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POLITICO New York Health Care, presented by the NYeC Gala & PATH Awards: Health Republic concerns; Cuomo's decision day

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 and we'll set you up for trial access.

written by Dan Goldberg

PROVIDERS IN A BIND OVER HEALTH REPUBLIC — MagnaCare, one of the largest provider networks in the state will no longer process claims from Health Republic Insurance customers, a decision that could impede coverage for thousands of New Yorkers during the next three weeks and force physicians, rehab centers, hospitals and health systems to provide care for which they are unlikely to be fully reimbursed. MagnaCare's decision does not absolve providers of their contractual responsibility to provide care for Health Republic customers. That contract remains valid through the end of November, but some patients are reporting providers have already started turning them away. The majority of patients may still be seen, but if they are, it means the providers who treat Health Republic customers will almost certainly receive less than full payment because Health Republic is winding down. State officials have told providers they are hopeful "modest payments" can be made on outstanding claims at some point in the future but a cents on the dollar promise for future payments puts doctors, hospitals and health systems in a bind. "Hospitals are in no position to absorb such losses," Ken Raske, president of the Greater New York Hospital Association, said in an email. Read my story here:

GIBSON FORMALLY ASKS DINAPOLI TO INVESTIGATE — U.S. Rep. Chris Gibson has written a letter to state Comptroller Tom DiNapoli requesting he investigate the state’s Department of Financial Service’s oversight of Health Republic. “An independent investigation of DFS by your office is necessary to examine the efficacy of our state regulators’ oversight of the market,” Gibson, a potential Republican challenger to Cuomo in 2018, wrote. DiNapoli's office did not immediately respond to request for comment. Read the letter here:

FLANAGAN’S TAKE — Asked if there should be an independent investigation into Health Republic, state Senate Majority Leader John Flanagan said the Senate’s investigations and government operations could be tasked with looking into the insolvent co-op. “We have committees, certainly we have the investigations committee in the Senate that can take a look at something like that,” Flanagan told reporters in the Capitol. “It is a very fair and important question because it goes, again, to people’s quality of life, health coverage, health care, the insurance exchange. But a lot of this stuff is related to actions taken by the executive and not by the Legislature. So perhaps their review should start from the executive’s standpoint, as much as they’re in charge of it.”

NOT JUST HEALTH REPUBLIC — The Buffalo News reports that Independent Health will no longer offer its Medicaid program in Niagara County, meaning 15,000 customers will have to find a new plan by the end of the year. “The Amherst-based insurer said in a statement Tuesday that its Niagara County Medicaid program, known as MediSource, has lost $18 million over the past three years and is on track to lose another $12 million in 2015. Independent Health said it will continue to provide managed Medicaid insurance in Erie County and Child Health Plus coverage in Niagara and Erie counties. The only providers of Medicaid coverage in Niagara County now are Fidelis Care New York and United Healthcare of New York.”

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DECISION TIME — Gov. Andrew Cuomo must decide today whether to sign or veto the expedited medical marijuana bill. Cuomo has given no indication of what he will do. Read more here.

STUCK WITH THE BILLS — Cuomo had 80 bills delivered to his desk on Tuesday. Many of them were health care related including one that allows New Yorkers make a tax-free donation to a fund to help pay for public awareness campaigns for mental health. See the health bill here:

NOW WE KNOW — Vanilla yogurt makes people happy. That’s according to a study published in Food Research International, which found different yogurts could change people’s moods. Yogurts with lower fat content gave people a stronger positive emotional response while yogurts with different fruits did not show much difference in their emotional effect. "We were surprised to find that by measuring emotions, we could get information about products independent from whether people like them," lead author Dr. Jozina Mojet, from Food & Biobased Research, in the Netherlands, said in a press release accompanying the article. By the way, previous research has shown vanilla scents can reduce aggression.

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** 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. **

LEAVE NO MAN BEHIND — The Associated Press has a touching story about a kidney transplant between two Vietnam veterans and longtime friends. “Once rare, kidney transplants among senior citizens are becoming more frequent. Eighteen percent of U.S. recipients last year were over 64, compared with 2 percent in 1988, according to federal statistics. Only 3 percent of all living donors last year were 65 or older, but their ranks and percentage have grown in recent decades.”

OUTLINING THE STATE’S CHALLENGES — The United Hospital Foundation outlined four challenges New York state health officials will face as they work to move children with behavioral health needs into managed care. The challenges, explained in a report released Tuesday, are: strengthening and modernizing the behavioral health workforce; expanding new health information technology capacity; forging effective managed care arrangements between providers and insurers; and the creation of a more robust quality measurement system. About 2 million children in New York are enrolled in Medicaid, and about 10 percent need behavioral health services. Read the report here:

FINNEGAN IS OUT — Kevin Finnegan, the political director of powerful health care workers' union 1199 SEIU, is leaving his position, Crain's and Capital Tonight reported Tuesday. A national search is being conducted for his replacement, but Finnegan will also stay on as a lobbyist for the union if whoever replaces him lacks experience with the vagaries of New York politics. Read more here:

CONGRATS — State Medicaid Director Jason Helgerson was among one of the nine people honored by Governing magazine for being an outstanding leader in state or local government.

CHINA BOUND — Weill Cornell Medicine has entered into an agreement with Top Spring Huaxia Medical Investment Co. Ltd, a real estate developer, to help it develop a modern outpatient diagnostic clinic in China, according to a press release from WCM. The pair will create a clinic in Shenzhen, China’s fourth-largest city. Weill Cornell will lead a feasibility study to determine what specialties to cover, the release said. Chinese physicians will learn the latest Western practice techniques and standards across multiple specialties, the release said.

STROKE CENTER — NYU Lutheran has been received comprehensive stroke center certification.

START-UP — The Albany Business Review reports on Cureatr, a New York City based company, which works with hospital systems for free as a sort of patient registration service. “It then allows providers and insurers to subscribe and get real-time notifications when patients go to the emergency room, are discharged or are transferred elsewhere.”

PHARMA REPORT: Pharmalot’s Ed Silverman examines the new Centers for Disease Control and Prevention’s recommendations, which call on doctors to prescribe opioids only after other therapies have failed.

MORE THERANOS TROUBLE — John Carreyrou reports that Safeway’s $350 million investment to build clinics in more than 800 supermarkets that would offer blood tests from Theranos Inc. is not bearing fruit. The tests never began. “[T]he clinics are now used largely for flu shots and travel-related vaccines, and the two companies have been negotiating to officially dissolve their partnership, according to people familiar with the matter. Current and former Safeway executives said Theranos missed deadlines for the blood-testing rollout. They also said several Safeway executives questioned the accuracy of results Theranos gave to Safeway employees tested at a clinic in the supermarket chain’s headquarters in Pleasanton, Calif.”

-HOSTILE TAKEOVER — The Wall Street Journal looks at Mylan’s hostile takeover bid of Perrigo. “If more than half of Perrigo’s shareholders agree to sell by the offer’s Nov. 13 deadline, [Judy Gawlik] Brown and Perrigo’s chairman and chief executive, Joseph Papa, will lose the 128-year old company they transformed from a regional player, often mistaken for stroller maker Peg Perego, into a global maker of generic over-the-counter drugs valued at more than $23 billion.”


-NEVER APPROVED, OFTEN USED The Boston Globe’s STAT investigated the Lariat, a heart device that has never been cleared by the FDA but is widely used. “Nearly all of the surgeries were performed on patients with atrial fibrillation, a common condition in which patients have an irregular heartbeat, putting them at high risk of stroke.”

-MEDICARE PREMIUMS — Medicare premiums have been kept in check after the budget deal signed into law last week avoided a major spike, POLITICO reports. “Roughly thirty percent of Medicare beneficiaries were facing potentially huge rate hikes prior to the budget breakthrough. Those beneficiaries would have seen their monthly bills rise by more than 50 percent, to $159.30 next year. Instead they will only increase to $121.80, CMS announced Tuesday. The majority of beneficiaries will continue to pay the same monthly premium of $104.90. Medicare enrollees with incomes above $85,000, who account for less than 5 percent of beneficiaries, are subject to higher premiums. The premiums are for Medicare Part B, which covers physician visits and hospital outpatient services. Only a tiny fraction of beneficiaries pay premiums for Medicare Part A, which covers hospital services.”

TODAY'S TIP — Comes from Montefiore Health System: “Pay attention to these early warning signs of Alzheimer's disease.”


-OPINION — Edward Bednarczyk, pharmacy practice chair in the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, said it is wrong for medical dispensaries to sell recreational marijuana. “This, unfortunately, is the direction things are going in,” he said in a press release. “Removing the veneer idea of there being a distinction between medicine and recreation has the potential of slowing down meaningful research on cannabis.”

-EARLY INDICATOR — Dr. Stephan Mayer from the Ichan School of Medicine at Mount Sinai suggests loss of consciousness may be an indicator of a severe bleeding event and therefore a predictor of death or poor functional outcome a year later, according to an article published by JAMA Neurology.

** 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. **

MISSED A ROUNDUP? Get caught up here: 11/10, 11/9, 11/6, 11/5, 11/4

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