Health Care Rounds

In today’s Our Take read-in, here’s the lead: “A judge ordered Johnson & Johnson to pay $572 million to Oklahoma for creating a ‘public nuisance.’ The state had sought $17.5 billion in a lawsuit against J&J, contending that the company had engaged in misleading marketing and contributed to the opioid epidemic that has claimed the lives of more than 6,000 Oklahomans. J&J plans to appeal, and the company’s shares rose in after-hours trading on the day of the ruling, suggesting that investors believed the outcome could have been much worse.” To sign up for the weekly email brief, click here. Other briefs include: Capital Rx, a startup pharmacy benefit manager, launches its Clearinghouse Model. A federal judge officially approves the merger between CVS Health and Aetna. Michigan-based insurers Priority Health and Total Health Care will merge. Amgen will buy Celgene’s Otezla (apremilast), a psoriasis drug, for $13.4 billion. CMS rejects Idaho’s request for a waiver for Medicaid expansion. Blue Cross

In today’s Our Take read-in, here’s our lead story: Good Neighbor Pharmacy tops the list of chain drugstores in customer satisfaction, according to a new survey by J.D. Power and Associates. The network of independent pharmacies received the highest overall score among brick-and-mortar chain store pharmacies, with a score of 914 out of 1,000 possible points, followed by Health Mart (893), Rite Aid Pharmacy (865), Walgreens (840), and CVS (834). To sign up for the weekly email brief, click here. Note that we’re not uploading a read-in next week due to the Labor Day holiday. Other briefs include: CMS announced that quality star ratings for qualified health plans offered on the Health Insurance Marketplace will be available in 2020. Signify Health and Remedy Partners signed a definitive agreement to merge. SSM Health formed a joint venture with Denver-based Paladina Health to offer direct-to-employer primary care in the St. Louis area. Three new drug approvals for AbbVie, Genentech, and Nabriva Therapeutics. A

This week, Bob Roth returns to Our Take to discuss America’s growing aging population and implications for ignoring what he calls the Aging Crisis. Bob’s passion for caring for the elderly stems from his personal experience with his own mother, which led to the creation of Cypress HomeCare Solutions, the Roth family business. Listen to the elder care issues Bob is calling out—and what we need to do about it. Speaker Bios Bob Roth, Managing Partner, Cypress HomeCare Solutions Bob Roth founded Cypress with his family in 1994 and has been at the helm as Managing Partner since December 2003. Experienced in consumer products, healthcare and software since 1984, Bob is considered an innovator of technologies used to enhance communication and effectively support customers and peers in the health and home care industries. Bob was a finalist for the 2015 Phoenix Business Journal’s prestigious Healthcare Heroes award. In 2013 Cypress was awarded the Better Business Bureau’s Business Ethics Award, the only home care age

In today’s Our Take read-in, we discuss Commercial Accountable Care Organizations, including updates on programs from UnitedHealthcare, Aetna, Cigna, Humana, and Anthem. To sign up for the weekly email brief, click here. Other briefs include: Harvard Pilgrim Health Care and Tufts Health Plan have signed a definitive agreement to merge. Humana files a lawsuit against Mallinckrodt plc. The FDA has approved Pretomanid Tablets, a game changer in the treatment of treatment-resistant tuberculosis. Centene is expanding its health exchange offerings to ten more states. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 201

In today’s Our Take read-in, “The FDA announced Tuesday that Novartis submitted the drug application for Zolgensma, the company’s novel gene therapy treatment for spinal muscular atrophy, with manipulated data. The FDA said it is assessing the matter and ‘remains confident’ that the gene therapy will continue to be available to patients.” To sign up for the weekly email brief, click here. Other briefs include: Allscripts Healthcare Solutions reached a tentative $145 million settlement agreement with the Department of Justice. CMS has agreed to reimburse any FDA-approved chimeric antigen receptor (CAR) T-cell therapies. SSM Health is introducing an individual health plan in the St. Louis market this fall. Provention Bio’s teplizumab received the FDA’s Breakthrough Therapy Designation. New York City launched NYC Care, a program that offers health care to uninsured residents. CVS has expanded its CarePass program to participating CVS pharmacies throughout the U.S. Walgreens customers can soon get select prescri

In today’s Our Take read-in, we discuss several CMS initiatives announced last Monday. The email version of Our Take includes several important links to other final and proposed rules from CMS. To sign up for the weekly email brief, click here. Other briefs include: Pfizer signed a definitive agreement to merge its Upjohn division with Mylan. HHS is working on a plan to allow the legal importation of prescription drugs. CMS denies Utah’s request for partial Medicaid expansion. Cigna and Memorial Sloan Kettering (MSK) sign a value-based agreement. Philadelphia’s Temple University will sell its Fox Chase Cancer Center to Thomas Jefferson University. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health c

In today’s Our Take read-in, we discuss a bipartisan bill to lower drug prices that cleared a Senate committee. On Thursday, the Senate Finance Committee voted 19-9 to advance a bill proposed by Sens. Chuck Grassley, R-Iowa, and Ron Wyden, D-Ore., that includes numerous provisions to lower drug prices. The bill, called the Prescription Drug Pricing Reduction Act (PDPRA) of 2019, is likely to undergo considerable changes before it reaches the Senate floor for a full vote — if it gets that far. Over the span of a decade, the PDPRA as it currently stands would save $85 billion in Medicare spending and another $15 billion in Medicaid spending. Further, the Congressional Budget Office estimated that Medicare beneficiaries would save $27 billion in out-of-pocket costs and $5 billion in premiums during that same time period. Other briefs include: New research on ACOs with two-sided risk suggests lower costs and improved health outcomes. Tenet Healthcare Corp. is spinning off its Conifer business unit. CVS is testin

In this week’s episode, John sits with military psychologist Dr. Julie Kinn to talk about the latest behavioral health mobile apps and online resources developed by the Defense Health Agency (DHA). Dr. Kinn discusses how DHA’s technology combats the stigma present around behavioral health issues so that both veterans and civilians are more inclined to seek care. Check out some of their free mobile apps: Virtual Hope Box, Breathe2Relax, and T2 Mood Tracker. For more resources, go to www.health.mil/connectedhealth. Speaker Bios Dr. Julie Kinn is a licensed clinical psychologist with over 15 years of experience researching and implementing health technology for suicide prevention and other behavioral health promotion. At the Department of Defense (DoD), Defense Health Agency (DHA), Julie oversees the development and implementation of health technology for the military and veteran community and leads the DHA Usability Lab. She also initiated the Military Health Podcast program and produces/hosts three DoD podcast

In this week’s episode, we focus on Intermountain Healthcare’s announcement that it has formed a “comprehensive health platform company focused on elevating value-based care capabilities.” The new organization, named Castell, will be led by Rajesh Shrestha as president and CEO. Shrestha will continue to serve as vice president and chief operating officer of Community Based Care for Intermountain. Other briefs include: Gilead Sciences’ research and development collaboration with Belgian biopharmaceutical company Galapagos NV, valued at more than $5 billion. Genentech’s recent spate of research agreements. John Muir Health is forming “a comprehensive relationship” with Optum. The closing of Michigan’s Together Health Network. Physician participation in CMS’ Advanced Alternative Payment Models doubles in 2018. Care New England withdraws from merger discussions with Lifespan and Brown University. Memorial Hermann names Dr. David Callender as its new president and CEO, effective September 1. About Darwin Researc

Last Tuesday, three judges from the federal appeals court in New Orleans heard oral arguments regarding the ruling made last December in Texas v. United States. The district judge overseeing the case ruled that the Affordable Care Act (ACA)’s individual mandate is unconstitutional and, therefore, the entire ACA must be overturned. This week’s Our Take discusses what happened during oral arguments and what’s expected next. Other briefs include: A federal judge has blocked a Trump administration rule stipulating that drug manufacturers include wholesale prices in television advertising. President Trump signed an executive order designed to transform kidney care in the U.S. Boston-based Partners HealthCare announced that its Biobank has surpassed 100,000 participants. Evanston, lll.-based NorthShore University HealthSystem is merging with Swedish Covenant Health. Southfield, Mich.-based Beaumont Health System signed a letter of intent to acquire Akron, Ohio-based Summa Health. About Darwin Research Group Darwi

CMS’ Innovation Center has, through federal grants, helped states address specific population health needs. But what happens when entrepreneurs take healthcare improvement seriously, and are able to find innovative ways to align partnerships to effect change? This week, John sits down with Craig Brammer, CEO of The Health Collaborative and President & CEO of the Network for Regional Healthcare Improvement. Craig is an inspirational leader—helping to create change at the national level driven by grassroots efforts of local healthcare leaders. Speaker Bios Craig Brammer serves as President & CEO of the Network for Regional Healthcare Improvement (NRHI) & The Health Collaborative, a regional health improvement collaborative in Cincinnati. In these concurrent roles, he is responsible for helping leaders set a shared strategic direction and execute on a broad agenda of improving health and healthcare across the country. At NRHI, Craig oversees a membership base of over 30 members/state partner regional

In this week’s episode, we focus on the Supreme Court’s decision to hear arguments from health insurers, who claim $12.3 billion in losses after the federal government reneged on payments owed to certain payers under provisions in the Affordable Care Act (ACA). Business leaders, including the Chamber of Commerce, had urged the court to review an appellate court ruling in June 2018 that Health and Human Services is not obligated to make risk corridor payments to insurers. Other briefs include: AbbVie is set to acquire Allergan for approximately $63 billion. President Trump’s executive order on health care pricing transparency. Sanford Health and UnityPoint Health signed letter of intent to merge. CityMD and Summit Medical Group agree to merge. City of Hope will invest more than $1 billion to create a comprehensive cancer campus in Irvine, Calif. North Memorial Health and Blue Cross and Blue Shield of Minnesota create joint venture. About Darwin Research Group Darwin Research Group Inc. provides advanced mark

Why are integrated health systems and academic medical centers increasing their focus on international medicine? What lessons can we learn from our colleagues abroad? Find out this week as John sits down with Dr. Heitham Hassoun, vice president and medical director for Cedars-Sinai International Health and Telemedicine. Speaker Bios Heitham Hassoun, MD, a leading international health expert, is vice president and medical director of Cedars-Sinai's Center for International Health and Telemedicine. Dr. Hassoun was previously medical director for Global Healthcare at Johns Hopkins Medicine International and an associate professor in the Department of Surgery at Johns Hopkins School of Medicine. Prior to his work at Johns Hopkins, Hassoun served as medical director for Methodist International in Houston and was an associate professor of cardiovascular surgery at Weill Cornell Medical College In New York. He completed his fellowship training in vascular surgery at Northwestern University in Chicago and earned his

In this week’s episode, John shares some of the results from our fifth annual ACO Executive Survey. Results discussed include: ACO priorities 2019 initiatives Operational issues Factors affecting quality and cost Electronic health record interoperability Partnering activity About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.

In this week’s episode, John reviews some of the lessons learned from ExL’s 13th Partnering with ACOs & IDNs Summit, which took place in Boston, June 10-11. Briefs include: Anthem signed a definitive agreement to acquire Beacon Health Options. Washington state proposal to pay for hepatitis C drugs using a “subscription” model approved by CMS. Penn Medicine has created a clinical alert app that reduces stays in the intensive care unit. Ascension’s leadership lineup will undergo several changes, beginning July 1. New York Proton Center has opened its doors. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010

This week, John sits down with Brett McClain, chief operating officer for Dignity Health’s St. Joseph’s Hospital and Medical Center, where he recently oversaw the launch of Dignity’s systemwide specialty pharmacy. Brett speaks to the development of the specialty pharmacy through a strategic partnership, how pharma engages with his health system, the Dignity-CHI merger, and more. Speaker Bios Brett McClain is the Chief Operating Officer for Dignity Health’s St. Joseph’s Hospital and Medical Center, and St. Joseph’s Westgate Medical Center. Brett has been with Dignity Health since 2008. His career spans nearly 25 years of health care management experience overseeing various hospital and medical clinic operations. He is an active leader within St. Joseph’s Hospital and Medical Center with roles in a variety of operational and strategic committees and councils. Brett earned degrees in both finance and marketing from the University of Arizona and an MBA from Regis University. He is a Fellow of the National Associ

In this week’s episode, John reviews CVS’ move to expand its HealthHub stores to 1,500 by the end of 2021. HealthHub stores have expanded space for health-related products and larger health clinics with a lab for blood testing and screening. They also have a general wellness room used for yoga classes and educational events. We also have our first subscriber feedback, which addresses John’s editorial from last week on Novartis’ new gene therapy priced at $2.1 million. Briefs include: Supreme Court ruling on CMS payments to disproportionate-share hospitals. Partners canceling its agreement to acquire Care New England. Bon Secours Mercy Health selling its majority share in Ensemble Health. Connecticut’s withdrawal of a bill to offer a public health insurance option. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based c

In this week’s episode, John reviews Novartis’ new gene therapy for spinal muscular atrophy, priced at more than $2.1 million. ICER, a nonprofit research institute that evaluates the cost effectiveness of pharmaceuticals, said Novartis’ price is within the upper bound of the organization’s value-based price benchmark range. Briefs include: A broad bipartisan draft health care legislation package containing dozens of provisions was recently released by the Senate Health Committee. Forcing oncology practices to take on downside risk in CMS’ Oncology Care Model in July could result in more than half of them owing the government. UnitedHealth Group pointed to price variations for diagnostic tests as a potential way to reduce overspending. Mallinckrodt plans to spin off its specialty generics business to shareholders. The FDA’s recent approval of Novartis’ Piqray (alpelisib). FDA clears a new wearable device to treat migraine. Biogen is scrapping its investigational treatment for Alzheimer’s disease, and is cance

This week, John sits down with Dr. David Radley, senior scientist for The Commonwealth Fund, and Dr. Trafford Crump, assistant professor at the University of Calgary. Trafford and Dave welcomed John to Dartmouth’s PhD program in health economics and clinical epidemiology back in 2005, and have remained good friends ever since. In this episode, they talk about the politicization of health care, health system performance, what's driving healh care cotsts, patient-reported outcomes, and more. Speaker Bios David Radley is a senior scientist for The Commonwealth Fund’s Tracking Health System Performance program. Dr. Radley and his team develop national, state, and substate regional analyses on health care system performance and related insurance and care system market structure analyses. He is also a senior study director at Westat, a research firm that supports the Scorecard project. He joined the Commonwealth Fund in July 2010 from Abt Associates where he was associate in Domestic Health Policy with responsibili

In this week’s episode, John talks about the latest bombshell lawsuit filed by 44 states accusing Teva and other generic drugmakers of price fixing. Other briefs include: A house bill introduced to address surprise medical billing. CMS’ guidance designed to eliminate spread pricing. Advent International to acquire AccentCare. Civica Rx announces first two drugs in production. A hearing is set to review CVS-Aetna merger. About Darwin Research Group Darwin Research Group Inc. provides advanced market intelligence and in-depth customer insights to health care executives, with a strategic focus on health care delivery systems and the global shift toward value-based care. Darwin’s client list includes forward-thinking biopharmaceutical and medical device companies, as well as health care providers, private equity, and venture capital firms. The company was founded in 2010 as Darwin Advisory Partners, LLC and is headquartered in Scottsdale, Ariz. with a satellite office in Princeton, N.J.