UPDATE – Lots of health policy stuff, all right here!

This biweekly edition of Health Wonk Review brings the best writing about health care, policy, and the impacts thereof direct to your eyeballs – with NO effort on your part!

Apologies to Hank Stern – somehow I missed his contribution for this edition.  The ever-prolific Mr Stern asks why coverage for some autism treatment ends at 21.  Good question.

Roy Poses leads us off with his intel on the rollout of the Sunshine Act – the part of PPACA requiring much more disclosure of financial relationships between doctors and suppliers.  Dr Poses opines that the beginning has been anything but smooth – but far better to have a rocky rollout than continued ignorance.

Our friends at Wing of Zock have a great post from Steve Lipstein, CEO of BJC Healthcare.  Steve has a much-needed outsider’s perspective on the Wilensky-Berwick committee’s recommendations on graduate medical education. His take is that re-vamping higher ed is going to be affected far more by operating models and the economic models in each physician specialty area than by pronouncements on high.

The problem in the diagnosis of Thomas Duncan, the Dallas Ebola patient, reflects the promises and pitfalls inherent in electronic health records, and Peggy Salvatore’s synopsis of the situation and lessons learned is a very high-value read.

From Health Insurance Colorado we get intel on how things are looking in Colorado – the state Exchange is doing very well; the uninsurance rate dropped by six points and enrollment in private plans via the Exchange has almost hit the 150,000 mark. That said, improvements can still be made.

If are ever going to get better quality and lower costs, it will happen because payers and providers work together to tie value much closer to payment.  Health Affairs brings us an update on progress to date – which is considerable – while warning that continued progress is not assured.  Here’s the Holy Smoke! headline – 40% of commercial insurers’ payments to doctors and hospitals now “flow thru value-based payment methods”, up from 11% in 2013.  See Suzane DelBanco’s take on value-based purchasing here…

A great companion piece is Jason Shafrin’s review of the recent national survey of ACOs, noting that there’s a lot of variation amongst and betweenst (my new word) ACOs – which is all to the good as the variability means we’ll learn a lot about what models work and what doesn’t.

There’s good news for those who like their current non-ACA compliant health plans; many will be “grand mothered”.  Louise Norris tells us “Grandmothered – or transitional – plans are those that are not grandfathered but were effective prior to 2014.”  Simply put, grand mothered plans must have some aspects of ACA-compliant plans while grandfathered plans don’t – unless they are changed significantly.  

Pharmacists are one of the more-often-taken-for-granted clinical professions, and Brad Flansbaum is here to update us on the state of the profession. In a phrase; “over-staffed”.  There are far more graduates of PharmD programs that jobs, with one pundit predicting 20% of graduates will not find jobs in 2018…

David Williams gets us up to speed on Apple’s health application plans and prognosticates on its market position – think “one of” and not “THE” health apps.  As always, David’s knowledge and experience make his view well worth consideration.

Starting in January, employers’ OSHA reporting requirements will change – while this may seem esoteric, it would behoove risk managers and their colleagues to make sure they are complying – Julie Ferguson gives us the skinny at WorkCompInsider...

Good friend and colleague Sandy Blunt reminds us that a lot of what drives success is the simple stuff – blocking and tackling.  While fancy moves and tricky plays are entertaining, they don’t deliver like the basics do…

Richard Krasner contributes his piece on poor actors and poor actions in work comp with a focus on an employer in Florida where over a hundred undocumented workers were accused of work comp fraud. Richard details other transgressions wherein workers were penalized/ due to transgressions that sure look to be endorsed, if not authorized by employers. Hat tip to David DePaolo for his original work on the FL case…noting that Florida CFO Jeff Atwater busted the FL workers for fraud, even though only a handful had filed work comp claims…as David said; 105 workers get arrested for immigration and documentation fraud under a workers’ compensation statute, even though most did not file any injury claims…”

I round out the work comp section with my take on the current non-sale of Aetna’s Coventry Workers’ Comp Services unit to APAX; while it may not be a dead duck, it looks to be on life support.

Thanks to all – see you in two weeks.