Thread by @Farzad_MD

1/ Here we go!

The @SenateHELP ‘‘Lower Health Care Costs Act’’ just dropped
I—ENDING SURPRISE MEDICAL BILLS
II—REDUCING THE PRICES OF PRESCRIPTION DRUGS
III—IMPROVING TRANSPARENCY IN HEALTH CARE
IV—IMPROVING PUBLIC HEALTH
V—IMPROVING THE EXCHANGE OF HEALTH
INFORMATION

2/ There will be lots to digest in the days to come, but let's take a quick look at the major provisions in the Section by Section Summary:
help.senate.gov/imo/media/doc/…

Full text here: help.senate.gov/imo/media/doc/…

3/ TITLE I: Ending Surprise Medical Bills
Congress hates to get involved in private contracts. The fact that we are here is testament to just how abusive & immoral the behaviors of certain providers has been. Every one of these provisions has 1000 constituent letters behind it

4/ There's been great work on this by reporters like @sarahkliff and policy folks like @LorenAdler - go read their feed for more in-depth analysis of the bipartisan measures proposed. My quick scan is that these provisions make sense for consumers-and will be fought by providers

5/ Patients are only required to pay the in-network cost-sharing amount for out-of-network emergency care, for care provided by ancillary out-of-network practitioners, and for out-of network diagnostic services at in-network facilities. “balance” bills barred.

Good!

6/ patient must be given advance notice of any out-of-network care, an estimate of
the patient’s costs for out-of-network care, and referrals for alternative options
for in-network care. If not given adequate notice, patient protected from surprise bills or out-of-network costs

7/ Resolution of bills? Here the HELP committee punted a bit- will get feedback on the House proposal, AEI/Brookings, NY-style arbitration
a) In-Network Guarantee
b) Independent Dispute Resolution
c) Benchmark for Payment

fair enough (I like option a, in case you're curious)

8/ TITLE II: Reducing the Prices of Prescription Drugs
Again, every measure listed here is written because of specific abuses, many of which @ScottGottliebMD warned against and did his best through guidance and clarification to head off, but needed legislation to clean up

9/ Like this little know beauty: "the abuse of the citizen petition process, which can be used to unnecessarily delay the approval of a drug application."
Read all about it from @ScottGottliebMD here: fda.gov/news-events/pr…

10/ A great resource for all the gaming that has been used to reduce generic competition is this @commonwealthfnd explainer ,,, with Henry Waxman!
commonwealthfund.org/publications/f…

11/ It's also interesting that many of the proposals were contained in the President's Budget. Every year that thing comes out and people say it's "DOA" needs leg, etc- but I think it's an important tool for signaling priorities- like here. commonwealthfund.org/blog/2018/trum…

12/ OK, that's all good for you Pharma PolicyHeads-I'm most excited about this next section. TITLE III—IMPROVING TRANSPARENCY IN HEALTH CARE
Pharma costs are a lot less than hospital costs, and a big driver of hospital costs has been lack of competition/ anticompetitive behavior

13/ Here's what this guy @MartinSGaynor and Paul Ginsburg and I said in @JAMA_current a couple of years (!) ago on hospital gag clauses, anti-tiering, anti-steering provisions, and the like.

14/ What's a hospital gag clause? That's when a big player tells a plan that not only do they have to pay them extravagantly, but they also can't tell anyone about it, INCLUDING THE SELF INSURED PURCHASERS PAYING FOR IT. That's crazy
modernhealthcare.com/government/sen… @SusannahLuthi

15/ "Anti-tiering, Anti-Steering" means "don't you dare measure what my cost and quality actually are, and heaven forbid you use that to influence anyone's behavior."
This goes to the heart of monopoly rents. Pay me cause I said so, not cause I'm worth it. washingtonpost.com/national/healt…

16/ And as @FTC commissioner @RKSlaughterFTC said a couple of weeks ago, regulators and researchers need DATA -> Sec. 303. Designation of a nongovernmental,nonprofit transparency organization to lower Americans’ health care costs.

Yes. I hope @HealthCostInst is eligible!

17/ There's also support here for state-based All-Payer Claims Databases.
"Authorizes grants to states to maintain or create similar transparency initiatives."
(I am somewhat skeptical - there's a huge lift here, and execution risk IMO)

18/ This is a new one to me: "Sec. 305. Timely bills for patients."
I'm not sure if 30 days is the right number, but the concept makes sense to me. I imagine there was more than one constituent who got a bill more than a year later for something they can't even remember.

19/ TITLE IV: Improving Public Health
I'm all for that! (and it should help get some Dem support in the house too)
Glad to see not only support for vaccines and maternal mortality but also fundamental strengthening of the state/local public heath infrastructure
@deBeaumontFndtn

20/ TITLE V: Improving the Exchange of Health Information
Yes! Great support of the @ONC_HealthIT @CMSGov @SeemaCMS #BlueButton #MyHealtheData agenda- applied to commercial payers
APIS for health insurance claims data; in-network practitioners; expected out-of-pocket costs.

21/ at the same time (wisely)
Sec. 503. GAO study on the privacy and security risks of electronic transmission
of individually identifiable health information to and from entities not covered by
the Health Insurance Portability and Accountability Act
@HealthPrivacy @SavageLucia

22/ All-in-all, this is a serious and sweeping set of BIPARTISAN reforms to improve competition across several sectors of health care.

Committees of jurisdiction can add in other measures like site-neutral payments (a pay-for!) +support for rural hospitals-but it's a great start