to discuss the co-op’s demise.

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

DOCTOR TESTIFIES AGAINST SILVER — Dr. Robert Taub, the physician at the center of the Sheldon Silver trial, took the stand for the government Wednesday. Prosecutors hope Taub will convince the jury that Silver pushed him to refer mesothelioma patients to Weitz & Luxenberg, the firm where Silver was of counsel and from where he collected portions of settlements while allegedly funneling state health care funds to Taub’s research center at Columbia University. Taub said he was more than happy to do so. “I wanted to develop a relationship with him to help fund mesothelioma, and help my patients as well.” Taub also testified that he leaned on Silver for help getting internship and job opportunities for his children and for funding for his wife’s nonprofit. When Silver’s lawyer, Steven Molo, began his cross-examination, he went to the heart of the defense argument shortly after starting his cross-examination. “You did not have an explicit agreement to exchange patients for [state] grants, did you?” Molo asked Taub. “I did not,” Taub replied. POLITICO New York’s Colby Hamilton has more: http://politi.co/1HakzTc

IS COMPETITION GOOD FOR HEALTH CARE? — Jason Helgerson, who is leading the state’s Medicaid reform, which has helped spur unprecedented consolidation among providers, said the current health care delivery system is broken and something needs to be done to upend what we have. “I question the premise that competition is good in health care,” Helgerson said during a New York State Health Foundation conference in Manhattan. "In the U.S., we tried it. We have the highest costs, not very good outcomes and millions of Americans — even after the Affordable Care Act — go without access. This is based on the premise of the market giving us efficiencies. Efficiencies? Really? We are the most inefficient system." Elinor Hoffmann, deputy chief for the state Attorney General’s Antitrust Bureau, disagreed, saying there are certainly times when the potential benefits of consolidation outweigh the potential harms, but her office felt that should be determined on a case-by-case basis. This isn't merely an academic debate. State policies, such as the Delivery System Reform Incentive Payment program, a $7 billion effort to transform Medicaid, hinge on competitors collaborating and, in some cases, contracting together. The Department of Health is encouraging the very strategy that the Attorney General must regulate.

...Collaboration gives providers more patients under their umbrella, which is good for modeling value-based payments, but it also gives them greater leverage with which to negotiate prices, a fact not lost on insurers who fear hospitals will use that leverage to drive up costs.

Helgerson agreed that's a concern, but collaboration is essential for value-based contracts to work. And the move to value-based contracts is necessary to provide better care at lower costs, Helgerson said. The lack of collaboration, he said, has led to inadequate or non-existent care.

"There is a real human toll to our disintegrated system," Helgerson said. "Medicaid [in New York] spends $1.6 billion on avoidable hospital use. That translates into thousands of individuals sicker than they should be." Harold Iselin, external counsel for the New York Health Plan Association, which represents insurers, said Helgerson's line of thinking is too radical, and suffers from the idea that the move to value-based payments will somehow make New York immune to the trends that impact every other state. Read my full story here: http://politi.co/1kbP3Kn [PRO]

NOW WE KNOW — Calcium is the key to the perfect grilled cheese, and you want a low pH in your cheese. Find out more from this video: http://bit.ly/1Q62IiZ

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 the New York eHealth Collaborative’s Gala & PATH Awards: Join 300 CEOs, C-level executives, and influencers from New York State health systems, health plans, large employers, and the public sector leading New York's healthcare transformation by reshaping it into a new, secure, digital system. The awards honor individuals and organizations who have contributed to the advancement of health IT in New York State. 2015 Honorees: Steven M. Safyer, MD, President & CEO, Montefiore Medical Center; and Jason Gorevic, CEO, Teladoc. Register today to join our exclusive community of healthcare leaders. November 18, 2015, at Capital, New York, NY. **

TOAD VENOM IS NOT AN APHRODISIAC —The city's health department is warning New Yorkers to be careful not to ingest an illegal aphrodisiac sometimes known as "stone." This aphrodisiac does make your heart skip a beat but not in the good way. The product, which killed a 39-year old man last week, also goes by the names Piedra China, Jamaican Stone, Love Stone, Black Stone and China Rock. Stone is a solid brown chunk and is filled with bufadienolides, which are made from toad venom. http://politi.co/1ktTqQt

DEMENTIA SPENDING — New York is on track to spend $4 billion this year on dementia-related Medicaid costs for people 65 and older — more than any state in the country, a report by the Alzheimer’s Association has found. The report projects that Medicaid-related costs for people with Alzheimer’s and other forms of dementia in New York will increase by 38.8 percent to $5.55 billion by the year 2025. Read the full report here: http://bit.ly/1zqVcCQ

SETTLED — New York State's Medicaid program will receive nearly $8.5 million from two pharmaceutical companies that were accused of underpaying drug rebates owed to the states, according to Attorney General Eric Schneiderman. AstraZeneca will pay New York $7.49 million and Cephalon, a subsidiary of Teva Pharmaceuticals, will pay $996,000, part of a $54 million settlement with 48 states and the District of Columbia, which was first settled in July. The settlements stem from a 2008 whistleblower suit filed by Ronald Streck, a pharmacist and attorney. Read the AstraZeneca settlement here: http://bit.ly/1NdAbSD Read the Cephalon settlement here: http://bit.ly/1NdAhts

SINAI AND CHOP — The Mount Sinai Health System on Wednesday announced an alliance with the Children’s Hospital of Philadelphia. The two hospitals will begin working together on pediatric oncology this fall, and then move to cardiac care and fetal medicine. http://prn.to/1HauxUm

A DIFFERENT VIEW — While the Seneca nation may have voted in favor of looking into a medical marijuana program, the Onondaga nation wants nothing to do with it, according to the Syracuse Post-Standard. http://bit.ly/1Haj6Mo

HAPPENING TODAY — Fortis Property Group, the developer replacing Long Island College Hospital, is holding its first community advisory panel at 3 p.m. at 349 Henry Street to discuss the health care services offered to the Cobble Hill community. The meeting is being convened with NYU Langone. This meeting is not open to the public. It is open to representatives from organizations including 5th Avenue Committee, Families United for Racial and Economic Equality, Brooklyn Community Justice Centers, NYU Lutheran and others.

GRANT LAND — The Sophie Davis School of Biomedical Education received a three-year $75,000 grant from the American Medical Association’s Accelerating Change in Medical Education Consortium for its project, “Growing Our Own: Partnering with Health Care Centers to Educate Practitioners for the 21st Century.” The project entails partnering with Urban Health Plan, Inc., a South Bronx community health center, to develop and implement a curriculum that prepares medical students for modern-day practice in clinical sites that deliver primary care to underserved communities. http://bit.ly/1Har08H

ACROSS THE RIVER — Rutgers University hopes to open a center for adults with autism, the university announced Wednesday. The Rutgers Center for Adult Autism Services, which would occupy two buildings on the Douglass Campus in New Brunswick, would provide up to sixty adults with autism university jobs and support by clinicians and graduate students.

MEET STAT — Stat, a national publication covering health, medicine and life science news from Boston Globe owner John Henry, officially launched Wednesday. The venture is edited by Rick Berke, a former New York Times editor who was hired this year after working as an executive editor at POLITICO. Berke spoke with POLITICO about the site, his editorial mission and his plans to make Stat, Henry's biggest and most ambitious standalone site yet, a profitable venture. Read that here: http://politi.co/1HallQ7

...And check out one of their first stories. It’s about Donald Trump and the vitamin company that went bust. http://bit.ly/1HalqmO

PHARMA REPORT — Also from Stat, Ed Silverman reports that the world’s least-developed countries have reportedly won a 17-year extension of a waiver from world trade rules. “The extension was sought so that non-profits, health programs and generic drug makers working in those 48 countries could make, import or export medicines for life-threatening diseases without fear of being sued for patent infringement.” http://bit.ly/1Hamirq

-THE U.S. SENATE IS ON THE CASE — The New York Times reports a Senate committee has started an investigation into the large drug price increases by Turing Pharmaceuticals and three other companies. “The Senate’s Special Committee on Aging requested documents and information on Wednesday from Turing, Valeant Pharmaceuticals and two other drug makers already under scrutiny for recent price spikes. Notably, the senators called for a face-to-face meeting with the chief of Turing, Martin Shkreli, ‘as soon as it is practicable.’” http://nyti.ms/1Ham4k5

WHAT WE’RE READING:

-OHIO SAYS NO TO MEDICAL MARIJUANA — The Associated Press reports: “Ohio voters rejected a ballot proposal Tuesday that would have legalized both recreational and medical marijuana in a single stroke — a vote-getting strategy that was being watched as a potential test case for the nation.” http://wapo.st/1Q62xEm

-MEDICAL MARIJUANA IS RACIST — The Florida Black Farmers and Agriculturalists Association told members of the Legislative Black Caucus Tuesday night that Florida's law governing low-THC medical marijuana is discriminatory and will lock black farmers out of the pot-growing business,the Tampa Bay Times reports. The association said the requirement that nurseries have been in business for 30 years and grow at least 400,000 plants in order to be considered to apply for licenses will lock black farmers out of the market. “Thirty years ago, we were fighting the USDA for discriminatory practices for not loaning money,” said the group's president Howard Gunn Jr. http://bit.ly/1RTX40O

-LIFTING THE BAN — Reuters reports: “France has decided to end a more than 30-year-old law that banned gay men from donating blood, a measure originally put in place to stop the spread of diseases such as HIV. … The U.S. Food and Drug Administration in 2014 recommended easing the ban on gay blood donors to men who have abstained from sex with other men for a year prior to a donation, similar to policies in Britain and Australia.” http://reut.rs/1HajOcG

-BUSH ON OXYCONTIN — Jeb Bush said Tuesday that the government's decision to endorse powerful prescription painkillers for children was inappropriate in part because "pain is part of life," according to POLITICO. “The governor was speaking during a larger conversation about the scourge of overprescribed drugs like OxyContin and Vicodin, which have particularly ravaged New England. Bush lamented that 9 in 10 painkiller prescriptions worldwide originate in America. But he saved particular criticism for the decision of the FDA's recent support of a version of slow-release OxyContin for children.”

TODAY'S TIP — Comes from First Lady Chirlane McCray, who offers nine self-care tips that can be used daily. http://bzfd.it/1NPTeoJ

STUDY THIS:

-NEW THERAPY — Researchers at Weill Cornell Medicine write about a new combination therapy that manages mantle cell lymphoma without some of the side effects that come with traditional treatments. Their findings, published in The New England Journal of Medicine, explain the pill Lenalidomide, taken with the antibody Rituximab, provides an effective alternative to chemotherapy. "For patients, their quality of life was preserved or improved, and that's a huge step up from regular chemotherapy," lead author Dr. Jia Ruan, an associate professor of clinical medicine and a member of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, said in a press release accompanying the article.

-RETURN OF THE JEDI — Scientists at the Icahn School of Medicine at Mount Sinai have developed the Just EGFP Death-Inducing T-cell, or JEDI T-cells, which enable the visualization of T-cell antigens. According to an article published in Nature Biology, this will allow researchers to see how T-cells interact with different cell types, model disease states, and determine the functions of otherwise poorly characterized cell populations. “JEDI T-cells provide an unprecedented technology to study, model and visualize immune responses and immunotherapies in ways that were never before possible, and this has the potential to revolutionize immunology research,” Dr. Brian Brown, associate professor of Genetics and Genomics Sciences and senior author of the paper, said in a press release accompanying the article. “Immunotherapy is considered one of the most important breakthroughs in cancer care in decades, but there is more research needed to improve its success in the clinic.” http://bit.ly/1HarPOE

** A message from the New York eHealth Collaborative’s Gala & PATH Awards: Join 300 CEOs, C-level executives, and influencers from New York State health systems, health plans, large employers, and the public sector leading New York's healthcare transformation by reshaping it into a new, secure, digital system. The awards honor individuals and organizations who have contributed to the advancement of health IT in New York State. 2015 Honorees: Steven M. Safyer, MD, President & CEO, Montefiore Medical Center; and Jason Gorevic, CEO, Teladoc. Register today to join our exclusive community of healthcare leaders. November 18, 2015, at Capital, New York, NY. **

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