By the time Donnie Missouri met Rosaleita Fulford, the soft-spoken 44-year-old woman had funded a drug habit with prostitution and theft. "I was off the chain," she says. Fulford's T-cell count was low; she missed doctor's appointments to look for her next high. She got sick often, and when she did, she went to the emergency room instead of to an inexpensive clinic. It all came at the government's expense. Fulford represents the nation's "super-utilizers," the 1% of the population who account for 22% of health care spending, according to the Centers for Medicare and Medicaid Services. In the states' Medicaid programs — which increased by at least 3 million people in 2014 because of the Affordable Care Act — 5% of users account for 54% of spending.
HealthCare.gov is still not fully secure two months out from its second launch date, federal investigators said in a report Tuesday. The nonpartisan Government Accountability Office (GAO) said that while health officials have strengthened parts of the website's security, they failed to implement best practices across the entire system, leaving small weaknesses that place sensitive information "at risk." The report is likely to dominate a House Oversight Committee hearing scheduled for Thursday, where Republicans have urged CMS Administrator Marilyn Tavenner to testify. Lawmakers are concerned about news that a hacker breached part of HealthCare.gov this summer, though no consumer information was apparently viewed or taken.
Although few healthcare organizations view first-adopter status as a business advantage, those that more quickly implement new technologies do reap valuable returns on these investments, a new study suggests. Consumer behavior and expectations are the primary factors driving healthcare market changes, according to 61% of respondents in "The Digital Dividend: First Mover Advantage," a study conducted by Harvard Business Review Analytic Services and sponsored by Verizon. Today's consumers expect their providers to use electronic health records; a year ago 41% of patients said they would be willing to switch doctors to get online access to their medical records, according to an Accenture study.
Massachusetts health insurers said Monday that Partners HealthCare's planned acquisition of three hospitals would raise costs for consumers across the state and called on a Superior Court judge to achieve stricter price controls and other limits on Partners before allowing the expansion to go through. In their first public comments on the case, filed with Attorney General Martha Coakley's office, the insurers stopped short of asking the court to block the mergers, as other groups and individuals have. But without major modifications to a settlement between Partners and Coakley, the insurers said, it would hamper their ability to contain rising premiums and add to the "dysfunction'' of health care pricing.
With an expansion of Medicaid in Virginia all but pronounced dead, the state's hospitals and health care systems are bracing for tough decisions on how to balance their budgets. Lawmakers are holding a special legislative session on the topic starting Thursday, but there's been no sign that Republican opposition to Medicaid expansion has wavered. And Democratic Gov. Terry McAuliffe has conceded that he lacks the executive power to expand the federally funded program on his own. Not adding 400,000 low-income adults to the ranks of Virginia's insured has now left the state's health care industry with some painful decisions.
Jameson Health System on Tuesday said it plans to merge into the UPMC network as soon as the beginning of next year. In a joint news release, the New Castle-based health system and UPMC announced board members have signed a nonbinding letter of intent, which they hope to finalize by the first quarter of 2015. Officials on Tuesday said the goal of the merger is to create a regional approach to health care by integrating the boards and strategies at Jameson in Lawrence County and UPMC Horizon in Mercer County.