With Rachana Pradhan, Alice Miranda Ollstein and Victoria Colliver
— Medicare’s flagship accountable care organization program saved nearly $740 million last year, CMS announced.
— Juul is halting its fight to overturn San Francisco’s sweeping vaping ban, as the e-cigarette giant continues to pivot amid regulatory scrutiny and public pressure.
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— HHS awarded more funds to patch its Title X family planning network, but women’s health experts say it doesn’t address the core problem.
HAPPY FISCAL NEW YEAR — And according to tradition, the ritual “casting off of sins” is upon us. (Feel free to find your nearest inspector general or beat reporter.)
Your regular PULSE author is headed to the heartland for a reporting trip; wave if you’re passing through O’Hare or cruising around Iowa. Grabbing the newsletter baton tonight: Adam Cancryn (firstname.lastname@example.org).
DRIVING THE DAY
WHY SEEMA VERMA IS CELEBRATING THE ACO PROGRAM NOW — The CMS administrator on Monday said that Medicare’s flagship ACO program saved nearly three-quarters of a billion dollars last year, adding that almost 11 million Medicare fee-for-service beneficiaries now get care from an ACO.
“Patients are receiving better care as a result of these efforts, and we look forward to continuing on this journey,” Verma wrote at Health Affairs.
— Verma had critiqued the Obama-era program last year, warning that the Medicare Shared Savings Program wasn’t living up to its “laudable aspirations” because it didn’t put enough participants at risk of losing money if they under-performed. That prompted a Trump-era overhaul of the rules that’s begun to kick in this year.
And Verma wasn’t alone in her criticism of ACOs. Researchers and other critics have said that it’s been tough to track ACO-related savings, since Medicare beneficiaries can switch providers. They’ve also worried that it’s empowered more health care consolidation, which could lead to higher prices for patients.
— But ACO groups loudly celebrated the results: Aledade chief Farzad Mostashari touted his company’s physician-led ACOs that he said outperformed their hospital-backed counterparts. Privia Health pointed to four of its ACOs that it said generated $70 million in net savings combined.
“These numbers put to rest any notion that ACO savings are ‘modest’ and illustrate the strong performance of the leading Medicare alternative payment model,” said Clif Gaus of the National Association of ACOs.
JUUL BACKS DOWN ON SAN FRANCISCO VAPING BAN — The e-cigarette giant is halting its support of a ballot measure to overturn the city’s sweeping ban on e-cigarette sales, POLITICO’s Victoria Colliver reports.
The measure, Proposition C, will still appear on November’s ballot — but without any more support from Juul, which has already poured in more than $18 million. The Yes on Prop. C campaign on Monday night said it would immediately halt its efforts too, deprived of its biggest funder, although opponents said they remain skeptical of Juul and its allies and are reserving judgment until all ads and other spending are suspended.
— It’s one of the first big decisions of Juul’s new CEO, K.C. Crosthwaite, who replaced Ken Burns last week. The beleaguered company is facing pressure from federal regulators and around the nation.
“I am committed to seeing that Juul engages productively with all stakeholders, including regulators, policymakers and our customers,” Crosthwaite said in a statement. “This decision does not change the fact that as a San Francisco-founded and headquartered company we remain committed to the city.”
INSIDE THE HUMPHREY BUILDING
HHS HANDS OUT $33 MILLION TO FILL GAPS IN TITLE X — Fifty state health agencies and organizations are getting supplemental funds intended to plug holes in the federal family planning program network, POLITICO’s Alice Miranda Ollstein reports.
Planned Parenthood, other organizations and seven states dropped out of Title X this summer after HHS imposed new restrictions on abortion referrals. The Trump administration has argued in court that the restrictions won’t harm the more than 4 million low-income Americans who depend on Title X for birth control and other services because this new funding will create a “zero-sum game.”
— But the new funds represent a fraction of the more than $80 million in funding relinquished by the groups that quit the program in protest of what they consider a “gag rule,” Alice reports.
For example, two of Illinois’ three grantees quit the program, giving up a collective $7.5 million dollars. The state’s sole remaining provider, Aunt Martha’s Health and Wellness, told POLITICO they were awarded an additional $825,000 — less than half of what they requested.
“There’s a lot of need,” CEO Raul Garza told POLITICO. “We’re busting at the seams just in our pediatric clinic alone.” But Garza added that the organization is “happy because this should allow us to see at least 2.5 times more patients than we serve now.”
— The new HHS funds don’t address a core issue: “There are still a lot of places in our country where there are sites that are not getting Title X funds” like Oregon, Utah and Maine, KFF’s Alina Salganicoff told POLITICO’s Victoria Colliver. “It’s just giving more money to those that are already in the program.”
— Neither of the faith-based medical providers that HHS welcomed into Title X this year — Obria in California and Beacon Christian Community Health Center in New York — were awarded supplemental funding. Beacon confirmed to POLITICO they did apply for the additional money. Obria declined comment.
WELLNESS INITIATIVE RAISES SOME HOPES BUT MOSTLY RED FLAGS — CMS announced Monday that it’s soliciting applications from states that want to let individual market health plans set up wellness programs for participants.
“Allowing states to implement these wellness programs in their individual markets offers the opportunity to not only improve the health of their residents but also to help reduce healthcare spending,” Verma said in a statement, inviting 10 states to apply for the demonstration program.
— Some groups are cheering. “CAHC has long championed solutions that unleash innovations already underway in private health insurance markets while also delivering greater flexibility to states,” said Joel White of the Council for Affordable Health Coverage. “This CMS demonstration project holds potential to do exactly that.”
— But there’s widespread skepticism given wellness programs’ track record. “We’ve got loads of evidence that wellness programs do not work,” tweeted Nick Bagley, a University of Michigan law professor, adding that the initiatives are “creepy” and don’t save money. “Yet now the Trump administration is pushing them onto the individual market.”
There’s also some question about whether CMS, by announcing applications ASAP before soliciting public comment on guidance or state proposals, is ignoring public involvement and sidelining consumer protections. “The requirements of the guidance do not fully implement the statute,” Tim Jost, emeritus law professor at Washington and Lee, cautioned PULSE.
BERNIE SANDERS‘ allies ramp up attacks on ELIZABETH WARREN over Medicare for All. The Vermont senator’s campaign is flagging even as Warren surges, POLITICO’s Holly Otterbein reported Monday. That’s led some of Sanders’ allies to try and draw deeper distinctions with Warren, particularly over single-payer health care, which both candidates say they support.
“It’s become abundantly clear that there is simply one candidate who will aggressively fight for the legislation, and it’s Bernie Sanders, the man who wrote the damn bill,” Ana Kasparian wrote at the Hill, criticizing Warren’s “vagueness” on single-payer.
While Warren says she supports Sanders’ bill, she’s avoided echoing Sanders’ rhetoric on the need for tax increases, prompting skepticism of her position, the Washington Examiner’s Naomi Lim reports.
IN THE COURTS
Administration weighs new policy on undocumented minors, abortion. Federal officials are exploring whether to issue a new policy over whether undocumented minors would have to notify their parents of abortion decisions, according to a filing in federal court on Monday.
The U.S. Court of Appeals for the District of Columbia previously ruled that the Trump administration can’t block undocumented teens in federal custody from obtaining the procedure, but the issue over whether mandatory disclosure was required for parents or other individuals remains unresolved, POLITICO’s Rachana Pradhan writes.
But proceedings in front of the court are on hold in light of HHS’ potential new policy. In the meantime, federal officials won’t notify third-parties about unaccompanied minors’ abortion decisions.
— Also coming down the pike: The Justice Department also has until Oct. 15 to decide whether it will ask the Supreme Court to review the main question underlying the case — whether the federal government can prevent undocumented minors from having an abortion.
NAMES IN THE NEWS
It’s ADAM BOEHLER’s last day at CMMI. The CMS innovation center is holding an all-hands meeting today as Boehler departs for a new role steering U.S. investment in developing nations, multiple individuals with knowledge of the schedule told POLITICO.
ROBERT CALIFF heads to Alphabet. The former FDA commissioner and current Duke cardiologist was announced last week as the new medical strategy and policy chief for the Alphabet Company, which includes Google Health and Verily Sciences. CNBC has more.
CHUCK GRASSLEY undergoes hernia surgery. The Iowa senator underwent a scheduled, outpatient surgery and is now resting at home after a successful procedure, his office announced Monday night. Grassley is slated to resume work later this week.
WHAT WE’RE READING
Alabama sheriffs have been releasing sick inmates in order to avoid paying their medical bills, Connor Sheets writes for AL.com and the ProPublica Local Reporting Network.
The KHN/NPR bill of the month: A $2,170 facility fee for a woman who needed a biopsy.
Was “eat less red meat” simply bad advice? NYT’s Gina Kolata looks closer at a remarkable turnabout in the scientific literature.
Fox is debuting a TV drama tomorrow about a fertility doctor who secretly fathered more than 100 children. Critics like EW’s Kristen Baldwin are panning the premise.
Date: October 03, 2019