Obamacare premiums could spike next year

Companies selling individual health plans on Obamacare’s insurance marketplaces must grapple with the impending expiration of two of the law’s key early-stage programs, likely foretelling premium increases in 2017, as PricewaterhouseCoopers points out in a new regulatory brief.

The Affordable Care Act included a trio of provisions meant to counteract insurance marketplace uncertainty in its nascent years.

Collectively dubbed “the 3 Rs,” risk adjustment, reinsurance, and risk corridors were intended to act as shock absorbers for a newly reformed individual health insurance market in which participating firms were, essentially, shooting in the dark when setting premium levels and gaming out how sick and costly new enrollees would be.

Here’s a basic breakdown of how those three policies work: Risk adjustment is a transfer program which redistributes funds from insurers which paid out significantly less in medical claims to those which had to pay more; reinsurance is an insurance policy for insurance companies; and risk corridors take a percentage of the profits reaped by Obamacare insurers which set their premiums too high to those which set them too low.

Risk adjustment is the only one of these programs which will persist beyond 2017. Furthermore, the policies have provided significantly less buffer to insurers than originally hoped. That adds up to an added burden of uncertainty in Obamacare’s marketplaces, which may already contain more sick and costly enrollees than originally expected, according to insurers such as Blue Cross Blue Shield.

And when it comes to the insurance industry, uncertainty almost guarantees defensive pricing.

“The end of reinsurance and risk corridors payments will likely prompt insurers to raise premiums,” wrote PwC. “The loss of these programs increases the potential for financial instability for insurers.”

It’s important to note that those premiums are also likely to stabilize in the years following the 3 R’s expiration. But for the time being, insurance companies are still in some ways playing a guessing game when it comes to premium levels.

Source: http://www.msn.com

Mammograms May Detect More Than Breast Cancer

New study finds calcium deposits in breast tissue can predict calcium in arteries, a known risk factor for heart disease.

Mammograms are widely and often successfully used to detect breast cancer, the second leading cause of cancer death among U.S. women. Now, new research published in the journal JACC: Cardiovascular Imaging suggests it can help protect against an even bigger threat to women: cardiovascular disease.

Researchers believe breast calcification — small calcium deposits in the blood vessels found in breast tissue — is a good indicator of coronary arterial calcification, a very early sign of cardiovascular disease, Newsweek reported. Calcium narrows the arteries, which can increase the risk for heart attack. In breasts, though, calcium is very common and generally benign.

Doctors currently use CT scans to check for calcium deposits in arteries; however, scientists and doctors disagree that the cardiac scan is an effective screening method, according to the study. Meanwhile, mammography is more accepted — it is recommended annually for women over 40 years of age, and every other year for women 50 to 75 years old and women at high risk for breast cancer. Digital mammography in particular is more sensitive to the presence of calcifications, researchers said in a statement.

"Many women, especially young women, don't know the health of their coronary arteries," Dr. Harvey Hecht, lead author of the study and director of cardiovascular imaging at Mount Sinai St. Luke's hospital, said in a news release. "Based on our data, if a mammogram shows breast arterial calcifications it can be a red flag — an 'aha' moment — that there is a strong possibility she also has plaque in her coronary arteries.

For the study, researchers recruited a total of 292 women who had mammography and CT scans done within the past 12 months. Of those, 42.5 percent had calcium deposits show up on their mammogram. And 70 percent of women with these deposits also had calcium on their CT scans. Overall, 63 percent of those with breast calcification also had arterial calcification.

Researchers found that women with calcium deposits in their breast tissue were more likely to be older, have high blood pressure, and were less likely to be smokers. Interestingly, they also found that younger patients — those under 60 — had fewer false positives. If a younger woman had breast calcification, there was an 83 percent chance she also had calcium deposits in her coronary arteries.

Although more research and larger studies on this topic are needed to understand the significance of breast calcification, researchers said the findings show that mammograms could provide an opportunity to identify women with heart risks who ordinarily would not have been considered for cardiovascular screening.

Source: http://www.msn.com

2 New Cancer Therapies That Might Help Patients 'Live Again'

Cancer can be devastating to the individuals and families it affects. The disease alters patients' routines, roles, and relationships with others. Luckily, in the age of cancer research, millions more Americans are surviving the horrible disease, showing that you can live with cancer rather than die from it. In Big Think's latest video, 2 New Cancer Treatments That Give Patients Hope Again, medical researcher Dr David Agus explains two current revolutions in cancer therapy that could potentially eliminate all types of cancer.

The first treatment, known as immunotherapy, was successfully tested on former president Jimmy Carter. When cancer cells appear, they send out a "don't eat me" signal to the immune system. But now, there are drugs that can block that "don't eat me" signal, which allows the immune system to come in and "eat" — or attack — cancer cells. Immunotherapy has shown dramatic results with melanoma, kidney cancer, and some types of lung cancer. According to Agus, immunotherapy teaches you how to harness the power of your own immune system so that it can attack cancer on a more frequent basis than conventional chemotherapy treatments.

The second cancer treatment is known as precision, or personalized medicine. This means that if you have cancer, a doctor can take a piece of your cancer and sequence the DNA to look at which genes are “turned on” and which genes are “turned off.” The goal of this treatment is to develop a way to turn off the genes driving a particular cancer. Because this is still a developing therapy, though, it doesn't work on all patients.

"We don't have drugs to turn off every gene, but I can sequence the DNA of the cancer and develop a personalized therapy of that patient" Agus said in the video.

These new treatments reflect another way of thinking about cancer. In the 1800s, European doctors were classifying cancer by the body part it affected — hence breast cancer, prostate cancer, and lung cancer. Today, however, students and doctors are beginning to classify cancer by the genes that are driving the disease, which sometimes might apply to more than one cancer.

For Agus, “cancer is a verb and not a noun. ... You're cancering,” he said.

Cancer is something the body does, not something the body gets, he said. This philosophy provides a new way of approaching the disease, and encourages doctors to target and treat it with new, more effective therapies.

Source: http://www.msn.com

Federal officials, advocates push pill-tracking databases

WASHINGTON (AP) — The nation's top health officials are stepping up calls to require doctors to log in to pill-tracking databases before prescribing painkillers and other high-risk drugs.

The move is part of a multi-pronged strategy by the Obama administration to tame an epidemic of abuse and death tied to opioid painkillers like Vicodin and OxyContin. But physician groups see a requirement to check databases before prescribing popular drugs for pain, anxiety and other ailments as being overly burdensome.

Helping push the administration's effort forward is an unusual, multi-million lobbying campaign funded by a former corporate executive who has turned his attention to fighting addiction.

"Their role is to say what needs to be done, my role is to get it done," says Gary Mendell, CEO of the non-profit Shatterproof, which is lobbying in state capitals to tighten prescribing standards for addictive drugs.

Mendell founded the group in 2011, after his son committed suicide following years of addiction to painkillers. Previously Mendell was CEO of HEI Hotels and Resorts, which operates upscale hotels. To date, Mendell has invested $4.1 million of his own money in the group to hire lobbyists, public relations experts and 12 full-time staffers.

A new report from Shatterproof lays out key recommendations to improve prescription monitoring systems, which are currently used in 49 states.

The systems collect data on prescriptions for high-risk drugs that can be viewed by doctors and government officials to spot suspicious patterns. The aim is to stop "doctor shopping," where patients rack up multiple prescriptions from different doctors, either to satisfy their own drug addiction or to sell on the black market. But in most states, doctors are not required to check the databases before writing prescriptions.

Last week, the White House sent letters to all 50 U.S. governors recommending that they require doctors to check the databases and require pharmacists to upload drug dispensing data on a daily basis.

The databases are "a proven tool for reducing prescription drug misuse and diversion," said Michael Botticelli, National Drug Control Policy Director, in a statement.

But government health officials say virtually all state systems need improvements, including more up-to-date information.

"There isn't yet a single state in the country that has an optimal prescription drug monitoring program that works in real time, actively managing every prescription," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, in a press conference last week.

Physicians warn about the unintended consequences of mandating use of programs that can be slow and difficult to use. Patients may face longer waits and less time with their physicians, says Dr. Steven Sacks, president of the American Medical Association.

"There really is a patient safety and quality-of-care cost when you mandate the use of tools that are not easy to use," Sacks said.

The report from Shatterproof highlights the gaps in current prescribing systems. When doctors are not required to log in, they generally only do so 14 percent of the time, according to data from Brandeis University.

The report points to positive results in seven states that have mandated database usage: Kentucky, New York, Tennessee, Connecticut, Ohio, Wisconsin and Massachusetts. In Kentucky, deaths linked to prescription opioids fell 25 percent after the state required log-ins in 2012, along with other steps designed to curb inappropriate prescribing.

The same information can be used to prevent deadly drug interactions between opioids and other common medications, including anti-anxiety drugs like Valium of Xanax.

Opioids are highly addictive drugs that include both prescription painkillers like codeine and morphine, as well as illegal narcotics, like heroin. Deaths linked to opioid misuse and abuse have increased fourfold since 1999 to more than 29,000 in 2014, the highest figure on record, according to the CDC.

Earlier this month the CDC released the first-ever national guidelines for prescribing opioids, urging doctors to try non-opioid painkillers, physical therapy and other methods for treating chronic pain.

But pain specialists fear requiring pill-tracking databases will discourage doctors from prescribing the drugs even when appropriate, leaving patients in pain. Dr. Gregory Terman says it takes him three minutes to log in to the system used in his home state of Washington.

"If it was easier to use, more people would use it," said Terman, who is president of the American Pain Society, a group which accepts money from pain drugmakers. Like many physicians, Terman says he supports the technology but doesn't think it should be required.

Last week, two states targeted by Shatterproof signed into law database-checking requirements: Massachusetts and Wisconsin. Mendell says his staffers are lobbying now in California and Maryland.

"I don't think we can afford to wait decades for this to slowly get implemented into the system," he says. "I think we need to take action now."

Source: http://www.msn.com