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POLITICO New York Health Care, presented by the NYeC Gala & PATH Awards: State changes course on Health Republic; FIDA update

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

CUOMO ADMINISTRATION RESPONDS TO HEALTH REPUBLIC CRISIS — In an effort to head off a potential health insurance disaster, state officials on Sunday announced a series of steps to protect roughly 200,000 customers who are set to lose their health coverage, and promised to investigate the company behind the crisis. The state announced it will extend the enrollment deadline for Health Republic customers until Nov. 30, providing those about to lose their insurance with an additional two weeks to shop for a new plan. Those who do not choose a plan will be automatically enrolled in a new plan, though the state has not yet made clear how exactly that will work. DFS also announced it has begun an investigation into Health Republic's "inaccurate financial reporting," and the agency is "collecting and reviewing evidence relating to Health Republic's substantial underreporting ... of its financial obligations." Alvarez & Marsell, a restructuring firm, is taking over the management of Health Republic. Read my full story here: http://politi.co/1NYAlzZ

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FIDA UPDATE — The state's plan to improve care for some of Medicaid's costliest patients faced another difficult month, and the continued struggle has prompted both the state and federal government to consider changing the rules. The Fully-Integrated Duals Advantage (FIDA) program enrolled 7,280 New Yorkers, as of September 1, while 57,375 have opted out of the program. That's 400 fewer than were enrolled on Aug. 1, an indication that the FIDA program continues to struggle even as the federal government maintains its importance and creates a second version for New Yorkers. On Thursday, CMS announced it was partnering with the state to create a Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD). Read my story here: http://politi.co/1NY0fEf

NOW WE KNOW — Mixed martial arts is bloodier than boxing but it is also less dangerous, according to a study in the Clinical Journal of Sports Medicine. You see, boxers get punched in the head — a lot — and therefore are more likely to suffer serious harm. "Most of the blood you see in mixed martial arts is from bloody noses or facial cuts; it doesn't tend to be as severe but looks a lot worse than it actually is," lead author Shelby Karpman, a sports medicine physician at the Glen Sather clinic, said in a press release accompanying the article. http://bit.ly/1S7IPpr

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. **

SCHUMER AND PEANUT BUTTER — Senator Chuck Schumer wants the Food and Drug Administration to investigate a new caffeinated peanut butter, according to the Associated Press. “It’s called STEEM Peanut Butter, and was launched by three friends in Massachusetts last year. Right now, it’s sold mostly online and at a few fitness centers and small shops in Massachusetts and Connecticut. The developers say it combines the protein of peanuts with the energy boost of caffeine. They say the caffeine is released slowly because peanut butter takes longer to digest.” http://cbsloc.al/1MQKj9x

TUITION SET — The CUNY School of Medicine will charge $38,000 per year to in-state residents and $63,000 per year to out-of-state residents. That's equal to what SUNY charges for its four medical schools but still not enough to cover the school's costs.

INTERFAITH AMBULANCE — Interfaith Medical Center has received certification from the FDNY and EMS to operate an ambulance, according to a press release from the hospital. The basic life support ambulance will be dispatched through the 911 system. “Our ability to operate a certified FDNY/EMS ambulance permits us to increase access to emergency care for the members of our community,” Interfaith President and CEO Steven Korf, said in the release.

MAKING ROUNDS — Dr. Philip Stieg, Chairman of Neurological Surgery and professor of neurological surgery at Weill Cornell Medicine, Neurosurgeon-in-Chief, NewYork-Presbyterian, and founder of the Weill Cornell Brain and Spine Center, will be named president of the Brain Tumor Foundation on Tuesday evening. http://bit.ly/1XWDlSh

ALSO MAKING ROUNDS — Dr. Benjamin Schwartz has been appointed to the senior leadership teams at Southside, Huntington and Plainview hospitals, according to a press release from North Shore-LIJ. Schwartz has practice locations in Brightwaters and Port Jefferson. http://bit.ly/1NYCZpx

GRANT LAND — The University at Buffalo and Virginia Tech Carilion Institute were awarded a $2.4 million grant to study and improve maladaptive decision-making that may contribute to Type 2 diabetes. http://bit.ly/1NYCLP5

NEW LOOK FOR NYAM — The New York Academy of Medicine has a new logo, replacing the image of Hippocrates, which it has had since its founding in 1847. http://bit.ly/1XWE3Pw

ACROSS THE RIVER — Prime Healthcare Services and Prospect Medical Holdings, two California for-profit companies are bidding for Saint Michael’s in Newark, POLITICO New Jersey’s Katie Jennings reports. Prime has already purchased two other New Jersey hospitals, Saint Mary’s in Passaic and Saint Clare’s Health System in Denville. Prospect is in the process of acquiring East Orange Medical Center. Read more here: http://politi.co/1iIyW5r [PRO]

PHARMA REPORT: The Wall Street Journal reports: “Theranos is looking for a laboratory director to oversee one of its key facilities amid questions raised in laboratory circles about the qualifications of a physician who now runs the lab.” http://on.wsj.com/1iIuWBP

-DRUG APPROVED — The New York Times reports: “The Food and Drug Administration approved a new one-pill H.I.V.treatment on Thursday with a new, apparently safer form of tenofovir, a powerful H.I.V. inhibitor. The new pill, called Genvoya, from Gilead Sciences, joins several other one-pill treatments, including Atripla, Complera, Triumeq and Stribild.” http://nyti.ms/1NYCFHb

-MORE SCRUTINY — The U.S. Attorney’s Office for the Eastern District of Pennsylvania and the Justice Department’s civil division are seeking information from Valeant Pharmaceuticals International Inc. and Eli Lilly & Co. about how they calculate and report drug prices for the Medicaid rebate program, according to The Wall Street Journal. http://on.wsj.com/1WFAeAX

WHAT WE’RE READING:

-MORE TROUBLE FOR RISK CORRIDOR PROGRAM — Standard & Poor's says insurers are only planning to pay out 10 percent, as much as they're expecting to receive, according to financial filings for the second quarter of 2015. Remember, S&P was right on the money when it predicted the risk corridor shortfall that is now plaguing so many co-ops, including Health Republic Insurance of New York. The National Association of Insurance Commissioners is currently weighing how to advise health plans to account for the funds. CMS has emphasized that insurers will eventually get their money, but given the systemic shortfalls in the three-year program, it remains a mystery where those funds will actually come from. http://bit.ly/1XWCAZr

-ANOTHER OBAMACARE CASE HEADS TO THE SUPREME COURT — The U.S. Supreme Court on Friday agreed to hear another challenge to the Affordable Care Act, this one over whether religiously affiliated organizations should require their health plans have contraception coverage for women at no cost. According to the Washington Post, the case will likely pit religious organizations against women’s rights groups. http://wapo.st/1SwFNMn

-TROUBLE FOR NURSING HOMES — POLITICO reports: “Nursing homes are sounding the alarm over a little-noticed provision in the budget deal that could significantly raise the maximum monetary penalties they face. … The American Health Care Association calculates that its members could face penalties of over $20,500 per day, up from $10,000 per day. ... A senior Democratic aide tells POLITICO that the CBO didn't score the provision. It was not included in the budget specifically as a revenue-raiser. ‘We thought that as a general principle, the penalties should be updated and kept current with inflation in the future,’ the aide said. AHCA said it may ask Congress to re-open the issue or ask HHS Secretary Sylvia Mathews Burwell to use her discretion not to raise the penalty limits.”

-ANTI-TRUST — Modern Healthcare reports: “Federal antitrust officials on Friday filed a complaint alleging the deal by Cabell Huntington Hospital to acquire nearby rival St. Mary's Medical Center would create a “near monopoly” in four West Virginia and Ohio counties for acute-care services and outpatient surgery. The hospitals would have 75% of the market share, the FTC said in a news release.” http://bit.ly/1iIy3d2

-CLINTON CALLS FOR MARIJUANA RECLASSIFICATION — Hillary Clinton on Saturday said she’d like to see medical marijuana reclassified as a Schedule 2 drug so that it would be legal to study its medicinal purposes. "I want to move from Schedule 1 to Schedule 2 so researchers can research what's the best way to use it, dosage, how does it work with other medications," she said.

TODAY'S TIP — Comes from the city’s Health and Hospitals Corporation: “Never tell your kids that medicine tastes like candy.” http://ow.ly/ODtth

STUDY THIS:

-SWITCHING SUCCESS — Researchers at Columbia University’s Mailman School of Public Health, writing in JAMA, found that HIV-infected children in South Africa were able to transition to efavirenz-based therapy. The advantage of this therapy is once-daily dosing, simplification of co-treatment for tuberculosis, preservation of ritonavir-boosted lopinavir for second-line treatment, and alignment of adult and pediatric treatment regimens. “Until now, there had been little guidance available as to what clinicians ought to do when confronted with a child older than 3 years who has begun treatment with ritonavir-boosted lopinavir,” Dr. Louise Kuhn, who is also part of Columbia’s Sergievsky Center, said in a press release accompanying the article. “As a result, it has been left to individual interpretation, and there are anecdotal reports of clinicians switching to efavirenz in the absence of data to support such a practice. This study provides evidence to support the safety and efficacy of switching to efavirenz, the recommended drug for children older than 3 years, among children with viral suppression.” http://bit.ly/1OxW454

-DO YOU TAKE STATINS? — The New York Times reports on two studies that found “statins, the cholesterol lowering drugs, may weaken the effect of the flu vaccine.” http://nyti.ms/1S7JU0k

** 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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