Insight Entries

WHG - Weekly, August 19-23

As the August Congressional recess stretches into its third week today, the Trump Administration’s regulatory health care agenda remains at center stage. After the rollback of the drug rebate rule, the setback with the direct-to-consumer (DTC) ad rule, and the retreat on six protected classes changes, the Administration remains intent on releasing its proposed International Pricing Index (IPI) model. Nearly... Read More

(Llamas, 8/19/19) #Insurance Reform, #Medicare Part D, #Prescription Drugs

WHG - Memo: Hospital Price Transparency Proposals in the CY 2020 Hospital OPPS Proposed Rule

The attached memorandum provides a detailed overview of the proposed price transparency requirements included in the Calendar Year (CY) 2020 hospital outpatient prospective payment system (OPPS) proposed rule. Pursuant to a recent Executive Order, the Centers for Medicare & Medicaid Services (CMS) used the rule as a vehicle to advance regulatory changes designed to drive down hospital costs by making... Read More

(Wynne Health Group, 8/16/19) #Costs, #Hospitals, #Transparency

WHG - Weekly, August 12-16

The controversial move by Senate Appropriations Committee Chairman Richard Shelby (R-AL) to redirect $5 billion in the fiscal year (FY) 2020 Labor-HHS-Education spending bill to fund President Trump’s long-sought border wall has House Democrats fuming. With the proposal likely dead on arrival in the House and only a few weeks in September to flesh out a deal, Congress will likely... Read More

(Llamas, 8/12/19) #Budget, #Insurance Reform, #Prescription Drugs

WHG - Weekly, August 5-9

Members of Congress have scattered across the country for the summer recess, having delivered a $2.7 trillion budget agreement that reverses $126 billion in automatic spending cuts and suspends the debt ceiling through July 2021. This Congress still has a long to-do list of high-priority items – namely, prescription drug pricing, surprise medical billing, DSH cuts, finishing up appropriations –... Read More

(Llamas, 8/5/19) #Insurance Reform, #Medicare Advantage, #Prescription Drugs, #Disproportionate Share Hospitals (DSH)

WHG - Democratic Presidential Candidates' Proposals on Health Care

We provide a side-by-side analysis of Democratic presidential candidates’ proposals on health care that have been released thus far. For each of the four candidates below, the chart examines their key provisions regarding plan implementation, enrollee eligibility, benefit design, cost sharing, balance billing, prescription drugs, implications for providers and private plans, and finance mechanisms. Vice President Joe Biden; Sen. Kamala... Read More

(Llamas, 8/5/19) #Costs, #Insurance Reform, #Prescription Drugs

WHG - The Drug Pricing Debate Part II: The Many Acts of Congress

In a blog post featured on the Commonwealth Fund's To the Point, the Wynne Health Group sketches the current landscape of congressional drug pricing proposals and begins outlining what a final legislative package my look like. Specifically, the authors examine which measures have moved forward in the Senate, and cross-reference those with related measures advanced on the House side... Read More

(WHG, 7/30/19) #Costs, #Generic Drugs, #Medicare Part D, #Transparency, #Drug Pricing

WHG - Weekly, July 29-August 2

Following last week’s House passage of a two-year budget deal (H.R. 3877) that raised spending caps and suspended the debt ceiling for fiscal years 2020 and 2021, the Senate is poised to clear the bill just in time for August recess. The debate on surprise medical billing, prescription drug pricing and health care extenders, however, will continue into the fall... Read More

(Llamas, 7/29/19) #Budget, #Community Health Centers, #Insurance Reform, #Prescription Drugs, #Disproportionate Share Hospitals (DSH)

WHG - Issue Brief: Addressing the Social Determinants of Health in Federal Health Coverage Programs

In recent years, the Department of Health and Human Services (HHS) has advanced toward a greater recognition of the social determinants of health in federal health coverage programs, via expanded non-clinical benefit offerings, meaningful quality measures and the like. As HHS continues along a trajectory of advancing value-based payment, opportunities persist to expand the focus on addressing non-health care needs... Read More

(Wynne Health, 7/19/19) #Waivers, #Social Determinants of Health, #Delivery Reform

WHG - Updated Chart: Key Legislation on Surprise Medical Billing

We provide an updated side-by-side analysis of the major Congressional (Senate and House) legislation intended to protect patients from surprise medical billing that have been introduced thus far in the 116th Congress. We added the No Surprises Act recently advanced by the House Energy and Commerce Subcommittee on Health. For each of the four proposals outlined below, the chart examines... Read More

WHG - Highlights from Night Two of the Democratic Presidential Debate: Medicare for All Takes Center Stage Again, Along With Rx Drug Pricing, Women's Health, and More

On June 27, 2019, a second set of 10 candidates took the stage for what was part two of the first series of debates for the 2020 Democratic Presidential primaries. As with the first night, candidates answered questions spanning across many key policy topics, including climate change, gun safety, immigration, and foreign policy, among others. The conversation of course included... Read More

(WHG, 6/27/19) #Affordable Care Act, #Public Option, #Women’s Health, #Drug Pricing, #Medicare for All

WHG - Democratic Presidential Debate Highlights: Medicare for All, Rx Drug Pricing, Opioids and More

The first of this week’s two-part 2020 Democratic Presidential primary debate kicked-off tonight in Miami, FL, featuring 10 Democratic candidates (listed in our summary below). Initial questions focused on the national economy but quickly moved to other topics, including health care, immigration, foreign affairs (particularly focused on Iran), gun violence, and climate change. Tomorrow’s debate, also in Miami, will feature... Read More

(Pahner, 6/26/19) #Mental and Behavioral Health, #Women’s Health, #Opioids, #Delivery Reform

WHG - Chart re: Medicare Part D Reform Proposals

Wynne Health Group has developed a side-by-side analysis of three major Medicare Part D reform proposals. The proposals we examined are: The Medicare Payment Advisory Commission (MedPAC)’s June 2019 Report to Congress Chapter on Reforming the Medicare Part D Benefit Structure; The 2018 Policy Proposal from the American Action Forum (AAF) on Reforming Medicare Part D; and, The Draft Bill... Read More

(LaRosa, 6/20/19) #Medicare Part D, #Reinsurance, #Drug Pricing

WHG - Updated: 2019 Legislative and Regulatory Outlook

Wynne Health Group has updated its Legislative and Regulatory Outlook for 2019 to include changes stemming from the Administration’s Spring 2019 regulatory agenda. This documents seeks to provide a comprehensive collation of key federal health policy developments that we expect to see in the remaining months of this year. Of note in this update, you will find that many planned regulatory... Read More

(WHG, 6/11/19) #Food and Drug Administration, #Health Insurance Exchanges, #Medicare Part D, #Demonstration Programs

WHG - WHG Update: Recent Developments Impacting Access to Housing, Nutrition, and Other Social Determinants of Health

Much has happened in recent months with respect to social determinants of health, including administrative actions that might impact access to public benefits and health programs both in negative and potentially some positive ways. Developments related to public charge determinations, the calculation of the federal poverty level, housing assistance and nutrition program eligibility, and the removal nondiscrimination protections threaten to... Read More

(Wynne Health Group, 6/4/19) #Social Determinants of Health, #Nutrition

WHG - WHG Chart: Key Legislation on Raising the Tobacco Sale Age to 21

In the attached chart, we provide side-by-side analysis of the major Congressional (Senate and House) legislation intended to reduce youth tobacco use that have been introduced/released thus far in the 116th Congress. For each of the four proposals outlined below, the chart examines key provisions regarding tobacco products, restrictions, new enforcement authority, user fees, and preemption. Specifically, we look at:... Read More

(Llamas, 5/29/19) #Food and Drug Administration, #Public Health

WHG - WHG Chart: Key Legislation on Surprise Medical Billing

In the attached chart, we provide side-by-side analysis of the major Congressional (Senate and House) legislation intended to protect patients from surprise medical billing that have been introduced/released thus far in the 116th Congress. For each of the three proposals outlined below, the chart examines key provisions regarding prohibited balance billing scenarios, payment rates, implications for plans and providers, cost-sharing... Read More

(Wynne Health Group, 5/21/19) #Costs

WHG - A Tell-All on Telehealth: Where Is Congress Heading Next?

The Centers for Medicare and Medicaid Services (CMS) recently enacted modest but important expansions in Medicare’s telehealth policy. Telehealth, which uses telecommunications to support virtual health care delivery to improve access to and quality of health care, is moving from promise to reality. The benefits are appealing: Patients can interact with their providers remotely, which improves access to care and... Read More

(Wynne Health Group, 5/16/19) #Costs, #Health Information Technology, #Telehealth

WHG - Issue Brief: Assessing the Political Landscape and Outlook of Medicare for All

The political and public discourse around single-payer and “Medicare for All” proposals has rapidly gained momentum in 2019. Whereas in 2016, Medicare for All was championed most prominently and singularly by unsuccessful Democratic primary challenger Bernie Sanders (I-VT), in 2020 we will see nearly every Democratic presidential contender endorse a variation on the theme and will most certainly see the... Read More

(WHG, 5/13/19) #Public Option, #Single Payer

WHG - Accelerating Primary Care Redesign: CMS’ Innovation Center Announces Five New Transformative Models

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) announced the Primary Cares Initiative (PCI), a suite of five voluntary payment models aimed at overhauling primary care. Marking the Trump Administration’s latest investment in Medicare value-based reform, PCI focuses on the role of primary care providers as the central coordinators of patient health, with the goal of enhancing... Read More

(Wynne Health Group, 4/24/19) #Primary Care, #Value-Based Purchasing, #Demonstration Programs

WHG - Health IT Policy and Interoperability Issue Brief

Attached here, please find a Wynne Health Group issue brief that provides an overview of federal health information technology (health IT) policy, beginning with the evolution of the Centers for Medicare and Medicaid Services’ (CMS) Promoting Interoperability Programs, formerly the Medicare and Medicaid Electronic Health Record Incentive Programs (EHR Incentive Programs). Next, the brief expounds upon the Medicare and Medicaid... Read More

(Wynne Health, 4/4/19) #Health Information Technology, #Medicare Access and Chip Reauthorization Act of 2015 (MACRA)

WHG Insights