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POLITICO New York Health Care, presented by the NYeC Gala & PATH Awards: Fidelis to pick up Health Republic customers; Insurers, hospitals spar over Health Republic

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written by Dan Goldberg and Josefa Velasquez

FIDELIS LIKELY TO PICK UP HEALTH REPUBLIC CUSTOMERS — Fidelis Care, the largest insurance exchange plan in New York and one of the state's largest Medicaid plans, is where a majority of Health Republic Insurance of New York customers are likely to be enrolled by state officials, unless they enroll themselves in a different plan by the end of the month. The Catholic Health plan — which, like Health Republic captured about 20 percent of the state's individual exchange market — is the most comparably priced plan throughout most of the state. "As part of our mission, Fidelis Care is committed to being a resource for Health Republic members who need to choose a new health plan in the days ahead," said Dave Thomas, the company's executive vice president and chief operating officer. "Although we are willing to work with the State as part of the auto assignment process, we encourage Health Republic members to research their options and take an active role in choosing their new health plan before the Nov. 30 deadline." [PRO]

INSURERS, HOSPITALS TRADE BARBS OVER HEALTH REPUBLIC — Health insurance companies condemned hospitals that are calling for a state refund that would repay the losses incurred by Health Republic’s unwinding. "At a time when everyone should be focused on coverage and continuity of care for Health Republic consumers, the hospitals of the Greater New York Hospital Association (GNYHA) are worried about their own wallets," said a statement from the New York Health Plan Association. GNYHA President Ken Raske fired back Thursday night, saying “New York’s hospitals care for the insured and uninsured with dignity and clinical expertise.” The tit-for-tat is likely to heat up in the months ahead. The state legislative session begins in January and hospitals will be demanding state reimbursement, while insurers seek a reformation of the prior approval process, which allows the state Department of Financial Services to approve, reject or modify an insurer's rate requests. Read more: [PRO]

… Two leading Republicans in the State Senate, Kemp Hannon, chair of the health committee, and James Seward, chair of the insurance committee, sent a letter to the Departments of Health and Financial Services expressing their “grave concern” over how the Cuomo administration handled the unwinding of Health Republic.

...State Comptroller Tom DiNapoli said he’s considering an investigation into DFS. “We’re looking at it; we’ve been in touch with the feds,” the comptroller told Time Warner Cable News. “There’s been an outreach. One of the challenges for us is when there are other entities doing investigations to not heavy foot and have us get in and complicate thing.”

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

WHAT HAPPENED TO THE MENTAL HEALTH ROADMAP? — First lady Chirlane McCray’s mental health roadmap has been almost a year in coming. When first announced in January, McCray said she expected it out by the summer. Then her goal became October. When that proved unreachable, the de Blasio administration said "the fall." The delays speak to a broader reality that mental health advocates have known for years: Mental health problems in New York City, and everywhere else, are really complicated and reaching consensus on how they should be addressed is a near impossible task. McCray was lauded last week for simply talking about the issue and many advocates are quick to point out that few have ever given mental health this kind of platform, but the first lady's own high bar may prove to be her toughest challenge.

… The mental health roadmap is made up of six guiding principles — change the culture; partner with communities; act early; compile better data; close the treatment gap; position government to help. Each is supposed to have a set of policies underneath them, but none has yet been made public, and so many mental health advocates are left wondering what exactly the city has planned.

NOW WE KNOW — The deeper the voice, the smaller the testicles, at least in male howler monkeys. According to studies from the universities of Utah, Cambridge and Vienna, a deep call scares away male competitors while attracting females, similar to how women prefer deeper voices in men.

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

** 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. **

SHORTAGE — Independent Health’s decision to pull out of Medicaid in Niagara County was prompted by a shortage in primary care physicians and other health care providers, the company says. Independent Health announced Tuesday it would no longer provide coverage through its Medicaid managed care program in Niagara County, leaving 15,000 members to find other coverage by the end of this year. “While our provider network met the Medicaid requirements for provider access, we’re seeing the effect of a shortage of primary care physicians, urgent care centers and critical specialties, such as oncologists, psychiatrists, and pain management and addiction specialists, which is unique to Niagara County,” John Fisher, a spokesman for Independent Health, told POLITICO New York. The shortages, he said, resulted in members receiving care in emergency rooms, which is significantly more expensive and not well coordinated. [PRO]

CUOMO DEFENDS MEDICAL MARIJUANA — Gov. AndrewCuomo, who had initially been cool to the idea of medical marijuana, defended his choice to expedite the state’s program. “Medical marijuana has been proven to be a cure for patients who haven’t been able to get any relief, and it's taken society a while to understand that marijuana, that has such a negative connotation when improperly used, could actually be a positive,” Cuomo told reporters.

LEGIONNAIRES UPDATE — St. Joseph's Hospital Health Center in Syracuse is lifting its water restriction for most of the hospital after a Legionella outbreak last month. “Low flow and infrequent use in these locations allowed the bacteria to be detected. The hospital is targeting these areas for additional disinfection and will not lift water restrictions in these locations until test results show that the remediation eliminates the bacteria from these water outlets —most of which are not in inpatient care areas,” hospital officials said. [PRO]

AIR RIGHTS — The New York Times reports: “Smoking would be prohibited in public housing homes nationwide under a proposed federal rule announced Thursday, a move that would affect nearly one million households and open the latest front in the long-running campaign to curb unwanted exposure to secondhand tobacco smoke.”

...Smoking Ban Proposal a Surprise to Some Public Housing Tenants “At the Lexington Houses in East Harlem, smoking is the least of some tenants’ concerns. So the news that the federal government wants to ban smoking in homes in public housing across the country did not go over well with Samuel Higgs, 60 years old and a smoker since he was 24. ‘My apartment desperately needs a paint job,’ Mr. Higgs said. ‘My gas hasn’t worked for a month. You’re not gonna fix my gas and then tell me I can’t smoke in my own house?’”

MALONEY ON ZADROGA — Rep. Carolyn Maloney said she hopes new House Speaker Paul Ryan will back the full renewal of federal legislation that provides benefits to 9/11 victims and first-responders, instead of moving ahead with competing Republican-sponsored legislation. POLITICO New York’s Conor Skelding has more:

ACROSS THE RIVER The Larc School in Bellmawr, New Jersey, is the first school in the nation to allow students to consume medical marijuana on its grounds. Earlier this week Gov. Chris Christie signed a law that regulated medical marijuana for students with developmental disabilities.

-BANKRUPTCY COURT — A federal bankruptcy judge approved the sale of Saint Michael’s Medical Center in Newark on Thursday to a California for-profit hospital chain. But the sale to Prime Healthcare Services cannot be finalized until it is also approved by the state Department of Health and the state Attorney General. The state of New Jersey hasn’t given any indication of the timeline for its approval. Approval of the sale is complicated by the fact the state stands to lose upwards of $170 million in the transaction. POLITICO New Jersey’s Katie Jennings has the details.

PHARMA REPORT: Sorry parents and children, looks like you’ll have to endure the flu shot this year. AstraZeneca, the makers of the FluMist nasal spray, are experiencing a nationwide shortage.


-UTERUS TRANSPLANT — The Times reports “Six doctors swarmed around the body of the deceased organ donor and quickly started to operate.The kidneys came out first. Then the team began another delicate dissection, to remove an organ that is rarely, if ever, taken from a donor. Ninety minutes later they had it, resting in the palm of a surgeon’s hand: the uterus. The operation was a practice run. Within the next few months, surgeons at the Cleveland Clinic expect to become the first in the United States to transplant a uterus into a woman who lacks one, so that she can become pregnant and give birth. The recipients will be women who were either born without a uterus, had it removed or have uterine damage. The transplants will be temporary: each uterus will be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs.”

-PERIOD APP CHANGES CULTURE — Apps that track women’s periods and send an alert once a month, two days before they’re due to get their periods, is changing the way women, not only teenagers, are talking about their menses. Women are openly talking about their periods and companies are listening. The Times reports, “period tracker apps, which have helped shift attitudes, demystifying and normalizing menstruation by assigning cute icons to once unmentionables like heavy flow, maxi pads and period pimples. Most important, the apps transform the input into crunchable data that can tell a young woman when her period is due, when it’s late and even why she might be feeling so blue.There are over 200 different period tracker apps to choose from.”

-ACA POPULARITY ON THE RISE — Despite it being a political punching bag among Republicans, the Affordable Care Act is growing in popularity among Americans, according to data released by Center for Medicare and Medicaid Services. Roughly 540,000 people selected health insurance plans for 2016 during the first open enrollment week, a 15-percent jump from the open enrollment coverage of 2015. POLITICO Florida’s Christine Sexton has more: [PRO]

-WOMEN OVERTAKE MEN IN OBESITY RATES — Despite more than a decade of public awareness campaigns for people to watch their weight, obesity is still on the rise, with women surpassing men in that category, according to the Centers for Disease Control and Prevention. Nearly 38 percent of adults in 2013-2014 are obese, up from the 32 percent a decade earlier. Thirty-eight percent of women were obese compared to 34 percent of men.

TODAY'S TIP — Comes from the Cleveland Clinic. A hint of spearmint in your diet can relieve symptoms of digestive problems while also containing vitamins A and C.


-HIDING THE DATA POLITICO reports: “Drug companies are failing to report results for about one-third of clinical trials as required by federal law, according to a new BMJ Open study. Public availability of results data varied widely by company, according to the study, which examined trials of 15 drugs made by large pharmaceutical companies and approved by FDA in 2012. Gilead ranked the worst, disclosing results for just seven of 34 trials for its HIV drug Striblid. Johnson & Johnson, Pfizer and GlaxoSmithKline disclosed all clinical trial results for at least one of their reviewed drugs. U.S. law only requires drug companies to publish results of all controlled trials except Phase I studies associated with approved drugs. Selectively releasing trial results can distort the medical evidence, posing challenges for physicians, payers, pharmacy benefit managers and others trying to direct patients to the right drugs, the authors wrote. The authors - Jennifer Miller of New York University School of Medicine, David Korn of Harvard Medical School, and Joseph Ross of Yale School of Public Heath - conclude that drug makers may not be complying with federal reporting requirements because of FDA's limited enforcement power and the companies' various interpretations of the law. They also argue that the lack of disclosure violates ethical standards for research, contending that experimentation on humans is justified by the potential to contribute to societal knowledge.”

-DON’T DRINK THAT — Consuming an energy drink can significantly increase blood pressure in young healthy adults, according to a study in the Journal of the American Medical Association. Drinking an energy drink increases not only blood pressure, but heart rate and can lead to increased cardiovascular risk.

** 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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