The tech giant is looking to the former exec for guidance on addressing healthcare improvement in a way that could reduce burden on providers.
Toby Cosgrove, MD, the Cleveland Clinic's former top executive, will share a stage Tuesday afternoon with several colleagues from his new employer: Google.
Cosgrove, who served as the clinic's CEO from 2004 through 2017, signed on as an executive advisor to the Google Cloud Healthcare and Life Sciences team, the company announced in a blog post last week. An update to his LinkedIn profile indicates he's been in the role since January.
As part of his new role, Cosgrove will join National Institutes of Health Chief Information Officer Andrea Norris for a conversation Tuesday about how advances in cloud computing are changing healthcare.
Those advances can help stakeholders go beyond achieving the triple-aim of healthcare improvement—better patient experience, improved population health, and reduced cost—to add a fourth aim, according to Gregory J. Moore, MD, PhD, vice president of healthcare for Google Cloud, who will moderate the conversation.
Although advances in technology have added to the recordkeeping burden on healthcare workers, people like Cosgrove can help companies like Google improve the work experience of physicians and their staff, Moore wrote in the blog post.
"Technology may have been the cause of some of these challenges, but we believe that it can also be the cure," Moore wrote.
Cosgrove, who retired from Cleveland Clinic in January, also joined the board of Denver-based healthcare IT company RxRevu, as HealthLeaders Media reported last month.
The combined company would be privately held and led by current LifePoint Chairman and CEO William F. Carpenter III.
Two rural hospital operators announced plans Monday morning to merge in a private-equity deal valued at $5.6 billion.
The combination of LifePoint Health and RCCH HealthCare Partners, both of which are headquartered in Brentwood, Tennessee, would form a single company with 84 non-urban hospitals across 30 states.
LifePoint Health Chairman and CEO William F. Carpenter III—who would lead the combined company as a privately held entity under the LifePoint Health brand name—said the two companies are aligned in their missions.
"Together, we can extend this shared focus while generating new opportunities for growth and partnerships that will help us navigate the changing healthcare industry dynamics," Carpenter said in a statement.
RCCH Chairman and CEO Martin Rash said the combined company's patients, workers, and partners will benefit from its size, scale, and growth-minded focus.
"I am thrilled that these two great companies are coming together," Rash said.
The deal calls for private-equity firm Apollo Global Management, which owns RCCH, to buy LifePoint Health in the $5.6 billion deal, which includes $2.9 billion in net debt and minority interest, according to the announcement.
Payday for LifePoint shareholders: The deal calls for LifePoint shareholders to receive $65 in cash per share. That's 35.7% higherthan their closing price on Friday, as CNBC reported.
LifePoint shares skyrocket: After closing at $47.90 on Friday, LifePoint shares rose more than 34% on Monday morning to trade above $64.20 apiece by 11 a.m. (Their gain widened to more than 35%, trading as high as $64.90 by early afternoon.)
Combined financials: Pro forma 2017 revenues for the two companies topped $8 billion, with about 60,000 employees, more than 12,000 licensed beds, and 7,000 affiliated physicians, according to the announcement.
The companies expect to complete their deal "over the course of the next several months," pending shareholder and regulatory approvals.
A bit of potential regulation CMS sent to OMB for review suggests the agency may be tweaking its formula to appease a federal judge.
Less than two weeks after the Centers for Medicare & Medicaid Services unleashed another wave of uncertainty across the health insurance industry by freezing billions of dollars in expected risk-reduction payments, the agency signaled Thursday that it may reverse course.
Although a CMS official tells HealthLeaders Media that the government is continuing to review all of its options, an interim final rule CMS sent Thursday to the Office of Management & Budget for review suggests one of those options could be to restart the program.
The title of the potential regulatory item, "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act," indicates that CMS is looking to recalibrate the way it calculates payments. Doing so could accomplish what critics said CMS should have done in the first place, instead of halting the payments.
Andy Slavitt, who served as an acting CMS administrator under former President Barack Obama, said drafting an interim final rule would easily solve the problem at hand. Slavitt described the halting of risk-reduction payments as "aggressive and needless sabotage" targeting the ACA.
The Wall Street Journal reported on Friday, July 6, that the Trump administration was expected to suspend the ACA risk-reduction program altogether. That weekend, on Saturday, July 7, CMS announced that it would freeze the payments, citing a February order from a federal judge in New Mexico.
"As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold," CMS Administrator Seema Verma said.
A federal judge in Massachusetts sided with CMS in January, ruling that the ACA risk-adjustment methodology was legal. But the federal judge in New Mexico reached the opposite conclusion in February, ruling that the risk adjustments could not be based on statewide average premiums.
In a hearing held June 21, CMS formally challenged the ruling of the New Medico judge, who indicated he would review the matter further and aim to have a subsequent opinion by the end of the summer, according to court records.
In a court filing Thursday, CMS notified the New Mexico judge that it had begun promulgating an interim final rule that could impact the case. The title of the potential regulatory item was included in the filing, but additional details and an estimated timeline were not.
Health Plans Weigh In
In a filing of their own Thursday, America's Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA) urged the New Mexico judge to alter his February ruling.
"CMS's unexpected decision to freeze all risk adjustment transfers nationwide has serious and time-sensitive ramifications for the functioning of the market for individual and small group health plans," they wrote. "That decision deprives many AHIP and BCBSA members of substantial risk adjustment payments that the Affordable Care Act guarantees and that they have relied on in making critical plan offering and pricing decisions."
The groups urged the judge to act quickly, as health plans are quickly approaching a number of deadlines in August, September, and October for the 2019 plan year.
There's even uncertainty over how health plans are supposed to treat risk-adjustment payments in calculating their medical loss ratio, AHIP and BCBSA said, noting that the deadline to do so is July 31.
The new program being launched by the University of Houston aims to bolster primary care to meet the state's demonstrated need.
If all goes according to plan, the University of Houston College of Medicine will enroll 30 medical students in fall 2020 and give each of them a full-tuition scholarship, thanks to an anonymous $3 million gift.
The university announced the gift Wednesday with a polished promotional video, touting the new college's emphasis on primary care. The university is still raising start-up funds for the project, which has yet to receive accreditation.
"This generous gift will allow such students an opportunity to attend and ultimately lead the future medical workforce," University of Houston President Renu Khator said in a statement, citing student debt as the top deterrent students face when considering whether to attend medical school.
Primary care emphasis: The goal is for at least half of each graduating class to specialize in primary care to meet a need in the region, the university said. Among the 50 states, Texas ranks 47th in terms of its primary care physicians-to-patient ratio, according to the Association of American Medical Colleges.
Partnering with regional provider: The university said it is working with HCA Healthcare's Gulf Coast Division on a partnership for first-year resident positions to begin next year. The goal is to have 389 such positions by 2025. An HCA spokesperson could not immediately be reached Thursday for comment.
Still seeking accreditation: The college says it is scheduled to admit 30 students for fall 2020, but that's contingent upon approval from state and federal policymakers. The college must be approved by the Texas legislature and the Texas Higher Education Coordinating Board, and accreditation must come from the AAMC-sponsored Liaison Committee on Medical Education.
Still fundraising: The university said it aims to raise $120 million for the college's start-up costs over a decade, about $40 million from each of three sources: philanthropy, state funding, and intellectual property revenue. More than $9 million has been raised through philanthropy thus far, the university said.
Stephen J. Spann, MD, MBA, vice president of medical affairs and founding dean for the college, said the new institution aims to be known for producing doctors who understand health disparities and how to provide high-value healthcare.
"Thanks to this amazing gift," Spann said, "we're one step closer to becoming a major resource for the community by addressing the shortage of primary care physicians."
There may be 'safe, select avenues for importation' that the U.S. government should consider, the HHS secretary said.
Health and Human Services Secretary Alex Azar made an announcement Thursday morning that seemed, at least at first blush, to contradict his claim two months ago that proposals to lower drug prices in the U.S. by importing product from Canada are "just a gimmick."
Azar had argued previously that drug importation would be ineffective and perhaps unsafe. But on Thursday he said there may be some circumstances in which importing drugs could be a useful tool in the Trump administration's effort to tamp down drug costs.
Azar directed the Food & Drug Administration to establish a working group to explore the possibility of permitting drug imports in a particular set of circumstances: when there's a significant price increase on a drug produced by a single manufacturer without the protection of patents or exclusivities.
This situation has happened a number of times in recent years with branded and generic drugs alike, he said. The price of Daraprim, for example, jumped more than 5,000%, from $13.50 to $750 per tablet, in 2015—more than six decades after the drug secured FDA approval.
"Safe, select avenues for importation could be one of the answers to these challenges," Azar said in a statement.
Defensive tone: The HHS announcement took a defensive tone, saying both Azar and the president "have consistently maintained that HHS is willing to explore all ways to tackle the soaring price of drugs" while keeping patients safe and protecting innovation. The narrow application of the working group's mission "stands in contrast to proposals to import a broader range of drugs," the HHS announcement states.
Support from a predecessor: Tommy G. Thompson, a former Republican governor of Wisconsin and HHS secretary under President George W. Bush, issued a statement praising Azar's move and emphasizing that it is a targeted tactic, not a general approach. "While importation doesn't make sense on a broad scale due to the inability of FDA to ensure safety, FDA should be able to carefully control the safety of importation in instances of clear abuse, and this will help patients," Thompson said. "This is a commonsense and pragmatic approach in instances where egregious business conduct harms patients."
A short-term tactic: In his own statement, FDA Commissioner Scott Gottlieb emphasized the short-term nature of this targeted tactic. "Any policy that involves the importation of drugs would be temporary until adequate competition enters these categories," he said.
Focus on safety: The HHS statement said medicines would not be imported if their safety cannot be guaranteed. "Importation will be limited to cases where drugs can be imported with adequate assurances of safety and effectiveness," the statement said.
The suggestion that such assurances of safety and effectiveness are possible undermines one of the arguments Azar raised in May against such importation policies.
"[T]he last four FDA commissioners have said there is no effective way to ensure drugs coming from Canada really are coming from Canada, rather than being routed from, say, a counterfeit factory in China," Azar said in May, according to his prepared remarks.
"The United States has the safest regulatory system in the world," he added. "The last thing we need is open borders for unsafe drugs in search of savings that cannot be safely achieved."
Azar's comments in May came as he explained the Trump administration's blueprint to reduce drug prices and as Vermont passed a law to allow whole drug importation from Canada.
Editor's note: This story has been updated to include statements from former HHS Secretary Tommy G. Thompson and FDA Commissioner Scott Gottlieb.
The plaintiffs had sought to keep their legal options open in case the White House moves to ban 'silver-loading.'
A federal judge in California tossed out a lawsuit Wednesday that had challenged the Trump administration's decision last fall to cut off cost-sharing reduction (CSR) payments to health insurers.
The 18 plaintiff states, led by California, had asked earlier this week that the litigation be put on hold rather than dismissed, so they could quickly raise objections to future actions by the government. But the judge decided to close the case instead.
"In the event a new lawsuit involving the same or similar issues is filed in this district, any party to the new lawsuit may file an administrative motion to consider whether the newly-filed lawsuit is related to the above-captioned one," Judge Vince Chhabria in the U.S. District Court for the Northern District of California wrote in his brief order.
The plaintiffs had expressed particular concern that the administration could move to prohibit a pricing tactic known as "silver-loading" on the Affordable Care Act exchanges. The practice had staved off instability in the individual market, at least temporarily, the plaintiffs acknowledged.
Commissioner Scott Gottlieb advocated for the plan during a Brookings Institution presentation.
The central theme in the Food & Drug Administration's "Biosimilar Action Plan" unveiled Wednesday is that competition can and should be leveraged to reduce drug prices.
FDA Commissioner Scott Gottlieb made the case for the plan during a presentation at The Brookings Institution, arguing that shifts in the marketplace in recent years have opened up opportunities that should be met with new models.
"Our current payment system, which reimburses drugs based on their average sales price, was designed in a single-source world," Gottlieb said. "It was a market of biologics where there was typically only one drug in a category."
Gottlieb, who worked for the Centers of Medicare & Medicaid Services in the early 2000s, said he was working at Medicare when the current system was designed and implemented. Things have since changed, he added.
"Now most of these biologics categories are highly competitive, with lots of different products aimed at the same target. Yet the current payment system doesn’t take full advantage of all this therapeutic competition," Gottlieb said, advocating for a new approach.
While the FDA may not be involved in the demand-side of the drug-buying equation, the FDA's action plan outlines four areas in which it can focus its energy to maximize biologic competition:
The processes by which biosimilars are developed and approved can be made more efficient.
Scientific and regulatory information can be provided with greater clarity to those seeking to develop biosimilars.
Patients, clinicians, and payers can be more effectively educated on biosimilars.
The FDA can combat unfair delays in competition by companies that game FDA requirements for their own gain.
"The branded drug industry didn’t build its success by being business naïve. They are smart competitors," Gottlieb said. "But that doesn’t mean we need to embrace all of these business tactics, or agree that they’re appropriate."
This is the fourth senior adviser hired to lead HHS Secretary Alex Azar's four priority areas.
Adam Boehler, the founder and former CEO of Landmark Health, will serve as senior adviser for value-based transformation and innovation, Health and Human Services Secretary Alex Azar announced Wednesday.
Boehler, who also founded laboratory benefit management firm Avalon Health Solutions, has been serving as director of the Center for Medicare & Medicaid Innovation (CMMI) since April. He will retain that position while taking on his new advisory role.
"Adam is the kind of results-oriented, transformational leader we need to deliver on what President Trump has promised the American people: better healthcare at a lower cost," Azar said in a statement.
"At CMMI, he has already demonstrated an ambition for bold change, and will now be able to bring his deep experience with private sector innovation to help HHS execute on the long-talked-about goal of transforming our healthcare system into one that pays for value," Azar added.
Boehler's appointment marks the fourth senior adviser Azar has named to take the lead on his four priority areas: fighting the opioid crisis, reducing prescription drug costs, grappling with both the availability and cost of health plans, and transforming U.S. healthcare into a value-based system.
Opioid crisis: Brett Giroir, MD, assistant secretary for health, was named senior adviser for mental health and opioid policy in March. Since then, Giroir has added coordination and policy planning to the HHS response to the opioid crisis, Azar said.
Drug costs: Daniel M. Best, was named senior adviser for drug pricing reform in March. Since then, Best has taken a leading role in the development of the drug-pricing blueprint released in May and other HHS efforts to lower drug costs, Azar said. Best previously served as corporate vice president of industry relations for CVS Health's Medicare Part D business; before that, he worked for Pfizer Pharmaceuticals more than a decade.
Health plans: James "Jim" Parker, MBA, was named senior adviser for health reform in April. Parker, who worked more than two decades for Anthem, has been tasked with working to address health plan cost and availability. In the past few months, Parker has led HHS efforts to "expand choice and competition in the individual and small-group insurance markets within the constraints of the Affordable Care Act," Azar said Wednesday.
Value-based transformation: As the U.S. healthcare system continues to move toward value-based models, Boehler's role will be to advise HHS on how it can guide and prod that shift—which Azar identified last spring as among his top four priorities for the department.
The HHS announcement notes that Boehler's work history includes a time as an operating partner with private equity firm Francisco Partners, where he focused on investments in healthcare technology and services.
The insurer implemented its policy in six states over the past year, leaving patients on the hook for bills Anthem determined after-the-fact to be non-emergent, plaintiffs claim.
A long-running disagreement over Anthem's policy of denying payment for emergency department visits that are later deemed non-emergent escalated Tuesday, with a lawsuit filed in federal court.
Two groups, the American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG), sued Anthem's Blue Cross Blue Shield of Georgia, alleging that the ER policy violates the "prudent layperson" standard in the Affordable Care Act—which, the plaintiffs say, requires Anthem and other insurers to cover emergency care based on a patient's symptoms rather than their final diagnosis.
"We can't possibly expect people with no medical expertise to know the difference between something minor or something life-threatening, such as an ovarian cyst versus a burst appendix," ACEP President Paul Kivela, MD, FACEP, said in a statementcalling the policy "dangerous."
The plaintiff organizations have tried repeatedly to work with Anthem to reverse the controversial policy, to no avail, Kivela said.
"We felt we had no choice but to take action to protect our patients, and therefore are asking the federal court to force Anthem's BCBS of Georgia to abide by the law and fulfill their obligation to their policyholders," he added.
A spokesperson for Anthem declined HealthLeaders Media's request for comment.
Longstanding claim of illegality: More than a year ago, ACEP joined with its Missouri chapter to publicly accuse Anthem of violating the law. In addition to Georgia and Missouri, the controversial policy affects beneficiaries in Indiana, Kentucky, New Hampshire, and Ohio, according to the plaintiffs.
Fatal consequences? "They're not going to change [this Anthem policy] until somebody dies and they get sued. That is going to happen at some point," Ryan Stanton, MD, an emergency medicine physician and CEO of Everyday Medicine in Lexington, Kentucky, told HealthLeaders Media in January.
Senators take notice: Anthem's policy caught the attention of some on Capitol Hill, including two Democratic senators who wrote a letter in March to Health and Human Services Secretary Alex Azar: "While we appreciate Anthem on their effort to encourage patients to seek medical care in lower-cost settings, we remain concerned that Anthem's ED policy still forces patients to determine, before they even leave their home, if their symptoms are serious enough to go to the emergency room," the senators wrote.
Not the first lawsuit: Tuesday's lawsuit follows one filed in February by Piedmont Hospital and five sibling facilities that accused Anthem of cutting costs at the expense of patient safety, as The Atlanta Journal-Constitution reported.
Physicians oppose the policy: More than 70% of physicians polled in Georgia said the average patient isn't sufficiently knowledgeable to determine whether a given medical situation is an emergency, MAG President Frank McDonald, MD, MBA, said in the plaintiffs' statement. "Even stopping to consider if it's an emergency could mean the difference between life and death," McDonald said.
The lawsuit asks the judge to block Anthem's policy under the ACA's prudent layperson standard and declare the policy to be in violation of the Civil Rights Act. It also seeks payment "for the services [ACEP] members legitimately provided" to Anthem's beneficiaries.
An appellate court decision dealt a major setback to hospitals unhappy with planned cuts to the Medicare drug reimbursement program.
The American Hospital Association's attempt to block $1.6 billion in cuts to the 340 Drug Pricing Program suffered a major setback Tuesday, when the D.C. Circuit Court sided with Health and Human Services.
The three-judge panel ruled that the lower court had properly dismissed AHA's case because the association failed to fulfill the legal prerequisites to judicial review.
More specifically, AHA failed to adequately present the matter to HHS Secretary Alex Azar. This "presentment" threshold is the obstacle that tripped up the AHA challenge at the district court level, a decision Tuesday's appellate ruling affirmed.
"When the plaintiffs filed this lawsuit, neither the hospital plaintiffs, nor any members of the hospital-association plaintiffs, had challenged the new reimbursement regulation in the context of a specific administrative claim for payment. Nor could they have done so, for the new regulation had not yet even become effective," the appellate judges wrote. "Therefore, they had neither presented their claim nor obtained any administrative decision at all, much less the 'final decision' required under [the relevant law]."
The AHA, along with fellow plaintiffs the Association of American Medical Colleges and America's Essential Hospitals, had argued that it met the presentment requirement by opposing the policy in writing during the rulemaking process.
Because the decision was based on a lack of subject-matter jurisdiction, it did not address the merits of AHA's claims.
The groups emphasized that the decision does not address whether they can obtain judicial review. It simply addresses when and how that review can be obtained.
"We will continue our fight to reverse these unwarranted cuts and protect access for patients, and we expect to refile promptly in district court," the groups added.
Editor's note: This story has been updated to include a statement from the American Hospital Association, the Association of American Medical Colleges, and America's Essential Hospitals.
