Primary care physicians (PCPs) should lead the charge in the battle against opioid addiction and overdoses, but one of the obstacles preventing that from happening include low payments from insurance companies for such treatment. So says Julian A.

News & Commentary
The insurance industry has some catching up to do when it comes to providing care for “high-need” adults, according to an issue brief by the Commonwealth Fund. High-need adults have three or more chronic conditions and cannot easily care for themselves or perform routine daily tasks, such as shopping or preparing food.

The penalty for those choosing not to have health insurance this year is 2.5% of taxable income, or $695, whichever is more. The penalty is about what someone would pay for a bronze plan on the health care exchange, the plan with the minimum amount of coverage.

Twenty-five percent of total Medicaid, Medicare Advantage, and commercial payments this year were made to health care providers in alternative payment models (APMs) such as ACOs and bundled payments.

Turns out that Patient 0 (as in the numeral), who’s been blamed for bringing AIDS into the United States, was actually Patient O (as in the letter) and was not in fact the single herald of one of the greatest health crises in modern times, according to a study in Nature.

Legislation & Regulation: Campaign 2016
Richard Mark Kirkner
Hillary Clinton and Donald Trump promise divergent approaches to the ACA if elected. Basically, Clinton wants to improve it; Trump promises to dismantle it. Of course, no president acts in a vacuum, and a lot will also depend on which party controls Congress.

A sleeping medication called secobarbital might soon become much better known if voters in Colorado approve Proposition 106 in the election.

A counterthrust in the debate about health insurance premiums on the ACA exchanges. Yesterday, the news was about how those premiums are expected to rise an average of 25%. Today, the news is about how those hikes are unlikely to affect the majority of ACA beneficiaries.

Richard Mark Kirkner

Bradley C. Leibovich, MD
Mayo Clinic

Sometimes it’s best to hold off. Patients and doctors fight the urge to rush in and treat as more types of cancer lend themselves to active surveillance. The advent of precision medicine makes this a more inviting option.

Even as they’ve become more and more popular with employers, wellness programs have taken hits in recent years with naysayers arguing that the effort discriminates against some workers by leveling fines for not reaching benchmarks and also represent an invasion of privacy.

The inability of the Obama administration to lure younger, healthy enrollees into ACA plans has resulted in a spike in premiums, McClatchy DC reports. Premiums for health plans sold on for 2017 rose an average of 25%, federal health officials announced yesterday.

Turns out that what has long been considered the cornerstone of the fight against hospital infection, sinks where workers can scrub down, might be making the problem worse, STAT reports. To add to the irony, hospitals have made the installation of sinks a priority.

Charlotte Huff

Mark Preston, MD

Experts are rethinking routine cancer screening. Genetic tests could be the answer. They may add upfront expense, but might eventually lead to savings by winnowing out unnecessary screening. Concern about false positives helps push this movement along.

More Medicare patients using hospice services accounted for the agency’s increasing spending on hospice by 52% between 2007 and 2015, according to a study by CMS researchers published in Health Affairs. Per patient costs remained largely flat during the period.

Most of the deaths from cancer in the United States can be attributed to smoking, according to a study in JAMA Internal Medicine. In 2014, 167,133 cancer deaths in the U.S. were attributed to smoking (that’s 28.6% of all cancer deaths).

The number of civil case filings against pharmacies, manufacturers, and distributors of opioids dipped drastically from 131 in 2011 to 40 in 2014, according to an investigation by the Washington Post.

Within five years of being diagnosed with breast cancer, 8% of Caucasian women die; for African American women, it’s 21%, the Philadelphia Inquirer reports. A troubling disparity that a recent study in Supportive Care in Cancer focused on.

Was a time long ago when hospitals sold cigarettes and many doctors would catch a smoke in between seeing patients in the examination room.

Thomas Reinke

Jonathan Friedlaender

Meet Jonathan Friedlaender, a cancer survivor whose 20-year-long struggle helps illustrate drug pricing’s important role in this arena.
Retooling Cancer Management
Ed Silverman

Caroline Pearson, Avalere Health

Perhaps with some justification. The organizations that develop these techniques do so with patients and doctors in mind, not health insurers.
Cover Story
Thomas Reinke
CMS’ Oncology Care Model program is bringing bundled payments to cancer care. With drug costs so high and hard to control, the 195 participating practices will have to figure out other ways to control costs if they want to beat financial benchmarks and earn bonuses.