National Effort to Lower Drug Prices, SIFs, and more...

Drug Prices in the Spotlight

The 2018 Cost Trends Report from the Health Policy Commission (HPC) released last month showed, as the report has in previous years, the persistent growth in prescription drug spending over the state’s healthcare cost growth benchmark.

In that report, the HPC noted that more than 50 bills have been filed in the Massachusetts legislature to get drug prices under control.  One such bill from the Baker Administration would enhance the ability of MassHealth to negotiate directly with drug manufacturers for additional supplemental rebates regardless of state procurement rules.  (There is currently a national Medicaid drug rebate agreement on the federal level; states can negotiate supplemental rebate agreements to further reduce expenditures.)

Last week, the Mass. Association of Health Plans held a policy forum where a representative from the National Academy for State Health Policy noted that 158 drug cost bills have been filed in state legislatures so far in 2019. State legislatures passed 45 such Rx-price laws last year.

Confronting the issue isn’t just limited to state actions.  After regaining the majority in the U.S. House, Democrats stated that bringing down drug prices is a priority. But the issue is bipartisan in nature.  For example, U.S. Health & Human Services Secretary Alex Azar wants to index Medicare Part B drug prices to lower prices paid by other advanced countries.  And Senate Finance Committee Chuck Grassley (R-Iowa) has indicated he’s open to studying a proposal to allow people to import their prescription drugs from Canada.

The American Hospital Association released a report in January showing that average total drug spending per hospital admission increased by 18.5% between FY2015 and FY2017, and that very large percentage increases (over 80%) of unit price were seen across different classes of drugs, including those for anesthetics, parenteral solutions, and chemotherapy.

Debate Continues on Safe Injection Facilities

Safe injection facilities (SIFs) – a location where people can inject illicit drugs under the supervision of trained staff – are on two distinct paths in the state.

On one path, the SIF concept is gaining the support of some legislators and healthcare professionals who see the benefit of providing a safe, clean place for those with substance use disorder to inject the drugs they’re addicted to – and avoid overdose, crime, and infection by doing so. Last week the legislatively mandated Harm Reduction Commission, created to explore strategies to address the opioid crisis, voted to support the creation of one or more SIF pilots. However, the commission also specified that any pilot SIF should have local approval and “rigorous evaluation" of outcomes and effects on surrounding communities. 

On the other, diametrically opposed path is U.S. Attorney Andrew Lelling, who wrote an op-ed last month in the Boston Globe saying SIFs are illegal and he’ll prosecute to stop them in Massachusetts. The Harm Reduction Commission's report last week noted the federal position on SIFs; it states: "An additional challenge is the federal government’s strongly stated current stance against supervised consumption sites. Action on the federal level is needed to shift policy in regards to the federal prohibitions on supervised consumption sites." Governor Baker weighed in last week saying that he sees no reason to pursue SIFs if it’s clear the federal government won’t allow them. Throughout his entire tenure as governor, Baker has been a staunch proponent of other opioid-fighting strategies, and his efforts in the area have received national recognition.

Now, observers are wondering how and if the two paths will merge. Some legislators have advocated for the passage of state law to support the implementation of SIF pilots. Others are keeping an eye on a court case in Pennsylvania in which SIF proponents say the federal law Lelling cited is drafted in such a way that SIFs may actually be allowed in that jurisdiction. The only certainty is that Massachusetts has not heard the last about SIFs.

AG Slams Door Shut on Online Vaping Merchant

The Massachusetts Attorney General’s office last week put a hard stop to an electronic vaping company’s sales in Massachusetts, saying that the Kilo Eliquid website had no measures to ensure that it was selling products only to those age 21 or older, that its mail order practices allowed release of packages to underage consumers, and that the company advertised on websites geared towards children.

The practices violate state law and regulations, the AG wrote the company in a “Demand to Cease and Desist” letter. Online retailers who sell in Massachusetts, where the legal age to purchase electronic smoking devices is 21, must use a database to verify a purchaser’s age, and must use a delivery method that requires the signature of someone at least 21 years old before the package is released.

“E-cigarette companies have taken a page out of the playbook of the tobacco companies to get young people addicted to their products,” said AG Maura Healey. “If these retailers are operating in our state, they must comply with Massachusetts laws and keep their products away from children.”

The Massachusetts hospital community has been a strong advocate in the fight against the use of tobacco products. The large majority of Massachusetts hospitals are tobacco-free, meaning that they disallow use of all tobacco products anywhere on their grounds, including parking lots and garages. More information about Massachusetts hospital effort to combat smoking – the leading cause of preventable death in the U.S. – is here.

National Program Encourages Age-Friendly Health Systems

National healthcare organizations have announced expansion of a program to assist hospitals in caring for an aging population.

The 4M Model for Creating Age-Friendly Health Systems is geared towards the current 46 million Americans age 65 and older – a population that is projected to double to more than 98 million by 2060. Older patients have complex health needs that make their medical care challenging, including side effects and adverse drug interactions from multiple medications, and changing care preferences that favor staying at home and prolonged independence. This 4M Model focuses on:  What Matters, Medication, Mentation, and Mobility.

Age-Friendly Health Systems, an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, involves proven practices that hospitals can adopt, including, among other things, age-friendly medications; a renewed focus on identifying and managing depression, dementia and delirium across care settings; and ensuring that older adults at home and in every setting of care move safely each day to maintain function. This program aligns with MHA’s recent work that resulted in guidance for developing an operational plan to address diagnosis and care for patients with Alzheimer’s disease and related dementias in hospital settings.

Five U.S. health systems, including Trinity Health, are testing this new approach in hospitals as well as in long-term care, ambulatory, and post-acute settings. Several Massachusetts hospitals are enrolled in the program and there is the opportunity for more hospitals to join the Age-Friendly Health Systems Action Community which begins in April 2019.  More information is available at ihi.org/AgeFriendly.

Deadline TODAY: Sign up for MAT Training

There is a special training this Wednesday, March 6, entitled “Understanding MAT for Adolescents and Young Adults with Opioid Use Disorder” but the deadline for registering is today. The training takes place at the Sheraton Framingham Hotel & Conference Center from 8:30 a.m. to 12:30 p.m. It is for behavioral health providers, social workers, case managers, or other clinical support staff working with youth or young adults struggling with substance use disorder and specifically opioid use disorder. Registration is $25. Click here for more info and to register. MHA, in collaboration with the Massachusetts College of Emergency Physicians (MACEP) and through a member workgroup, developed these guidelines to assist acute care hospitals in implementing a Medication for Addiction Treatment (MAT) program in their emergency departments or satellite emergency facilities.

State to Insurance Company: Not so Fast

The health insurer United Healthcare has been planning a benefit change whereby patients would be required to receive outpatient elective advanced radiologic imaging (that’s MRIs and CT scans) in non-hospital settings (with some exceptions).

MHA reviewed the policy and determined that there are not enough freestanding CT providers to fulfill the insurer mandate, and discovered numerous errors and faulty listings in United’s provider directory – the document consumers use to find a facility to conduct the CT scan.

MHA wrote the state Division of Insurance about the problem and DOI delayed the insurer from imposing the change from the original implementation date of January 1 to the new date of April 1. MHA, DOI, and hospitals will continue to monitor the situation.

Hospital Developments of Note

Baystate Health opened a new 54,000 square foot “Baystate Health & Wellness Center” in Longmeadow last Monday. The building offers patients primary and multi-specialty care, as well as laboratory and imaging services. Baystate Health President & CEO Mark Keroack, M.D., the chair of MHA’s Board of Trustees, was joined at the ribbon cutting by State Sen. Eric Lesser (D-Longmeadow) and State Rep. Brian Ashe (D-Longmeadow).

On February 28, South Shore Health announced the largest private gift in its 97-year history – a $10 million donation from John and Eilene Grayken of Cohasset to be used for substance use disorder (SUD) and behavioral health services and initiatives. Gene Green, M.D., president and CEO of South Shore Health, said the generous gift will allow South Shore to “to integrate behavioral health clinicians in our ambulatory sites; establish a rapid care treatment location for people with SUD;  launch a Mobile Integrated Health program which will include our Emergency Department and Emergency Medical Services working alongside local police and fire agencies; support our collaboration with Aspire Health Alliance (formerly South Shore Mental Health); and further our strong relationship with the Office Based Addiction Treatment (OBAT) program at Boston Medical Center (BMC). All of our plans fall under the umbrella of Substance Use Disorder and Behavioral Health. Our programs in these areas will be named the Grayken Center for Treatment at South Shore Health.”

Creating Paths to Operating Margin, Mission, and Market Essentiality

Leading health systems are undertaking extraordinary work to calibrate their margin, mission, market position, and operating model. Margin pressure is now the new normal. Despite traditional margin improvement initiatives in such areas as supply chain, throughput, clinical documentation, and revenue cycle, margins continue to decline. Fee-for-service reimbursement cuts, both past and future, promise to cost the sector billions as structural reforms are addressed. Recent downturns in hospital inpatient and ambulatory volumes due to affordability problems have exacerbated provider margin gaps. The ultimate call to action is for organizations to calibrate future margins, missions, and market positioning with their operating model and underlying technology platforms. This conference will look at effective current strategies for improved ROI across an enterprise. We’ll look at population health, finance automation, EMRs/digital technology, clinical re-design, and management of medical groups. The focus of this conference on Friday March 22 from 9 to 2:15 at MHA's Conference Center in Burlington, will be on tactics for margin improvement and we’ll highlight best practices from top health systems across the country. Click here to register and learn more.

John LoDico, Editor