Jan 17, 2019

Axios Vitals

Good morning … Some cool news from my home state: Louisville is renaming its airport after Muhammad Ali.

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1 big thing: Charity pays a lot of health care bills

Photo: Andrew Lichtenstein/Corbis via Getty Images

Crowd-funding sites like GoFundMe have become a critical part of the health care system — and GoFundMe’s CEO recognizes that that’s a bad thing.

By the numbers: GoFundMe sees more than 250,000 campaigns each year related to medical expenses. They account for about a third of the roughly $5 billion people donate through the site, according to Kaiser Health News.

What they’re saying: In an interview with KHN, GoFundMe CEO Rob Solomon made clear he is not thrilled about what this says for the U.S. health care system. Some highlights:

  • “I had no notion of how severe the problem is. You read about the debate about single-payer health care and all the issues, the partisan politics. What I really learned is the health care system in the United States is really broken. Way too many people fall through the cracks.”
  • “The system is terrible … there are people who are not getting relief from us or from the institutions that are supposed to be there. We shouldn’t be the solution to a complex set of systemic problems.”

Not everyone can launch a successful health care fundraiser. It often takes "medical literacy, social-media savvy and access to video-making equipment," as Marketplace noted last year.

  • The crowdfunding attempts that struggled the most came from people with “multiple and overlapping health and social crises” — the same people who often have the hardest time with the traditional health care system.

Our reliance on charity goes further, too. There’s a different charity, called R.I.P. Medical Debt, that buys up and pays off people’s medical debts. So far it has paid off $434 million — out of the $750 billion Americans owe.

The bottom line: Our health care system is … not great.

2. Big hopes for big tech

People are bullish about the role big tech can play in health care. In a PwC survey, majorities said they’re at least somewhat confident tech companies will be able to:

  • Improve patient satisfaction
  • Reduce costs
  • Simplify health care
  • Make personal health care information more accessible to patients

It hasn’t happened yet. The most significant progress so far would be on that last front, making personal health data more accessible — that’s where Apple is focusing a lot of its health care energy, and the early reviews are generally pretty positive. But even that is still in its early stages.

The latest: Apple is trying to get Medicare Advantage insurers to offer subsidized Apple Watches to seniors, for use as health trackers, CNBC’s Christina Farr reports.

Other tech companies have made moves into the health care world, none splashier than Amazon buying PillPack, but they’ve largely been pretty traditional moves.

The big picture: So far, Silicon Valley seems to be better at getting a piece of the health care system than changing it.

3. Hospitals fear Medicaid block grants

Unsurprisingly, hospitals are not happy about the Trump administration’s reported plans to pursue Medicaid block grants through a regulatory process.

"We have long voiced concerns about how block granting Medicaid could ultimately result in losses of coverage and negatively impact access to quality care," Ashley Thompson, the senior vice president of public policy analysis at the American Hospital Association, told Modern Healthcare.

Between the lines: Hospitals are some of Medicaid’s most powerful political allies.

  • They’ve pushed state governments aggressively to adopt the Affordable Care Act’s Medicaid expansion.
  • They also opposed Republicans’ ACA repeal bills, many of which would have hit Medicaid harder than the ACA’s exchanges.
  • And they’re not wild about Medicaid work requirements, either.

Even if hospitals can’t ultimately stop the administration from writing rules that open the door to Medicaid block grants, they could be a loud voice urging state governments not to take advantage of that option.

4. A major Blues plan is ready to share risk

Blue Cross Blue Shield of North Carolina and 5 prominent hospital systems in the state have agreed to put their finances on the line in pursuit of cost savings, Axios’ Bob Herman reports.

  • They’ll sign contracts that would allow the hospitals and doctors to get bonuses if the cost of their care doesn’t break the bank — and they’d also be on the hook to pay any losses that result from high-cost, poor care.

Why it matters: The vast majority of these kinds of Accountable Care Organizations don’t require providers to pay penalties if their care costs too much or if quality goes downhill. The Trump administration wants to change that, arguing that sharing in the losses is a better incentive — and now so does the dominant plan in North Carolina.

Details: A spokesperson for BCBS of North Carolina confirmed this program essentially mimics Medicare's Next Generation ACO program, which was overseen by BCBS of North Carolina CEO Patrick Conway when he was a top Medicare official during the Obama administration.

  • These new contracts will cover 25% of BCBS of North Carolina’s medical spending. The insurer will not steer patients toward these 5 hospital systems over others, the spokesperson said.
  • However, the insurer did not specify what the cost thresholds would be, so it’ll be difficult for the public to judge how well it is or isn’t working.
5. Buying the blood of the young


Ambrosia, a company that injects young people’s blood into older people, is now up and running in 5 American cities, the company tells Business Insider.

  • Filling your aged veins with 1 liter of a younger person’s blood costs $8,000, making 2 liters is a steal at $12,000.

This whole blood-replacement thing is marketed as an anti-aging treatment. But, as Business Insider notes, there’s essentially no evidence it has any medical benefit, and it has raised plenty of red flags along the way.

  • Ambrosia recently completed a clinical trial of its procedure, but hasn’t published the results yet.

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