Subscribe to The Pulse

Health Reform

Health legislation — Who won and who lost?

With the 2015 General Assembly session ending last week, here’s a list of the health care winners and losers during the 40 days of the Legislature.

clipboardAgree with GHN’s list? What did we leave out? Let us know . . .

Winners from the Legislative session:

Children’s health – Medical cannabis use was legalized for children with seizure disorders, so Georgia families living in Colorado to get access to the medicine can return home. Legislation was approved to require insurers to cover applied behavior analysis for young children with autism.

Primary care doctors and ob/gyns – They got a long-delayed pay bump of $23 million in state funds for treating Medicaid patients, which will be matched by an even higher amount from the feds.

The hospital industry – It lobbied hard and protected itself from changes to the state’s regulations for health care facilities, known as CON laws. (But hospitals got no legislative action on expanding Medicaid, a step that has buoyed the finances of struggling health care facilities in other states.) full story

Emory, Aetna create latest ACO care model

Emory Healthcare and Aetna are teaming up in a collaboration known as an “accountable care organization’’ (ACO), which aims to enhance patient care and reduce costs.

ACOs are networks of hospitals and doctors — and sometimes insurers — that arose as a central feature of the 2010 Affordable Care Act.

aetMedical providers in ACOs typically are rewarded based on the quality of care they provide. Under a special Medicare program, the organizations get paid more for keeping their patients healthy and out of the hospital. Several ACOs have been formed in Georgia.

The ACO announcement Thursday did not mention Emory’s potential merger with rival WellStar Health System, nor what role the Aetna ACO might have in a merged entity.

Emory and WellStar, both major players in the metro Atlanta market, are currently in talks to merge their health care assets into a new medical powerhouse. full story

Potential merger sparks concern on prices

As merger talks continue between Emory Healthcare and WellStar Health System, a consumer advocacy group has voiced concerns about the potential impact of a deal in the metro Atlanta market.

Beth Stephens

Beth Stephens

Georgia Watch said such provider consolidation “is leading to higher prices for consumers with little to no improvement in the quality of care individuals receive.”

Beth Stephens, the group’s health access program director, also said she is concerned that the public comment period about the merger lacks transparency.

“We want to know what stakeholders are being engaged, and why consumer advocacy organizations are being left out of the conversation,” said Stephens, who submitted her organization’s comments to Emory and WellStar this week.

Emory and WellStar issued a statement Thursday that said the two organizations “remain in discussion on this initiative and anticipate providing additional information in early April. We look forward to engaging with the community throughout the planning process.’’   full story

Mandl named to top posts at Emory Healthcare

Emory University announced Wednesday that Michael J. Mandl will take over as president and CEO of the university’s health care operations.

Michael J. Mandl

Michael J. Mandl

Mandl currently serves as chairman of Emory Healthcare’s board of directors.

The appointment comes at a pivotal time for Emory Healthcare, which is in negotiations on a potential merger with another metro Atlanta medical heavyweight, WellStar Health System.

Mandl has led those merger discussions on behalf of Emory from the outset and will continue to do so, the university said.

He will replace John Fox, who surprised industry experts in leaving as Emory Healthcare CEO and president for the same positions with a Detroit-based health system. full story

Is tobacco cessation being improperly slighted?

State insurance officials are investigating whether health insurers are covering tobacco-cessation products as a free benefit, as required under the Affordable Care Act.

“We have received several inquiries from [medical] providers and consumer groups,’’ said Glenn Allen, spokesman for the state insurance department, confirming the investigation.

Cigarette BurningThere are questions about several Georgia insurers — operating through the ACA exchange, the regular insurance market or both — not covering the tobacco cessation products.

The health law requires that certain “preventive” benefits be covered without a co-pay, co-insurance or a deductible. Besides tobacco cessation, these include immunizations, as well as screenings for cholesterol, blood pressure, depression and HIV.

Allen said the state office of Insurance Commissioner Ralph Hudgens is working with the federal Centers for Medicare and Medicaid Services on the cessation product investigation.

“We’re not aware of other states that are having the same issue,’’ Allen told GHN. But he noted that some of the same health insurers in Georgia operate in other states. full story

  • Sign up for our mailing list.