Georgia Chapter, American Academy of Pediatrics: June 2016

California's insurance commissioner is urging the Department of Justice to block a pending $54.2 billion merger between the insurance companies Anthem and Cigna.

The recommendation is a rebuke of one of two mega-mergers for the industry. It is the first opposition from any state regulator, and comes from the commissioner for the nation's largest insurance market. The federal Justice Department and several states are still examining both the Anthem and Cigna merger as well as Aetna's separate efforts to acquire Humana.

California's insurance commissioner does not have approval authority over the Anthem-Cigna merger, unlike state regulators in 23 other states. A separate regulatory body, the California Department of Managed Health Care, is overseeing the transaction in that state and could impose conditions on the transaction.

But despite his agency's inability to block the deal, Insurance Commissioner Dave Jones can draw attention to concerns. The agency Jones oversees held a March hearing on the merger at which Anthem executives testified.

"The enhanced market power of the merged companies will permit them to increase premiums, decrease the quality of care provided to their California members in a number of the state's regions, and reduce access to crucially needed insurance markets," Jones wrote in the statement released Thursday. "The Anthem and Cigna merger will harm Californians, California's businesses and our health insurance market."

Jones charged that the companies failed to fully explain how the proposed merger would result in $2 billion in efficiencies, as they have claimed. Anthem's justifications were "vague, speculative and impossible-to-verify assertions," he wrote in a press release.

Jones also takes pains to highlight the considerable overlap the two insurers share in many of the state's insurance markets.

Anthem has a 19 percent marketshare statewide in California; Cigna has a 3.6 percent. The National Association of Insurance Commissioners recommendations for mergers suggest that if a larger company has a market share above 15 percent, the smaller company's market share should not exceed 1 percent.

The state's administrative services market is more extreme. Anthem has 37 percent of the market share; Cigna has 24 percent. The next largest competitor has 13 percent.

An Anthem spokeswoman said the company has been working with the state's Department of Managed Health Care for more than 10 months.

"Expanding access to affordable health coverage is the foundation of our combination with Cigna and will remain Anthem’s top priority," the company said in a statement. "We do not believe that the California Department of Insurance’s opinion is based on the true merits of this transaction. We are confident that the highly complementary nature and limited overlap of our organizations that will benefit the complex and competitive health insurance markets will be reviewed on the facts by the DOJ and appropriate state authorities."

Despite Overdose Epidemic, Georgia Caps The Number Of Opioid Treatment Clinics | Kaiser Health News

Friday, June 17, 2016

Teen Obesity May Mean Liver Disease Later

Doctors' Group Backs Later School Start Times

Folic Acid Now Added to Corn Masa Flour: FDA

CDC Reports Six Cases of Birth Defects Caused by Zika

Georgia Ups Efforts To Track Mosquitoes Linked To Zika | WABE 90.1 FM

Georgia boosts efforts to track Zika mosquitoes | Georgia Health News

Thursday, June 16, 2016

Kathleen Sebelius questions big insurer mergers

74% of physicians, health plan executives say quality measures are too complex

Study: 3% of young children have high blood lead levels | AAP News | AAP Gateway

Music therapy easing pain for children with cancer - ABC News (Australian Broadcasting Corporation)

CMS finalizes changes to ACO cost targets - Modern Healthcare Modern Healthcare business news, research, data and events

North Carolina Providers Wary of Medicaid Overhaul

North Carolina Providers Wary of Medicaid Overhaul

By Marissa Evans, CQ Roll Call, June 07, 2016

North Carolina Republicans may be celebrating the submission of an application to overhaul the Medicaid program but some medical providers in the state are not buying in just yet.

Republican North Carolina Gov. Pat McCrory signed off on a federal application June 1 that would turn the Medicaid program into managed care, saying that would help beneficiaries “reach their full potential.”

“Our proposal provides a North Carolina Medicaid Plan that focuses on patient-centered care and improves health outcomes at more predictable costs,” McCrory said.

Under the proposed federal waiver, the Tar Heel State would dismantle the existing primary care management system and create two systems. Provider-led groups would be in charge of Medicaid funds and create their own networks while commercial insurers would administer services to Medicaid beneficiaries across the state.

The waiver application comes months after lawmakers voted in September to move toward a managed care program. The Republican-led legislature has long criticized the federal health law (PL 111-148, PL 111-152), including Medicaid expansion. Under expansion, the federal government would pay to cover 500,000 low-income North Carolina residents through 2017. By that year, states are responsible for chipping in on the cost until by 2020, they would pay for 10 percent of costs. Thirty-one states and the District of Columbia have broadened Medicaid.

Advocates are disappointed lawmakers are not considering Medicaid expansion this session, said Ciara Zachary, health policy analyst for the North Carolina Justice Center.

For the overhaul plan, Zachary said there are still unknowns with how the managed care regions would be split up, how network adequacy would be guaranteed and how beneficiaries with more intense health care needs will be treated.

“Because North Carolina has such a strong primary care case management system that’s been developed for so many years, people are just wondering is this going to be better than what we have in place,” Zachary said.

That program, Community Care North Carolina, or CCNC, serves 1.3 million Medicaid patients and has saved almost $400 million a year, according to a 2015 North Carolina State Auditor report. Providers argue that some of the measures that would be implemented under the managed care transformation could have been done through CCNC.

Ben Money, chief executive officer for the North Carolina Community Health Center Association, said in an interview that providers are most worried about the looming administrative burdens that come with the overhaul. He said if the prepaid health plans have varying billing and claims processes, providers may throw their hands up, choose the simplest one and try to force patients to switch to that plan. The situation could be detrimental for low-income people in the program if the health department does not streamline the billing process, Money said.

“If access were restricted across the state because fewer providers were accepting Medicaid payments we’d have to really ramp up to make sure we could meet the demand,” Money said.

While North Carolina may be focused on restructuring the program, the Centers for Medicare and Medicaid Services could still broach the idea of Medicaid expansion during negotiations, said Trish Riley, executive director for the National Academy of State Health Policy.

“It’ll be interesting to see how the negotiations go,” Riley said in an interview. “There’s a precedent for CMS negotiating waivers for states that don’t expand but that will be the test because uncompensated care would be diminished if they expanded.”