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09/26/2022

Substack Post #6, "CMS and the Masquerade of Equality" (September 26th)

Is at: https://substack.com/inbox/post/75107864

It opens with: In summarizing Professor Jedediah Purdy’s recent book, Two Cheers for Politics, The New Yorker’s Adam Gopnik recently wrote, “He [Purdy] is angry at the elites who supervise the bureaucratic capitalist state on behalf of their overlords while keeping up an elaborate masquerade of equality of opportunity.”   “Keeping up the masquerade of equality” accurately defines CMS’s continuing pretense to value or prioritize health equity.

 

 

09/23/2022

Upcoming Podcasts

I'm working on a week of October 3rd conversation about cancer care with Ms. Trish Goldsmith, CEO of Cancer Care (cancercare.org). 

Among other discussions, am working on:

  • state regulatory reform efforts to reduce carbon emissions;
  • policies to address the health effects of forever chemicals (PFAS);
  • recent reforms to address insulin prices - that have increased over the past few decades by approximately 1,500%; and, 
  • the mental and physical health effects of, and policies, if any, to address, social media.   

09/19/2022

Substack Post: What to Make of the House Ways and Means Climate and Health Hearing (September 19th)

This morning I posted this: https://davidintrocasophd.substack.com/p/what-to-make-of-the-house-ways-and

It opens with:

This past Thursday the House Ways and Means Committee, with jurisdiction over the Medicare program, held a hearing titled, “Preparing America’s Health Care Infrastructure for the Climate Crisis.”  The hearing, the first and only climate crisis-related hearing Ways and Means will hold this Congressional session, was motivated in part by Democratic majority staff’s release of findings resulting from three requests for information (RFIs) majority staff forwarded to industry providers, trade associations and group purchasing organizations earlier this year to help majority staff “better understand how climate events have impacted the health sector, as well as steps the health care industry is taking to address its role in mitigating the climate crisis.”   

The hearing and accompanying RFI findings are notable for at least five reasons.

09/14/2022

Matthew Albright Discusses Hospital and Insurer or Payer Price Transparency (September 13th)

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Over the past few years federal policymakers have instituted healthcare price transparency.  Until last year, healthcare prices were largely, if not altogether, unknown to patients.   As of this past July 1 most group health plans and issuers of group or individual health insurance are required to publicly disclose pricing information.  As of this past January 1, providers were no longer able to surprise or balance bill patients for care they unknowingly received from providers outside their insurer’s network.  As of January 1, 2021 hospitals have been required to provide clear & accessible pricing information about the items and services they provide.  Though price transparency is sound in theory, what effect, if any, it will have on patient or consumer decision making, reducing price growth and influencing care delivery and innovation are largely unknown.    

During this 36 minute conversation , Mr. Albright begins by briefly describing work done by Zelis.  He moves on to discuss/explain why healthcare price transparency took so long, what specific price data are hospitals and payers required to publicly disclose, how will employer-based insurers use the transparent data, he comments on hospital compliance or lack thereof, related state price transparency efforts and concludes with a comment regarding how and why price transparency will finally be realized.       

Mr. Matthew Albright is currently Chief Legislative Affairs Officer at Zelis.  Prior to joining Zelis, Matthew oversaw the certification Matthew_Albright_Headshot program at the Center for Affordable Quality Healthcare (CAQH) and Committee on Operating Rules for Information Exchange (CORE) to ensure conformance with the requirements of the Patient Protection and Affordable Care Act (PPACA).  He also served as Director of the Administrative Simplification Group for the Centers for Medicare and Medicaid Services (CMS).  In this role, Matthew was responsible for drafting the regulations that implemented Section 1104 of PPACA which specifies the requirements of the Health Insurance Portability and Accountability Act (HIPAA) administrative transactions.   Matthew is a published author on bioethics, has written numerous state and federal regulations, and taught as adjunct faculty at St. Martin's University and Pierce College in Washington State.   Mr. Albright earned a Master of Divinity from Harvard University with an emphasis in Bioethics, a BA in Religion Studies from the College of Santa Fe and a BA in Print Journalism from the University of Southern California.

 

09/12/2022

Substack Post: "How To Solve HHS’s Failure To Address The Climate Crisis" (September 12th)

For this week's post I noted my essay posted this past Friday by Health Affairs and titled, "How To Solve HHS's Failure to Address the Climate Crisis."  It is at: https://www.healthaffairs.org/content/forefront/solve-hhs-s-failure-address-climate-crisis.   It also appears via Substack at: https://davidintrocasophd.substack.com/p/how-to-solve-hhss-failure-to-address

It opens with: 

"From an anthropocentric perspective the climate crisis is fundamentally a threat to human health if not survival. The World Health Organization defines it as “the single biggest health threat facing humanity.” Logic dictates that the Department of Health and Human Services (HHS) take the lead in mitigating climate-related health harms. President Joe Biden immediately recognized this reality in a January 2021 executive order that stated because the US has a “narrow moment” to take action he directed HHS to, in sum, decrease climate-related risks among the elderly, children, and people with disabilities.

However, after two rule-making cycles, the Centers for Medicare and Medicaid Services (CMS) has failed to take any regulatory action requiring Medicare and Medicaid providers to reduce their considerable carbon footprint. CMS’s last 2023 opportunity was via the hospital inpatient prospective payment rule finalized August 1."

 

09/06/2022

Substack Post: The Inflation Reduction Act Offers the Healthcare Industry an Opportunity to Save Itself (Sept. 5th)

This writing makes note of the fact that the likely, if not definitively, more significant healthcare provisions of the Inflation Reduction Act are the new law's tax credits - because tax exempt entities, like the 60% of hospitals that are non-profit, can exploit them.  

 

Please read and as always feel free to comment.    

08/29/2022

Substack Post: "Environmental Justice is - Still - Unrelated to the Climate Crisis" (August 29th)

Dear Listeners:

Today, I posted my latest Substack writing under this title.  It largely makes note of the fact the CDC's recently-announced Environmental Justice Index (EJI), the topic of my first or last Substack writing, fails to recognize or moreover account for climate crisis-related health harms - fossil fuel combustion and resulting anthropogenic greenhouse gas warming are of course the leading cause of environmental injustice.  

The post is at: https://davidintrocasophd.substack.com/p/environmental-justice-is-still-unrelated?utm_source=email

Thank you.

 

08/22/2022

First Substack Newsletter Post: "HHS's Environmental Justice Index Constitutes Redlining" (August 22nd)

Dear Listeners:

Today, I posted my first Substack newsletter item.  The newsletter is titled, "Health Care Policy Analysis from DC."  This first post argues HHS' August 10th announced Environmental Justice Index (EJI), defacto, amounts to redlining, or the discriminatory practice that compromises minority populations' ability to access numerous financial and related services including healthcare insurance.  

The post is at: https://davidintrocasophd.substack.com/p/the-department-of-health-and-human?utm_source=%2Finbox&utm_medium=reader2

Feel free to comment.

Thank you.

08/17/2022

Greg Segal Discusses Organ Procurement and Transplantation Policy Reform (August 16th)

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During its recent August 3rd hearing titled, “A System in Need of Repair: Addressing Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network," Senate Finance Committee Chairman, Ron Wyden (D-OR), characterized efforts by the federally-contracted not for profit, UNOS (United Network for Organ Sharing) regarding organ procurement and transplant as grossly mismanaged and incompetent.  After a two plus year investigation that included reviewing over a half million pages of documents, the committee found efforts by UNOS and nation's over 55 Organ Procurement Organizations (OPOs), rife with inefficiencies, medical errors and poor leadership, that combined helps to explain why, conservatively estimated, over 6,000 Americans, disproportionately minorities, die annually awaiting an organ.  Listeners will recall I interviewed Alfred and Blair Sadler in early June.  They, in part, discussed their work at NIH in the late 1960s drafting the Uniform Anatomical Gift Act.

During this 37-minute interview Mr. Segal begins by describing Organize's mission.  He next provides an overview of how the process of human organs are procured and transplanted, largely the work by UNOS and OPOs, identifies and discusses more substantive problems associated with the transplant process including the lack of financial, performance, transparency and regulatory pressures placed on OPOs.  These leads to Mr. Segal defining policy reform opportunities including requiring OPO's to report standardized process data and what action Senate Finance and the Congress should take, moreover, the Organ Procurement and Transplantation Network (OPTN) contract, under which UNOS is contracted, be significantly revised.                   

Mr. Greg Segal is the Founder and CEO of patient advocacy group, Organize.  The non-profit advocates for structural reforms to increase the supply Unnamed of lifesaving organ transplants every year.   Mr. Segal started Organize after his father waited five years for a heart transplant.  Organize served as Innovator in Residence in the Office of the Secretary of the U.S. Department of Health and Human Services from 2015-2016.  The group's research has been heavily cited by the ongoing Congressional investigations from the Senate Finance Committee and the House Oversight Committee into the U.S. organ donation system.  Mr. Segal's writings regarding the need for data-driven reforms to organ monopolies have appeared in MedPage, Health Affairs, CNN, STAT and JAMA.   

Information on Organize is at: www.organize.org.

Documents related to the Senate Finance Committee's August 3rd hearing is at: https://www.finance.senate.gov/hearings/a-system-in-need-of-repair-addressing-organizational-failures-of-the-uss-organ-procurement-and-transplantation-network.  

 

08/05/2022

NACHC's Jeremy Crandall Discusses Inflation Reduction Act-Related Policy Reforms (August 4th)

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Two weeks ago Senate Majority Leader, Chuck Schumer, announced the $739 billion Inflation Reduction (IRA) Act of 2022, compromise legislation agreed upon by Senator Manchin.  The bill includes just a few of the healthcare policy reform provisions House Democrats included in House legislation passed late last year, moreover extending expanded ACA marketplace insurance subsidies and allowing the Medicare program to negotiate drug prices.  The IRA also includes, as has been widely reported, $369 billion in tax credits over ten years intended to accelerate the adoption of renewal energy.   (Some have suggested the bill should be more appropriately titled The Temperature Reduction Act.)   The legislation likely, if not in fact, represents the last chance Congressional Democrats and the Biden Administration have to pass health and healthcare related policy reforms this Congress under reconciliation rules - that expire September 30th.  

During this 40 minute interview Jeremy begins by describing NACHC's mission.  He goes on to discuss extending ACA insurance subsidies in context of the patients his community community health, or Federally Qualified Health Centers (FQHCs), serve, how might the Medicaid funding cliff be addressed, i.e., approximately 16 million current enrolls would lose their coverage at the end of the current public health emergency, and provides comments on extending telehealth coverage expansion, workforce shortages and the climate crisis.        

Jeremy Crandall is the Director of Federal and State Policy for the National Association of Community Health Centers, where he works to address Download policy issues concerning Medicaid funding, 340B prescription drugs, FQHC payment and delivery reforms, behavioral and telehealth policies and primary care workforce issues.  Jeremy previously spent six years working on state-based issues at the Blue Cross Blue Shield Association and at the Pew Charitable Trusts.  For eight years prior still he worked in Maryland state politics with Attorney General Brian Frosh and State Delegate Heather Mizeur.

Information on NACHC is at: https://www.nachc.org/.