California Names Former Google Scientist as the State’s ‘Mental Health Czar’

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Source: Stat

Noted psychiatrist and former Verily leader Dr. Tom Insel is going to be the “mental health czar” for the state of California, Democratic Gov. Gavin Newsom announced Tuesday.

Insel, the former National Institute of Mental Health director, will also continue his work with Mindstrong, a startup that is working on a mental health app, a company spokesperson confirmed. Insel joined the company in 2017 after leaving Verily, Google’s life sciences arm.

Insel’s new job will be to “inform the state’s work as California builds the mental health system of tomorrow, serving people whether they are living in the community, on the streets or if they are in jails, schools or shelters,” according to a press release from the governor’s office.

In a press conference, Newsom said Insel was “volunteering” his time as an adviser. “I’m calling him the mental health czar in the state of California,” he said.

Mindstrong, which is focused on using data on how people use their smartphone to detect trends in their mental health, already has a relationship with public officials in California. One of Mindstrong’s first large-scale rollouts was slated to happen in the state through county-level public mental health systems, STAT reported in October.

A spokesperson for Mindstrong said that Insel would recuse himself from conversations about the company, and noted that he will have “no fiscal or regulatory authority and will have no oversight of current programs in this voluntary role.”

The spokespeople for Newsom and for California Health and Human Services Secretary Mark Ghaly, with whom Insel will be working, did not immediately reply to a request for comment.

Mindstrong raised $31 million in an expanded Series B round in January led by General Catalyst, bringing the company’s total funding to about than $60 million.

“Our excitement over Mindstrong’s technology is bolstered by our inspiration in the core founding team,” an associate and the managing partner of General Catalyst wrote in a blog post in January about the investment.

Californians Want Leaders to Expand Access to Mental Health Care, Kaiser Survey Finds

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Source: Sacramento Bee

Californians indicated In a survey released Thursday that they want state leaders to put a priority on ensuring that people with mental health conditions can get access to treatment, with 49 percent saying it’s extremely important and 39 percent saying it’s very important.

The Kaiser Family Foundation and California Health Care Foundation designed and conducted the poll of 1,404 Californians in November and December, looking to gauge health care priorities and experiences in a state considered a leader in health-care trends. The study’s author noted that, while on the campaign trail, Gov. Gavin Newsom made health care a priority and announced sweeping plans for change in health care.

Survey findings offer a view of what state residents want, the survey authors said, as the new governor takes the reins and a new legislative session begins. Asked to rank what they felt state leaders should make their top priorities, poll respondents put improving public education in the top spot, but following closely behind was making health care more affordable.

While 86 percent of those surveyed considered improving public education very or extremely important, health care affordability ranked highly with 80 percent. Coming in third was making housing more affordable at 75 percent. The findings had an error rate of plus or minus 3 percentage points.

Asked to assess what aspects of health care mattered most to them, survey respondents ranked expanding access to mental health care as most crucial. Next on the list was making sure all Californians have access to health care and third, lowering the cost of health care for Californians.

“About half — 52 percent — of Californians say their community does not have enough mental health providers to serve the needs of local residents, compared to 27 percent who say it does have enough and 21 percent who say they don’t know enough to say,” survey authors said.

DOJ Approves $69B CVS-Aetna Merger with Part D Divestiture

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Source: Fierce Healthcare

The Department of Justice (DOJ) approved a $69 billion CVS-Aetna merger on Wednesday after Aetna agreed to sell off its Part D business.

The Part D divestiture was a condition of the merger’s approval, according to the DOJ. Late last month, Aetna agreed to sell its 2.2 million Part D business to WellCare.

Antitrust regulators said the divestiture would “fully resolve the Department’s competitive concerns.” The DOJ along with attorneys general in five states filed a proposed settlement that approves the deal on the condition that Aetna sell off its Part D plans.

“Today’s settlement resolves competition concerns posed by this transaction and preserves competition in the sale of Medicare Part D prescription drug plans for individuals,” Assistant Attorney General Makan Delrahim of the Justice Department’s Antitrust Division said in a statement. “The divestitures required here allow for the creation of an integrated pharmacy and health benefits company that has the potential to generate benefits by improving the quality and lowering the costs of the healthcare services that American consumers can obtain.”

In a complaint filed to U.S. District Court for the District of Columbia, DOJ attorneys argued that without the divestiture, the combined company would cause “anticompetitive effects, including increased prices, inferior customer service, and decreased innovation” in the 22 states where Aetna sells Part D plans. The court must approve the settlement in order for it to move forward.

“DOJ clearance is an important step toward bringing together the strengths and capabilities of our two companies to improve the consumer healthcare experience,” CVS Health President and Chief Executive Officer Larry J. Merlo said in a statement. “We are pleased to have reached an agreement with the DOJ that maintains the strategic benefits and value creation potential of our combination with Aetna. We are now working to complete the remaining state reviews.”

Part D consolidation was the primary issue raised among groups opposing the merger, including the American Medical Association and the California Insurance Commissioner.

Anthem-Cigna Becomes Second Mega-Merger to Get Shot Down

A federal judge in Washington, D.C., blocked the proposed mega-merger of health insurance heavyweights Anthem and Cigna. The $54 billion deal — Anthem was trying to acquire Cigna — would have created the largest health insurance company in the nation. The decision follows a similar ruling that halted Aetna’s bid for Humana Inc.

 The judge’s ruling came in a lawsuit brought against Anthem and Cigna by the U.S. Justice Department and the attorneys general in 11 states. The lawsuit argued that the merger would violate antitrust laws — basically, Anthem and Cigna are so huge that, when combined together, they would smother competition in the health insurance marketplace. And that would be bad for consumers because it would reduce the incentive to keep costs low and would likely instead drive up the prices of insurance plans.

 U.S. District Judge Amy Berman Jackson noted that Cigna and Anthem are two of only four insurers currently that offer a nationwide network capable of serving the country’s largest employers. That alone was reason to block the merger, she wrote, although she suggested that Anthem’s and Cigna’s combined might in other areas of insurance also caused concern.

“The proposed combination is likely to have a substantial effect on competition in what is already a highly concentrated market,” the judge wrote in her opinion.

Supporting Workplace Mental Health

In recognition of World Mental Health Day on Oct. 10, the Standard Insurance Company offered these tips on mental health accommodations in the workplace:

  • Understand the importance of accommodations: Living with an illness, injury, or chronic condition — like depression — can be challenging and can lead an employee to feel labeled by their diagnosis. Accommodations can put your employees at ease and allow them to be as productive as possible. Stay-at-work accommodations or other workplace modifications can go a long way to help an employee manage their condition. Accommodations may be regulated under the Americans with Disabilities Act. They often help an employee feel supported and valued and be more productive.
  • Use your disability carrier for assistance: Some disability insurance carriers provide assistance with an employee’s stay-at-work or return-to-work accommodations. Some provide mental health consultants to help employers develop and implement stay-at-work plans. A mental health consultant can contact the employee and their medical team to understand any limitations or restrictions. By having experts available to assess an employee’s needs and come up with a plan, the employee gets the best assistance and the company stays compliant with regulations.
  • Tailor accommodations to each employee: Mental health consultants can analyze the employee’s job role and work environment to help provide the best recommendation to keep them on the job.

Depending on the employee and their condition, effective accommodations can include giving an employee the flexibility to attend appointments, or move their workstation to an area with less distractions, says Dr. Jeff Guardalabene, senior behavioral health case manager from The Standard. He said that some accommodations require the employer to be flexible and creative. For example, an employee with bipolar disorder may find their natural rhythms disrupted. Not all jobs allow for flexible schedules, but if they do, allowing an employee to work when their sleep/wake cycle isn’t disrupted can avoid triggering mania or depression. “An employer that is proactive in how they provide assistance for an employee with a mental health condition can make all the difference between lost time and productivity,” he added.

Group Supports Mental Health Parity Enforcement

The National Alliance on Mental Illness (NAMI) is supporting legislation to ensure enforcement of the 2008 federal mental health insurance parity and expanded coverage under the ACA. “While significant progress has been made, people living with mental illness continue to encounter significant barriers in getting necessary mental health services covered in health insurance,” said NAMI CEO Mary Giliberti in a letter to Health Subcommittee Chair Joe Pitts (R-Pa.) and Ranking Member Gene Green (D-Texas.)

NAMI cited its 2015 report, “A Long Road Ahead,” based on a survey of approximately 3,000 health care consumers and analysis of 84 insurance plans in 15 states. Nearly one third of survey respondents reported insurance company denials of authorization for mental health and substance abuse care— nearly twice the rate for other medical care. NAMI thanked the subcommittee for its work on the “Helping Families in Mental Health Crisis Act” (HR 2646), which the House passed almost unanimously on July 6, 2016. Several provisions address parity enforcement. It requires federal agencies to collaborate to improve compliance with the mental health parity law, to report on federal parity investigations, and create a plan to improve federal parity enforcement. It also requires a Government Accountability Office (GAO) study on mental health insurance parity.Click here to see more.  “These provisions would be a significant step forward in eliminating discrimination towards mental illness and substance use disorders in health insurance,” Giliberti said. Enactment of parity enforcement provisions now depends on Senate action and coordination between the Senate and House in adopting final legislation.

Making the Most Out of Open Enrollment

OpenEnrollment

Nearly half of employees are stressed by the open enrollment process and only half are confident about the benefit decisions they made last year, according to a study by MetLife. Millennials are the most stressed and confused. When asked about the most effective benefit resources, respondents ranked one-on-consultations well above other resources. In fact, Millennials led their generational counterparts in valuing one-on-one consultations. However, only half of employers offer one-on-one consultations. Sixty percent of Millenials consult with their families and friends on benefits. MetLife says that employers need to help their employees connect the value of non-medical benefits to their day-to-day lives. Employers should also do the following:

  • Make sure that employees fully understand key terms such as “deductible,” “premium,” “PPO,” and “HMO.”
  • Have employees ask themselves, “Do I have a big life event coming up, such as marriage or retirement?” It’s critical to choose benefits based on present and future needs.
  • Make sure that employees review their benefits and fully understand them. Only half of employees said they thoroughly reviewed their benefits choices last year.

The survey also reveals how employees feel about their benefits:

  • Financial uncertainty: In contrast to decreasing unemployment numbers, American workers remain pessimistic about their financial future. Less than half feel in control of their finances. Even fewer expect their situations to improve in the next year (46% in 2015, compared to 52% in 2014). More than half are concerned about having enough money to cover out-of-pocket medical costs as well as meeting monthly living expenses and financial obligations. These worries that have increased every year since 2012.
  • Job Satisfaction: More than half of employees are satisfied with their jobs and are committed to the organizations’ goals. An increasing number plan to be with their companies a year from now.
  • Financial Benefits: 71% of employees consider work to be the foundation of their financial safety net. Sixty-two percent of employees want more financial security benefits. Millennials are more financially vulnerable compared to their counterparts. Gen Xrs say they are less secure than other generations.
  • Appreciation of benefits: Half of employees agree strongly that their benefits help them worry less about unexpected health and financial issues. Seventy percent of employees say that having customizable benefits would increase their loyalty to their employer.
  • Supplemental benefits: Employees continue to ask for a range of solutions, especially for more common benefits, such as medical, prescription, 401(k), dental, life, and vision care. Employers are keeping pace with many of their employees’ top benefit requests. However, there are large gaps in accident insurance, critical illness, and hospital indemnity. Most employers understand how non-medical benefits can provide financial protection, such as offsetting out-of-pocket medical expenses. Yet, only 47% of employees believe that supplemental health benefits can help close these gaps.
  • A streamlined plan design: Plan design, claims management, and implementation rank highly as advantages of streamlining the number of carriers that employers use.
  • Use of enrollment firms: Three-quarters of employers have positive attitudes towards enrollment firms. Seventy-one percent of employers say that working with an enrollment firm helped them improve benefit communications.
  • Wellness plans: More than two thirds of employees are interested in physical well-being programs that reward healthy behavior. This is especially true among Millennials (75%) and female employees (72%).
  • Retirement Benefits: Forty percent of employees say that having retiree benefits is a key reason to stay with their employer. Millennials feel the most strongly about this, probably due to their lack of financial confidence. About a third of employees plan to postpone retirement, an increase of 5% over 2015. Almost 6 in 10 employees plan to work or consult once retired. Of this 60%, 44% plan to work part-time.
  • Older workers: With today’s workers redefining what it means to be a retiree, employers must also redefine what retiree benefits look like in order to appeal to this rich reservoir of talent. For example, 63% of employees say that dental is a must-have retiree benefit while only 42% of employers offer it. Similar gaps can be found across other critical non-medical benefits, such as vision and life insurance. More than half of employees say that their employer does not offer any employer-paid non-medical benefits. With retiree benefits being such an important loyalty factor for many employees, employers have an opportunity to keep pace in 2016 and beyond.

Trump v. Clinton: How They Line Up On Health

The Philadelphia Inquirer offers an analysis on the Candidate’s Position on health care. The following is a summary the article:

Health insurance

  • Clinton: Wants to improve the Affordable Care Act. She wants to reduce the cost of health insurance purchased on exchanges and provide a tax credit of up to $5,000 a family to offset out-of-pocket costs and premiums above 5% of household income. She would expand tax credits and cap the cost of premiums at 8.5% of family income. She calls for fixing the “family glitch” so families can access coverage in the exchanges when their employer’s family plan is not affordable. She would allow undocumented immigrants to buy insurance through the exchanges. In what is seen as a nod to Bernie Sanders’ supporters, she is affirming support for a public option that would allow people as young as 55 to buy health insurance through Medicare.
  • Trump: Opposes requiring people to buy health insurance. He wants to repeal the Affordable Care Act. He proposes to make coverage more affordable by allowing sales of health insurance across state lines and permitting people to deduct health insurance premium payments from their taxes. He would emphasize tax-deductible health savings accounts (HSA) where funds could accumulate if they are not used. He wants to require price transparency by health-care providers so that people can shop around for the best prices. He also wants would-be immigrants to certify that they can pay for their own health care.

Prescription drugs

  • Clinton: Wants to eliminate tax breaks that pharmaceutical companies get for direct-to-consumer advertising, and require those that benefit from federal research spending to reinvest profits into research. She would ban legal settlements in which pharma companies pay competitors so they will hold off on introducing generics and would allow consumers to import cheaper drugs from countries such as Canada. She supports allowing Medicare to negotiate lower drug prices and would cap out-of-pocket costs for people with chronic health problems.
  • Trump: Calls for a free market for prescription drugs, including allowing consumers to import them from countries that regulate prices. This practice is now illegal, though the law is not firmly enforced.

Medicaid

  • Clinton: Supports president Obama’s proposal to let states that sign up for Medicaid expansion to get a 100% match for the first three years. She would expand access to Medicaid and children’s health insurance.
  • Trump: Wants states to get federal Medicaid funding through block grants, which could mean fewer dollars for many states, but would give local officials more authority over expenditures.

Medicare

  • Clinton: Has vowed to fight proposals to privatize or phase out Medicare, and would give Medicare the power to negotiate lower drug costs.
  • Trump: Is against abolishing Medicare.

Social Security

  • Clinton: Opposes privatizing Social Security, reducing annual cost-of-living adjustments, and raising the retirement age. Clinton would expand Social Security for some, such as widows and caregivers, and help to fund the benefit through a wealth tax.
  • Trump: Has voiced support for Social Security and called it “honoring a deal.” He has said that Republicans cannot win elections if they seek to change it substantially.

Veterans Administration

  • Clinton: Says she would ensure more timely benefits, block privatization efforts, and strengthen services for military families and employment programs for veterans.
  • Trump: Has vowed to reform the agency and make it more efficient in delivering service and employment assistance.

Abortion

  • Clinton: Wants to protect access to safe and legal abortion.
  • Trump: Back in 1999, he told Meet the Press that, despite his personal dislike of abortion, “I’m very pro-choice.” More recently, he announced, “I am pro-life.” This year, Trump he said on MSNBC that if abortion were banned, women who violated the law would have to be punished. Soon after, his campaign released a statement saying that providers, not patients, should be held liable. His running mate, Indiana Gov. Mike Pence, has backed some of the nation’s toughest abortion restrictions.

HIV/AIDS

  • Clinton: Her proposals include funding research to seek a cure; finding more affordable treatment, including capping prescription costs; urging all states to extend Medicaid coverage for people living with HIV; and increasing use of HIV prevention medication.
  • Trump: Has not issued a policy on HIV and AIDS, though some in the advocacy media say his goals of lowering prescription drug costs and increasing transparency about health care pricing could be beneficial.

Medical research funding

  • Clinton: Advocates increasing funding for Alzheimer’s research to $2 billion a year, paying for care-planning services through Medicare, and funding a federal program to help locate Alzheimer’s patients who wander.
  • Trump: Has called funding for Alzheimer’s research “a total top priority,” but he has not offered many specifics about policies he would pursue. He has alarmed the research community with scientifically unfounded statements about Ebola, autism, and climate change.

Autism

  • Clinton: Has called for a nationwide early-screening campaign. She wants to push all states to require health insurance coverage for autism services, help get adults on the autism spectrum connected to employment opportunities, and fund more research.
  • Trump: In tweets and during a presidential debate, Trump has linked autism to some vaccinations, a tie that has been widely debunked by international medical authorities and advocates, such as Autism Speaks, a group that Trump has supported.

Addiction and drugs

  • Clinton: Would increase funds for addiction treatment and prevention, and emphasize rehabilitation over prison for low-level and non-violent drug offenses. She wants more preventive services for adolescents, opioid antidotes for all first responders, and more training for drug prescribers.
  • Trump: In New Hampshire, Trump vowed to fight addiction on two fronts saying, “First, we have to support locally based and locally run clinics, and we have got to close the border. That’s where the drugs are coming from.”

Medical marijuana

  • Clinton: Supports the use of medical marijuana.
  • Trump:.Supports the use of medical marijuana.

Family and medical leave

  • Clinton: Advocates a paid family and medical leave of up to 12 weeks with at least a two-thirds wage replacement rate. She proposes paying for the plan with taxes on the wealthy.
  • Trump: He told Stuart Varney on Fox News last year, “Well, it’s something that’s being discussed. I think we have to keep our country very competitive, so you have to be careful of it.”

Federal funding of Planned Parenthood

Clinton: Supports federal funding of Planned Parenthood.
Trump: At a news conference on Super Tuesday, Trump said he would not give federal funds to Planned Parenthood because the organization performs abortions. But he praised the health care it provides, saying, “millions and millions of women – cervical cancer, breast cancer – are helped by Planned Parenthood.”

Medical Marijuana Reduces Medicare Part D Drugs Costs

 BY  IN INSURANCE INSIDER NEWSLETTER

medical marijuana

Medical marijuana saves state and federal governments millions of dollars on Medicare. For example, prescriptions for painkillers have dipped drastically in states where medical marijuana is available, according to a Univ. of Georgia study published in the July issue of Health Affairs. Researchers combed through data on all prescriptions filled by Medicare Part D enrollees from 2010 to 2013 for a total of over 87 million physician-drug-year observations. In medical marijuana–approved states, the average doctor prescribed fewer doses of antidepressants as well as seizure and anti-nausea medication. Researchers narrowed the results to conditions for which marijuana may be an alternative treatment, selecting nine categories in which the Food and Drug Administration had already approved at least one medication: anxiety, depression, glaucoma, nausea, pain, psychosis, seizures, sleep disorders, and spasticity.

In 2013, Medicare saved $165.2 million in lower prescription drug use when 17 states and the District of Columbia implemented medical marijuana laws. The results suggest that if all states had implemented medical marijuana, Medicare would have saved about $468 million. “The results suggest people are really using marijuana as medicine and not just using it for recreational purposes,” said study author Ashley Bradford.

The next study will look at medical marijuana’s effects on Medicaid. Researchers expect the cost savings to be repeated, saying their findings suggests that more widespread state approval of medical marijuana could provide modest budgetary relief.

A Profile of Uninsured Men

At the start of 2015, there were over 27 million uninsured non-elderly adults in the U.S. Over half were non-elderly men, according to a report by the Kaiser Family Foundation. Men are more likely to be uninsured than are women and less likely to have Medicaid or other public coverage. Many men were not eligible for Medicaid before the ACA since the program excluded non-disabled adults without dependent children. Seventy-six percent of non-elderly uninsured men live in a household with at least one full-time worker, but more than half are low-income. Thirty-two percent of non-elderly uninsured men said they were having trouble paying medical bills in 2014.

Forty-four percent of non-elderly uninsured men are eligible for financial assistance under the ACA. In Medicaid expansion states, 55% of men are eligible for assistance, including 35% who are eligible for Medicaid. In non-expansion states, 33% are eligible for assistance, including just 2% who are eligible for Medicaid while 20% fall into the coverage gap.

A man’s likelihood of being uninsured varies based on where he lives. The uninsured rate for men ranged from a high of 25% in Texas to a low of 6% in Massachusetts. The following factors raise the risk for men to be uninsured: they have family incomes below 100% of the federal poverty level; they have less than a high school education; they are Black, Hispanic, and/or non-citizen immigrants. The uninsured rate for White men was 11%.

Only 36% of non-elderly uninsured men have a usual source of care compared to 67% of those with Medicaid and 77% of those with private coverage. Non-elderly men with health coverage are more than two times as likely to get preventive care compared the uninsured. Non-elderly uninsured men are more likely (32%) than non-elderly men with Medicaid (15%) or non-elderly men with private coverage (10%) to have had trouble paying medical bills in 2014. Men without coverage are more likely to have serious financial strain due to medical bills. In 2014, 27% of non-elderly uninsured men said that medical bills caused them to use up all or most of their savings, have difficulties paying for basic necessities, borrow money, or be contacted by a collection agency. In contrast, only 9% of non-elderly men with Medicaid and 7% of non-elderly men with private coverage experienced this kind of financial strain due to medical bills.

Since many uninsured men are in working families, small businesses and job placement offices may be effective outreach sites for information on health coverage. Identifying trusted contacts will be key to increasing enrollment. For example, low-income fathers may be connected to father’s organizations that could connect them to health coverage options. Other community-based organizations and agencies that serve men may also be effective including workforce development programs, child support agencies, and justice-system agencies.

People learn about health coverage options through multiple avenues, including word-of-mouth, mass media, and healthcare providers. Broad-based messages are effective in educating people about coverage while targeted messages are important in enrolling hard-to-reach groups, including low-income men and fathers. Some messages have been found to be effective, including discussing the importance of coverage for maintaining good health, the value of getting screenings and preventive care; the affordability of coverage options, the availability of financial help, and the financial protections of having coverage; and how coverage helps them be an effective provider for the family. Messaging about free in-person enrollment assistance has also been particularly useful. Findings also suggest that talking with fathers about their children’s health and health care coverage can be an effective entry point for discussing their own health and health coverage

Last Updated 06/19/2019

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