Jan 11, 2019

Axios Vitals

Good morning ... Beginning next week, the Monday edition of Vitals will start coming to you from my colleague Caitlin Owens. A lot of you know Caitlin already, so you don't need me to tell you that she'll be great. You're still stuck with me on the other 4 days of the week.

1 big thing: It's the prices, and the prices aren't coming down

Illustration: Sarah Grillo/Axios

Health care executives gave no indication to bankers and investors at this year's J.P. Morgan Healthcare Conference that their pricing practices would change any time soon — even as two authors of the famous "It's the prices, stupid" article updated their findings this week to confirm that, yep, it's still the prices.

Axios' Bob Herman wraps up the lay of the land from the conference:

  • Health care companies, even not-for-profits like hospitals that don't have typical investors, have prioritized meeting revenue and profitability goals, and that short-term thinking compromises reform, according to interviews with people who attended the J.P. Morgan event.
  • Drug companies are still focused on raising prices or buying lucrative biotechs, while providers find more ways to maximize what they get paid from insurers. As a result, insurers and employers raise premiums or deductibles for taxpayers and employees, which affects everyone's paychecks.
"This is about money and [investors] getting a return."
— Stephen Buck, founder of cancer tech app Courage Health

The other side: Marc Harrison, CEO of Intermountain Healthcare, said in an interview that his hospital system has lowered the "cash price" of some services, like normal vaginal childbirth, to help people who have high deductibles.

  • Intermountain also has negotiated with insurers, with the exception of one unnamed company, to hold patients harmless if they get a surprise out-of-network bill, Harrison said.

Go deeper.

2. Shopping for health care is impossible

The Philadelphia Inquirer has some fresh evidence of just how hard it is to be a "smart shopper" for health care.

Details: This one centers around a female patient who needed a breast MRI and knew her insurance wouldn't cover the full cost, so she called the price-estimation hotline maintained by her insurer, UnitedHealthcare.

  • United told her it would cost between $783 to $1,375. She'd had the same procedure a year before, and paid $1,500, so that seemed about right, per the Inquirer.
  • Surprise! She got a bill for $3,237.

Why it works this way: Although the patient went to a facility United had recommended, and checked to see whether it was in-network and called about the cost, she didn't know she would have to pay more at an imaging facility that was part of a hospital, which hers was.

  • Had she had the exact same test performed in a different facility, the price may have only been about half as much.

The bottom line: The health care system makes it almost impossible to compare prices, much less quality, and make informed consumer decisions.

3. Opioids and the border fight

The Trump administration has requested $631 million above what's in the Senate's Homeland Security spending bill for technology to inspect for drugs, weapons and other contraband at ports of entry along the southwest border, Axios' Caitlin Owens reports.

Why it matters: Most opioid seizures occur at legal ports of entry, but only about 20% of vehicles entering the U.S. are inspected. This extra funding would allow for nearly all vehicles coming across the border to be inspected, which would undoubtedly lead to more opioid seizures.

Yes, but: This border security fight is such a mess that it's anyone's guess whether this extra funding is passed, even though everyone agrees it'd help with the opioid crisis.

  • This is part of the updated package that the administration has framed as an attempt to strike a deal that gives $5.7 billion for the border wall.
  • Democrats aren't buying the package, but it's worth noting that there's bipartisan support for beefing up border security as a way to reduce the supply of opioids being smuggled into the U.S. from Mexico.
4. Making Alzheimer's easier on caregivers

A cure or an effective treatment for Alzheimer's still seems to be a long way off. But in the meantime, STAT reports, tech companies are coming up with products aimed at family members and caregivers — who often incur an incredible financial and emotional burden.

  • They include a digital messaging platform to connect doctors, family members and other caregivers; as well as a virtual-reality simulation of a family member losing cognitive function.

My thought bubble: This is a lucrative market, given the extreme difficulty of caring for an Alzheimer's patient and the sheer number of people who are in that situation. (Once there is an effective treatment, holy cow is it going to be expensive.)

  • But that difficulty is real, so if these gadgets help, that's great.
5. Utah may seek work requirements

Utah legislators say they'll implement the Medicaid expansion voters approved in November, but may add work requirements to the program — which could also delay it, the Salt Lake Tribune reports.

Flashback: Work requirements had been part of the more limited expansion proposed in the state legislature last year, but that plan became moot once voters signed off on the full expansion, per the Tribune.

Meanwhile, Maine has finally started enrolling people in its Medicaid expansion, which voters there approved over a year ago but former Gov. Paul LePage refused to implement.

Send the health care team your tips.