Capital Health Care: DOH has insurance execs scrambling; Schumer takes on …

Welcome to Capital Health Care, an early-morning email full of scoops and storylines that will inform the daily conversation in New York among health-industry insiders and high-information consumers. Sign up for our morning newsletters here.

HEALTH SCOOP -– The state health department is considering requiring insurance plans on the New York exchange to cover out-of-network benefits, a move that could significantly disrupt one of the most successful insurance exchanges in the nation. I’m told insurance executives had no idea this was coming. Why would they? As recently as January, state officials were telling lawmakers that network adequacy was not a concern and were resisting calls from lawmakers to include out-of-network benefits in exchange insurance plans, citing the cost. If insurers are forced to provide out-of-network plans, they are likely to raise premiums. If they raise premiums, consumers, especially healthy consumers, may drop off the exchange. That could worsen the risk pool, raising prices further and creating a death spiral for the state’s marketplace.
… POLITICAL RAMIFICATIONS: If Governor Andrew Cuomo forces through a requirement that plans include out-of-network coverage, insurance premiums will likely rise. New Yorkers would see these higher prices when they shop in October, just weeks before November’s general election, in which the governor is seeking a second term.

DRUG PROBLEM –- Senator Chuck Schumer on Monday said he was appealing “to a higher authority” and called on HHS to overrule the FDA’s decision to approve Zohydro ER, a new opiate that some say will worsen the country’s growing prescription pill epidemic. The F.D.A.’s advisory committee voted 11-2 against approving the drug, citing concerns of “abuse and misuse.” But the regulators at the F.D.A. ignored their advisory committee and approved the drug.

NOW WE KNOW –- Hangovers don’t stop us from drinking too much the next time. The findings published in Alcoholism: Clinical Experimental Research found that hangovers have, at best, a minimal impact on our decision-making process. Some studies even found that younger drinkers don’t consider hangovers a negative experience. Turns out the positive, and more immediate effects of drinking leave a more powerful mark on our psyche than the negative and delayed effects of a hangover.


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BRAND NEW –- We’re pleased to announce Capital’s City Council tracker, a weekly guide to what’s happening at the City Council. Every week on Monday we’ll post about some of the upcoming hearings and track the progress of some of the more important pieces of legislation.

A dozen local merchants signed on with The Brooklyn Hospital’s proposal to redevelop LICH. “We trust The Brooklyn Hospital Center,” reads a letter signed by business owners on Columbia Street and Court Street. “Their physicians and healthcare providers know the diverse needs of our communities and they have deep experience providing high-quality, culturally sensitive care to Brooklyn families.” TBHC was one of four bidders to propose buying LICH before the most recent RFP was released. New bidders have until March 19 to submit a response to the RFP.

DOLLARS FOR DOCS — Late last night ProPublica released its latest version of Dollars for Doctors, which tracks what pharma pays to physicians. The analysis found that the pharmaceutical industry has reduced payments amid increased attention from regulators and the public. The stellar data team at ProPublica created a database that allows you to search for your doctors to see if they have taken money from the 15 companies that make such information available online.

GOOD TRIP —The New York Times reports on the first controlled trial of LSD in more than 40 years. The Swiss study tested the efficacy of the drug for 12 people nearing the end of life. “Most of the subjects had terminal cancer, and several died within a year after the trial — but not before having a mental adventure that appeared to have eased the existential gloom of their last days.”

UPSTATE CONCERN –– The AlbanyTimes Union reports on concerns from upstate hospitals, which want to ensure that the definition of “safety net” doesn’t exclude them from being considered for Medicaid waiver money. “Some groups in New York City are insisting that (to qualify as a safety net hospital) 40 percent of a hospital’s patients must be Medicaid patients,” the paper reports. “If this becomes part of the safety net definition, then health care providers across upstate will not qualify and will not be eligible to access the $8 billion in funding.”

WHAT WE’RE READING –- Clara Ritger’s piece in National Journal on how the FDA missed another deadline to publish final rules on the menu calorie-labeling requirement under the Affordable Care Act. The law requires food establishments to post calories on menus and drive-through signs, but does not specify which eateries would be required to do so.

INCENTIVES –- The Buffalo News reports that 47 upstate hospitals and health care facilities received $24.5 million in incentive payments from Univera Healthcare for meeting or exceeding performance measures last year, part of the Hospital Performance Incentive Program.

MAKING ROUNDS — America’s Health Insurance Plans has promoted Beth Leonard to executive vice president of public affairs, Politico reports. She will be working on strategic communications, media relations, marketing, digital and conferences.

CONTINUING EDUCATION — RNs can enroll part time, take nursing courses online and take general education courses online, or face to face at one of the Empire State College’s 35 locations in New York state. The average age of an undergraduate student is 35 years old.

BILL TRACKER -– Sen. John Flanagan introduced a bill that would prohibit smoking electronic cigarettes within 100 feet of schools. The bill was referred to the health committee.

Check out Capital’s bill tracker, a daily guide to the flow of the New York state Legislature.

TODAY’S TIP –- Comes from the state’s Department of Health, which reminds us that “most people who develop colorectal cancer are over age 50. Get screened today.”


-THE SOURCE – Researchers at the Icahn School of Medicine at Mount Sinai have discovered abnormal molecular signaling pathways that could lead the way to new treatments for chronic kidney diesease. The article published Monday in the Journal of Clinical Investigation showed that endothelial mitochondrial oxidative stress regulates the passage of proteins from blood to urine and filtration of waste products in the kidney. The doctors used a mouse model to scar a part of the kidney that allowed them to watch what happens as progressive amounts of protein pass into the urine. The researchers examined how different signaling mechanisms and cellular interactions work, and how, if disturbed, they promote chronic kidney disease. What they found is that key cells of the glomerular filtration barrier cause alterations in endothelin-1, a vasoconstrictor, activating the endothelin receptor A. The activated endothelin receptor A triggered disturbances that led to endothelial mitochondrial oxidative stress. “These processes were absolutely essential in causing protein in the urine [or albuminuria], injured podocytes (tiny ball-shaped structures that constrict the blood vessels in the filtering part of the kidney), and cause scarring, all of which can ultimately lead to long-term, irreversible kidney disease,” Dr. Ilse S. Daehn, the study’s lead researcher and assistant professor of medicine in the division of nephrology at the Icahn School of Medicine, said in a press release. “This is called crosstalk and it is poorly understood. We hope that these novel crosstalk findings lead to new therapies that help reverse or arrest chronic kidney disease, which affect millions of Americans.”

-OTHER USES – According to a study published Monday in Proceedings of the National Academy of Sciences, researchers are making progress toward treating Lou Gehrig’s disease. The study demonstrated that early motor neuron dysfunction is proportional to the degree of damage to the blood-spinal cord barrier and that restoring the integrity of the barrier delays motor neuron degeneration. The researchers also found that an experimental drug being studied for stroke patients appears to protect the blood-spinal cord barrier’s integrity in mice and delay motor neuron impairment and degeneration.

MISSED A ROUNDUP? Get caught up here: 3/3, 2/28, 2/27, 2/26, 2/25



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