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South Africa securing biometrics with 'bank' of imposter voices
 More organisations are using voice biometrics as second or third factor authentication.

The South African Fraud Prevention Service (SAFPS) is partnering with voice biometric authentication solutions provider OneVault to launch a shared imposter voice bank.

According to SAFPS, the initiative, which will be piloted with select participants before national roll-out, aims to reduce fraudulent transactions in local call centres.

Imposter voices will be loaded onto a single shared database created by OneVault. The database will then be distributed for use by multiple companies and automated to trigger alerts in real-time when suspects phone the contact centre.

Over the years, methods of authentication have evolved from an item owned (a driver's licence), to something known (mother's maiden name), to an individual's biometric reference point (voice or fingerprint) and is known as third factor authentication.

Paul Hutton, CEO of OneVault, explains: "Voice biometrics is an authentication solution that is similar to a fingerprint in that it represents an individual's biological construct and is therefore difficult to emulate. Thus, with a combination of two or all factors - commonly known as multi-factor authentication - it's more difficult to commit fraud."

Today, voice biometrics is used across various digital platforms to authenticate users within mobile apps, contact centres, connected cars and smart homes.

The SAFPS says the explosion of online and digital transactions has increased the demand for remote security and, more specifically, remote authentication. Hutton says voice authentication is as accurate as a fingerprint and eliminates the need for an individual to be physically present to conclude a secure transaction.

By using voice biometrics to automatically cross-reference each call with the shared imposter voice bank, the agent will be alerted if there is match against the 'watch list' and a defined process can be followed. The solution is sophisticated enough that it will trigger liveness detection functionality when artificial voice production or voice manipulation is detected, notes SAFPS.

The company encourages all its members to participate, in order to gain access to the recordings of known imposter calls.

"SAFPS has identified an innovative application to combat fraud through contact centres. Most fraud cases touch a contact centre at least once. The implementation of a shared imposter voice bank will have a substantial impact on combating this type of fraud," Hutton points out.

SAFPS says it will run a pilot for six months to enable it to apply necessary considerations to comply with South African regulations.

Manie van Schalkwyk of SAFPS says: "We decided to partner with OneVault to assist in the fight against fraud as they bring exciting new technology in voice biometrics. We want to see competitors taking hands in fighting fraud. Together we can eradicate fraud in SA."

According to international biometrics company VoiceVault, contact centre fraud is a major problem that enterprises globally are struggling to mitigate. Research shows 30% of cross-channel fraud is conducted through social engineering attacks in contact centres. This is a method of hacking that involves assuming someone else's identity in order to convince a live agent to surrender account information over the phone.

Voice biometrics firm Nuance says one out of every 2 500 calls into global financial institution's call centres is a fraudulent call and $42 546 is lost on average per account from phone fraud.

"Voice biometrics have an authentication success rate of 100%, while passwords have been proven to have a 90% success rate and fingerprints have an 80% success rate," adds Nuance.

Output: The South African Fraud Prevention Service (SAFPS) is targeting fraud at contact centres by developing an "imposter voice bank". SAFPS will work with voice biometric authentication firm OneVault for a six-month pilot, loading voices of known impostors onto a shared database while software using automatically cross-references each call, issuing an alert if a voice matches any on the watch list. The system can also detect the use of artificial voices or vocal manipulation. On average global financial institutions lose $42,546 per account through voice fraud, according to voice biometrics firm Nuance.


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Blackboard begins push into Indian education market
 National Cybersecurity Reference Framework launched 12 Jun 2023 | 9:00 PM Pune, Jun 12 (UNI) The Government of India announced on Monday the launch of National Cybersecurity Reference Framework (NCRF) in order to provide a structured guidance on cyber security to the critical sectors of the nation, including telecom, power and energy, transportation, finance, strategic and government entities and health. see more..

SJTA to make wide publicity of Jagannath Mahima 12 Jun 2023 | 8:59 PM Puri, June 12 (UNI) Sri Jagannath Temple Administration (SJTA) will make wide publicity of Jagannath Mahima (glory of Jagannath dharma), and develop the temple website to reach devotees across the globe. see more..

Inhumane lathicharge on Warkaris in Alandi "unfortunate": NCP spokesperson 12 Jun 2023 | 8:54 PM Mumbai, Jun 12 (UNI) NCP state chief spokesperson Mahesh Tapase on Monday expressed his deep displeasure over the inhumane lathicharge by police on the Warkaris at Alandi in Pune district saying that it was an "unfortunate" incident that tarnished the 300-year-old tradition of the Warkari Sampraday of Maharashtra. see more..

Air Vice Marshal Vohra calls on DGP J&K 12 Jun 2023 | 8:45 PM Srinagar, June 12 (UNI) Air Vice Marshal Praveen Keshav Vohra, commanding Jammu Kashmir and Ladakh called on the Director General of Police Jammu and Kashmir Dilbag Singh at Police Headquarters here on Monday. see more..

Output: US edtech company Blackboard has launched in India as part of a bid to provide its learning services to students across all Indian states by 2020, its president, Lee Blakemore, has said. The company will introduce a price model in line with Indian market conditions, he added. Currently, 110 million students from more than 19,000 educational institutions worldwide use Blackboard's edtech platform.


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Loyyal and MyList partner to widen gift and e-card user base
 SAN FRANCISCO, CA, Sept 11, 2017 - (ACN Newswire) - Loyyal, the leading blockchain network for the loyalty and rewards industry, today announced an accord with MyList, the premier gift card and merchandise fulfillment provider in the MENA region.Through this agreement, MyList's comprehensive network of e-Gift Cards will become available as a potential redemption option for any program operator who joins the Loyyal network."This is a relationship we are very excited about as it will provide extensive new options for program operators running nodes on the Loyyal network. Loyyal's program operators will now have access to e-Gift Card redemption options across 100's of retailers, merchants, and service providers in the MENA region. In addition to this, MyList benefits from increased sales volume - faster, cheaper and more securely than before because it is facilitated by Loyyal's blockchain technology," explained Greg Simon, Founder and CEO of Loyyal."We think the new partnership with Loyyal is an ideal way to expand our sales of e-Gift Cards whilst adding real value to Loyyal's customer experience as well. There are a lot of companies in the loyalty space in the region now, but Loyyal brings a professionalism and dynamic to the market that we can appreciate being a part of," says Julie Leblan, Founder and CEO of MyList Group.Using blockchain to build a global network platform, Loyyal provides existing and new program operators with capabilities that will reduce operating costs through revolutionary efficiencies and increase revenues through dynamic and personalized redemption options. Through this relationship, MyList will target increased revenue on e-Gift Card sales volumes and increased profit margins from the blockchain efficiency.About MyListMyList is the market leader in the MENA region offering comprehensive gift and reward fulfilment services, with both gift cards and merchandise from over 100 tier one retailers throughout the region. After initially pioneering the online gift registry business in the region, MyList has expanded into the employee reward, sales incentive and loyalty programme fulfillment markets. For more information, please visit mylist.ae.About LoyyalLoyyal is reinventing how loyalty is created and rewarded. Using blockchain and smart contract technology, Loyyal has built an interoperable loyalty and rewards platform to address a highly fragmented industry, and offer multiple industries an innovative way to incentivize customer behavior.For information about Loyyal, please visit www.loyyal.com or email to info@loyyal.com Source: LoyyalCopyright 2017 ACN Newswire . All rights reserved.

Output: San Francisco-based blockchain company Loyyal has partnered with Dubai firm MyList, enabling both firms to expand their customer bases. Loyyal's interoperable loyalty and rewards platform offers MyList greater sales volume and increased efficiency, enabled by blockchain technology. Programme operators joining Loyyal's platform will have access to offers with hundreds of retailers across the Middle East and North Africa that are part of gift card and merchandise fulfilment provider MyList's network.


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SM group offers insurance from shopping malls in the Philippines
 The SM group has opened up its vast shopping mall network nationwide to be a pioneering sales platform for insurance products, beginning with the simplest ones that required relatively small premium payments like compulsory third party liability (CTPL), travel and dengue insurance.

Eventually, the plan is to offer protection products even for pets, motorcycles and, further into the future, an insurance for weddings that fail to push through.

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The group has teamed up with 63-year-old Filipino-owned insurer Pioneer Insurance to offer these products to the mass market in a program called “InsureME@SM” or short for “insurance made easy at The SM Store.”

The idea of selling insurance through the SM group’s department store chain—in the same counter where people pay their utility bills—came from BDO Unibank chair and SM Investments Corp. vice chair Teresita Sy, who had seen similar arrangements work well in overseas markets, said BDO Insurance Brokers Inc. general manager and senior vice president Tracy Tan.

The challenge in this market, Tan said, was that awareness about insurance products was much lower compared to other markets. This is reflected in the very low insurance penetration rate in the country, which the SM group deemed as an opportunity.

“If we could make insurance more accessible, then it would create better awareness,” Tan said. “If we offered products that were simple enough to obtain over the counter, then it would increase people’s appreciation of what insurance is all about.”

Tan said Sy did not want to limit the initiative to one product, noting that retailing was all about giving choices to consumers.

“To cut a long story short, BDO Insurance Brokers and SM took on this challenge because we are the leaders in this industry and wanted to blaze the trail in terms of bringing insurance closer and more accessible to every Filipino,” Tan said.

Tan said SM group had tied up with Pioneer exclusively on the distribution of insurance products because this group was committed to invest in the system needed by the project.

“Insurance serves a noble purpose. The payment of a claim often makes a world of difference between an individual turning hopeless and the ability to get on with his life,” Pioneer Life president Lorenzo Chan said.

Once Filipinos have a better understanding of such product, he said this would cease to be a product that insurers would have to push and sell. Chan added that Pioneer was honored to be part of InsureME@SM.

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“Is there anyone who can deny that when it comes to serving millions no one has done it the way the SM has and it still does today?” Chan said.

On travel insurance, Pioneer’s Safe Trip Comprehensive Travel Insurance Worldwide 2.5M provides medical treatment cover of up to P2.5 million and satisfies the Schengen Visa requirement. It also offers personal accident insurance up to P1 million, personal liability up to P1.5 million and covers travel inconveniences such as trip cancellation, flight delay and loss of baggage. It also provides access to emergency and travel assistance hotlines. Safe Trip also comes in the P1 million (for worldwide travel) and P500,000 (for domestic travel) variants.

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Output: Wedding cancellation, personal accident and other insurance will soon be available from the Philippines' largest chain of department stores. The SM group is teaming up with Pioneer Insurance to offer coverage from its mall network, beginning with simple policies for third-party liability and dengue fever. The programme is already being sold from the chain's handle utility bill payment counters. The company sees the move as an opportunity to fill the Philippines' yawning insurance gap by making products more accessible.


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Bleach use linked to lung disease
 Stay ahead of the trend in fashion and beyond with our free weekly Lifestyle Edit newsletter Stay ahead of the trend in fashion and beyond with our free weekly Lifestyle Edit newsletter Please enter a valid email address Please enter a valid email address SIGN UP I would like to be emailed about offers, events and updates from The Independent. Read our privacy notice Thanks for signing up to the

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The regular use of disinfectant cleaning products such as bleach has been linked to an increased risk of developing fatal lung conditions, researchers said.

A study by Harvard University and the French National Institute of Health and Medical Research (Inserm) found that using the products just once a week could increase a person's chance of developing chronic obstructive pulmonary disease (COPD) by nearly a third.

The research involved data from more than 55,000 nurses in the US, and scientists looked at exposure to specific disinfectants, including bleach, hydrogen peroxide, alcohol and chemicals known as quaternary ammonium compounds (quats), which are often used to disinfect surfaces such as floors and furniture.

Recommended Disabled teenage girl suffers burns after being washed in bleach

All of these were associated with an increased risk of COPD of between 24 per cent to 32 per cent in the study.

COPD is an umbrella term for a series of conditions affecting the lungs including emphysema, chronic bronchitis and chronic asthma.

The condition affects an estimated 1.2 million people in the UK, with nearly 30,000 people dying from the disease each year.

Previous studies have linked exposure to disinfectants with breathing problems such as asthma, but it is believed this is the first piece of research to identify a link between disinfectants and COPD.

Dr Orianne Dumas, a researcher at Inserm, said: “The potential adverse effects of exposure to disinfectants on COPD have received much less attention, although two recent studies in European populations showed that working as a cleaner was associated with a higher risk of COPD.

“To the best of our knowledge, we are the first to report a link between disinfectants and COPD among healthcare workers, and to investigate specific chemicals that may underlie this association.”

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Dr Dumas will present the findings at the European Respiratory Society International Congress in Milan on Monday, where she will highlight that further research is needed to clarify the impact of disinfectant use in the home.

She added: “In particular, we need to investigate the impact on COPD of lifetime occupational exposure to chemicals and clarify the role of each specific disinfectant.

“Some of these disinfectants, such as bleach and quats, are frequently used in ordinary households, and the potential impact of domestic use of disinfectants on COPD development is unknown.

“Earlier studies have found a link between asthma and exposure to cleaning products and disinfectants at home, such as bleach and sprays, so it is important to investigate this further.”

As part of the research, scientists looked at 55,185 female registered nurses enrolled in the US Nurses' Health Study II, which began in 1989.

They looked at those nurses who were still in a nursing job and with no history of COPD in 2009, and then followed them for approximately eight years until May 2017.

During that time 663 nurses were diagnosed with COPD.

The nurses' exposure to disinfectants was evaluated via a questionnaire and other factors that could have distorted the results, such as the age, weight and ethnicity of the subjects, were taken into account.

Press Association

Output: Frequent use of disinfectants, including alcohol, bleach and hydrogen peroxide, has been linked to fatal lung conditions, according to research by Harvard University and the French National Institute of Health and Medical Research. The study, which used data from 55,000 nurses in the US, found that using such products just once a week could lead to the risk of chronic obstructive pulmonary disease (COPD) increasing by between 24% and 32%. COPD, which is a broad term for conditions including chronic bronchitis and asthma and emphysema, affects 1.2 million people in the UK and kills almost 30,000 each year.


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Google plans appeal against €2.4bn EU fine over shopping service
 Google has lined up an appeal in response to its record fine €2.4bn from the EU over allegedly breaking monopoly laws.

Google looks to appeal its record fine

The costly slap on the wrist will be appealed on Monday according to a report in the Telegraph. While the company has coughed up the fine, further down the line, it expects to face further charges on its online advertising and mobile operating system.

Output: Google has prepared an appeal in response to its €2.4bn ($2.9bn) fine from the European Commission for breaking EU monopoly laws. In June, the commission accused Google of exploiting its 90% domination of the search market to cut out rivals by pushing e-commerce sales to its shopping service. The fine is the biggest ever issued by the EU for anti-competitive behaviour. The commission is also investigating whether Google has an unfair advantage over rival online retailers because of its maps and image services.


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AARP: Specialty drug retail pricing escalates
 Generic drug retail prices decrease, despite some steep hikes

WASHINGTON — Retail prices for specialty drugs widely used by older Americans has surged, while pricing for generic drugs has dipped despite sharp hikes for some medications, according to a pair of new AARP Public Policy Institute (PPI) reports.

For the specialty drugs examined in the study, retail prices jumped by an average of 9.6% between 2014 and 2015, the highest increase since at least 2006, AARP said. Meanwhile, results were somewhat mixed in the generis segment: Though retail prices declined overall in 2015, 11% of generic drugs experienced price gains, with some topping 100%.

In 2015, the average annual cost of therapy with one specialty drug was $52,486, over three times higher than the average Social Security retirement benefit ($16,101) and twice the median income ($25,150) for someone on Medicare, AARP noted.

Conversely, the average annual cost of therapy for one generic drug in 2015 was $523, down from $714 the year before.

Of the 11% of generic drugs which saw price hikes, all of the increases surpassed the rate of general inflation. Between 2010 and 2015, all but one of the 399 widely used generics in the AARP PPI study experienced at least one retail price increase. Some of the price rises were steep, exceeding 100%. AARP said two manufacturers upped the retail price of doxycycline hyclate, a commonly used generic antibiotic, by more than 1,000%, the highest price increase noted in the generic drug report.

“American families can’t afford to keep paying for prescription drugs that cost more money than their salaries,” AARP chief public policy officer Debra Whitman said in a statement. “These price increases are particularly hard on older adults, who take an average of 4.5 prescription drugs per month and often live on fixed incomes.”

For the two studies, AARP’s PPI and the PRIME Institute at the University of Minnesota developed market baskets to gauge retail price trends among specialty and generic drugs widely used by older Americans, including Medicare beneficiaries. The market baskets for the Rx Price Watch reports included 101 specialty drug products and 399 generic drug products. Using data from the Truven Health MarketScan Research Databases, the studies analyzed retail price changes between 2006 and 2015 for the products in each basket. Medications included products used to treat common and often chronic health conditions, including high cholesterol, diabetes, arthritis and hypertension.

Used to treat complex, chronic health conditions, specialty drugs often require special care in how they are administered to patients, as well as in how they are handled and stored, AARP noted. Many specialty drugs treat conditions common among older people, including rheumatoid arthritis, multiple sclerosis, and cancer.

Based on the retail prices of the 101 specialty drugs examined, the average annual increase in retail prices was 9.6% (2014–2015), compared with 8.9% the year before. In contrast, the general U.S. inflation rate was 0.1%.

The average annual cost of specialty drug therapy used on a chronic basis climbed by almost $35,000 between 2006 and 2015. And in 2015, the average annual price of therapy for specialty medications was nine times higher than the average annual price of therapy for branded drugs and 100 times higher than the average annual price of therapy for generic drugs.

One drug, HP Acthar Gel, was dropped from the specialty drug analyses because its sharp one-time retail price increase (over 1,300%) in 2007 distorted the overall trends, AARP reported.

According to the retail prices of the 399 generics studied, the average annual retail cost of generic drug therapy was about $2,350 in 2015, more than twice the figure in 2006, when the Medicare Part D program began. One widely used generic diabetes drug had a 450%-plus retail price increase in 2015. AARP said the average annual generic drug price fell 19.4% from 2014 to 2015.

“Generics drugs currently account for almost nine out of 10 prescriptions filled at the pharmacy but only a quarter of total drug costs,” stated generic report co-author Leigh Purvis, director of health services research for AARP’s PPI. “Given Americans’ long-standing reliance on these products for savings — as well as recent price trends for brand-name and specialty drugs — it is incredibly important that we identify and mitigate the factors behind recent generic drug price increases.”

Output: Retail prices for specialty drugs widely used by older Americans has surged, while pricing for generic drugs has dipped despite sharp hikes for some medications, according to a pair of new AARP Public Policy Institute (PPI) reports.


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Fate of controversial California drug price bill up in air
 SACRAMENTO — A closely watched California bill could soon become the nation’s most comprehensive law aimed at shining a light on prescription drug prices.

Senate Bill 17’s goal of moving toward “transparency” in drug prices would enable health insurers to negotiate lower prices for drugs or, in many cases, replace those drugs with cheaper alternatives, its supporters say. They argue that the measure could make a huge difference because when California has required cost transparency in other areas of the health care industry, prices have stabilized or even decreased.

The bill is furiously opposed by the pharmaceutical industry, which has deployed legions of lobbyists and paid for full-page newspaper ads as the Legislature gets ready to take final votes on the measure, partially out of fear that SB 17 could become a national model and the first major step toward price controls.

“It’s a big deal,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group. “We have never come so close to having prescription drug price reform in my 15 years of doing this.’’

SB 17 requires pharmaceutical companies to notify health insurers and government health plans like Medi-Cal at least 60 days before scheduled prescription drug price hikes that would exceed 16 percent over a two-year period. It would also force drug companies to explain the reasons behind those increases.

The bill, which passed the Senate 28-10 in May, is set for a vote on the Assembly floor as early as Monday. The Assembly vote is expected to be much closer than the Senate vote.

Transparent or misleading?

The uproar over stratospheric drug costs has been building in the past few years, spurred by headlines over things such as the $600-plus retail price for a two-pack of EpiPens, the lifesaving auto-injector.

Under SB 17, whose main author is Sen. Ed Hernandez, D-West Covina, health insurers also would have to annually report the 25 most frequently prescribed drugs, the 25 most costly drugs, the 25 drugs with the highest year-over-year increase in total annual spending and the proportion of premiums spent on prescription drugs.

Getting those numbers, Hernandez said, should help health insurers and the public get a better sense of which drugs are driving up the cost of health care.

“There is a level of frustration with the black box of drug pricing and the uncertainty of price increases and the ability of states to balance their budgets,’’ said Trish Riley, executive director of the National Academy for State Health Policy. “It’s the perfect confluence of circumstances that gives states the impetus to act.’’

But pharmaceutical companies call SB 17 misleading because the list prices set by drug makers — like those set by car manufacturers — aren’t what most health plans pay after negotiating discounts, or what consumers actually shell out after they use rebates and coupons.

“The bill, which claims to be about price transparency, is not going to do what it claims to do,’’ said Priscilla VanderVeer, spokeswoman for the Washington, D.C.-based Pharmaceutical Research and Manufacturers of America, a trade group that represents 37 drug companies.

“When you are not having a conversation about the actual facts on the ground in the marketplace, then what is your legislation going to help accomplish?’’ asked VanderVeer, who said her group has tried to work with Hernandez on solutions, “but he is not going to talk to us anymore.’’

Hernandez disputes that characterization.

“We have been trying to work with the opponents,’’ said Hernandez, an optometrist who is chairman of the Senate Health Committee and is a candidate for lieutenant governor. “It doesn’t matter what we do. They’re always opposed to this bill because they don’t like being told what to do. What they want is to do nothing.’’

More support

The impact of SB 17, health industry experts say, could very well lead to other states adopting California’s template if Gov. Jerry Brown signs the bill into law.

At least three states — Vermont, Maryland, Nevada — have similar laws. But California’s is considered the most comprehensive, in part because it covers generic as well as brand drugs.

Hernandez introduced a similar bill last year, but he pulled the measure at the last minute after it was watered down with amendments.

He said he learned from the experience, went back and changed some parts of the bill.

The new bill has a lot more support than last year. Backers now include a handful of Republican legislators, the California Hospital Association, as well as more businesses and chambers of commerce. Billionaire environmental activist Tom Steyer, of San Francisco, also has signed on as a financial backer, alongside labor unions and insurers.

But most importantly, Hernandez said, he has the public on his side.

A poll conducted in April by the Kaiser Family Foundation found that most Americans favor tough government actions to lower drug costs. Eighty-six percent said drug companies should be required to publicly release information on how prices are set.

“One thing economists agree on is that we provide monopoly power to the drug industry when we give them patents for their discoveries,’’ said David Chiu, a San Francisco assemblyman who co-authored the bill. “What we don’t know is whether the billions of dollars earned by those companies are a fair rate of return, or price gouging in return for that monopoly power.’’

Cost of drugs

A drug made by Foster City-based Gilead Sciences has become another flashpoint in the debate over drug prices. Sovaldi, which cures Hepatitis C, surfaced in 2014 with a list price of $84,000 for a 12-week course of treatment.

When Gilead introduced Sovaldi, the state had to budget $340 million more for its Medi-Cal recipients in fiscal year 2014, Hernandez said.

“If we would control costs, even just slightly, the money could be used to pay for things like increased (Medi-Cal) provider fees, dental care restored for the poor and a lot of social services,” he said.

But drug manufacturers say the cost to develop drugs — 90 percent of which never get approval from the U.S. Food and Drug Administration — means the profits from those medications that do succeed must subsidize the failures.

Moreover, they say, the way Americans pay for medications is much more complex than most consumers realize. Many of them don’t understand that drug manufacturers routinely offer significant price concessions to insurers and consumers, according to the California Life Sciences Association, which represents at least 300 biopharmaceutical companies in the Golden State.

In 2015, the group said, discounts, rebates and other price concessions offset the price increase of brand name drugs by roughly 80 percent.

“It’s discouraging that California is moving forward with something like SB 17 that really just looks at the drug maker’s list prices,’’ said Brett Johnson, the trade association’s senior director of policy and regulatory affairs. “I don’t think that will help consumers or insurers or the public — or really help anyone understand the actual costs.”

Output: A closely watched California bill could soon become the nation’s most comprehensive law aimed at shining a light on prescription drug prices. Senate Bill 17’s goal of moving toward “transparency” in drug prices would enable health insurers to negotiate lower prices for drugs or, in many cases, replace those drugs with cheaper alternatives, its supporters say.


Instruction: create a high quality summary of the given input

Input:
Specialty Drug Prices Increase at Fastest Rate in Over a Decade
 Retail prices for specialty prescription drugs widely used by older Americans ballooned by an average of 9.6 percent between 2014 and 2015, the highest increase since at least 2006, while retail prices for some generic drugs saw more mixed results, with 11 percent showing price increases according to two new AARP Public Policy Institute (PPI) reports released Thursday. While generic drug prices decreased overall in 2015, 11 percent of generic drugs saw price increases, some exceeding 100 percent.

Specialty drugs generally include drugs used to treat complex, chronic health conditions. They often require special care in how they are administered to patients, as well as in how they are handled and stored. Many specialty drugs treat conditions that are common among older people, including rheumatoid arthritis, multiple sclerosis, and cancer.

In 2015, the average annual cost of therapy with one specialty drug was $52,486, an amount more than three times higher than the average Social Security retirement benefit ($16,101) and twice the median income ($25,150) for someone on Medicare. By comparison, the average annual cost of therapy for one generic drug in 2015 was $523, down from $714 the year before.

Among the 11 percent of generic drugs which saw price increases, all of the increases exceeded the rate of general inflation. Between 2010 and 2015, all but 1 of the 399 widely-used generic drugs in this study experienced at least one retail price increase. Some of these price increases were extraordinary, exceeding 100 percent. Two manufacturers increased the retail price of doxycycline hyclate, a commonly-used generic antibiotic, by over 1,000 percent, the highest price increase noted in the generic drug report.

“American families can’t afford to keep paying for prescription drugs that cost more money than their salaries,” said AARP Chief Public Policy Officer Debra Whitman. “These price increases are particularly hard on older adults, who take an average of 4 ½ prescription drugs per month and often live on fixed incomes.”

Specialty Rx Price Watch Report Highlights

Based on the retail prices of 101 specialty drugs:

The average annual increase in retail prices was 9.6 percent (2014–2015), compared with 8.9 percent the year before. In contrast, the general U.S. inflation rate was 0.1 percent.

The average annual cost of specialty drug therapy used on a chronic basis rose by nearly $35,000 between 2006 and 2015.

In 2015, the average annual price of therapy for specialty drugs was nine times higher than the average annual price of therapy for brand name drugs and 100 times higher than the average annual price of therapy for generic drugs.

One drug, HP Acthar Gel, was dropped from the specialty drug analyses because its enormous one-time retail price increase (1,300 percent+) in 2007 distorted the overall trends.

Generic Rx Price Watch Report Highlights

Based on the retail prices of 399 generic drugs:

The average annual retail cost of generic drug therapy was about $2,350 in 2015, more than twice what it was in 2006 when the Medicare Part D program began.

In 2015, one widely-used generic diabetes drug had a 450 percent+ retail price increase.

The average annual generic drug price decreased 19.4 percent (2014–2015).

“Generics drugs currently account for almost nine out of 10 prescriptions filled at the pharmacy but only a quarter of total drug costs,” said Leigh Purvis, Director of Health Services Research, AARP Public Policy Institute, and co-author of the report. “Given Americans’ long-standing reliance on these products for savings—as well as recent price trends for brand name and specialty drugs—it is incredibly important that we identify and mitigate the factors behind recent generic drug price increases.”

About Rx Price Watch Report Methodology

AARP’s Public Policy Institute, in collaboration with the PRIME Institute at the University of Minnesota, developed market baskets used to examine retail price trends among brand name, generic, and specialty drugs that are widely used by older Americans, including Medicare beneficiaries. The most recent Rx Price Watch reports focus on specialty and generic drug products.

The specialty market basket includes 101 specialty prescription drug products. The generic market basket includes 399 generic prescription drug products. Using data from the Truven Health MarketScan Research Databases, the reports analyzed retail price changes between 2006 and 2015 for the drug products in each market basket. The medications include products used to treat common and often chronic health conditions, including high cholesterol, diabetes, arthritis, and hypertension.

The full reports can be found at http://www.aarp.org/rxpricewatch.

Additional Resources

AARP is the nation’s largest nonprofit, nonpartisan organization dedicated to empowering Americans 50 and older to choose how they live as they age. With nearly 38 million members and offices in every state, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands, AARP works to strengthen communities and advocate for what matters most to families with a focus on health security, financial stability and personal fulfillment.

(Source: PR Newswire)

Output: Retail prices for specialty prescription drugs widely used by older Americans ballooned by an average of 9.6 percent between 2014 and 2015, the highest increase since at least 2006, while retail prices for some generic drugs saw more mixed results, with 11 percent showing price increases according to two new AARP Public Policy Institute (PPI) reports released Thursday.


Instruction: create a high quality summary of the given input

Input:
When It Comes to the Drug Pricing Debate, Talk Is Cheap
 In the last several months, individual companies have begun to take actions in an attempt to address pricing concerns and demonstrate their ability to “self-police” — especially in the face of bad actors that have fueled hatred of the pharmaceutical industry by taking significant price increases on single-source products.

These actions have ranged from taking pledges to limit annual price increases to improving transparency of pricing — including disclosing price increases, entering into value-based pricing schemes and devising innovative partnerships to lower the cost of certain medicines for patients — to entering into new partnerships to provide discounts on the medicines they sell at the pharmacy.

But the question remains — to what extent have or will these actions actually make a difference in how these companies are perceived by the public and by legislators? What is the potential benefit of these various actions for reputation, for gaining a seat at the table in policy discussions or for fighting off damaging state and federal legislation — compared to the potential risk of maintaining the status quo? Is staying out of the news enough, or are proactive actions required?

APCO Worldwide recently conducted opinion research to try and answer these questions and to understand what actions may be most helpful in positively positioning pharmaceutical companies in the current debate on drug pricing. Specifically, we asked stakeholders — including the opinion-leading public, health care providers and policymakers — what actions most demonstrate companies are doing the “right thing” when it comes to access and affordability.

So what moves the needle the most? We found that stakeholders want to see companies demonstrate that they have patients’ best interests in mind, act as an advocate to improve access and affordability. What actions accomplish this?

1.) Advocate for policies aimed at improving access to medicines – Companies must have a point of view on how to improve access and affordability for patients, and publicly advocate for that position.

2.) Partner to improve access – Stakeholders like to see companies working with others in the system — health insurers, pharmacy benefit managers or others — to improve access to patients. This suggests innovative discount programs that have recently been implemented by companies to reduce prices to patients at the pharmacy are widely viewed as positive.

3.) Share details on how medicines are priced — Transparency, transparency, transparency. Even if it doesn’t change how prices are determined, stakeholders expect to see companies disclosing more information about how their medicines are priced. Transparency helps improve trust and demonstrates companies are not taking advantage of patients or the system.

On the flip side, our research also showed the actions that don’t break through, or that can make things worse.

Interestingly, we found that maintaining the status quo will not be enough to address stakeholder concerns. Specifically, companies have increasingly tried to communicate that they negotiate with payers to help improve access — something that has been done in the industry for a long time — but this activity is not viewed especially favorably. Nor are the access programs that provide free or discounted medicines to patients in need — programs which companies have long touted.

Bottom line: Communicating more while continuing to do the same things will not help quell the ongoing criticism.

And finally, the worst companies can do? Get called out as a bad actor. Whether for taking large price increases or launching a medicine with a high price, giving large bonuses or salaries to senior executives or making exceptionally high profits, media coverage of these actions is distinctly viewed by stakeholders as doing “the wrong thing.”

While concerns about pricing are unlikely to dissipate in the near future, these results clearly demonstrate that there are several “right things” companies can do to address concerns.

The catch? Companies must be past the point of relying on words alone, and be willing to take concrete action that either directly alleviates patients’ pocketbook pains or addresses the confusion and uncertainty surrounding the high cost of drugs everyone is hearing about.

Over the last year, we’ve seen several companies take steps aimed at doing just that — from efforts meant to clarify their approaches to pricing to those engaging unique partnerships to provide additional discounts at the pharmacy counter.

In the end, our research suggests it will be these same companies that are increasingly able to move the needle and meaningfully engage in the pricing debate moving forward.

Chrystine Zacherau is a senior director with APCO Insight, the opinion research group at APCO Worldwide, and manages APCO Insight’s global health care research. April Claassen is a director of health policy in APCO Worldwide’s Washington, D.C., office and works with APCO’s health care clients.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: In the last several months, individual companies have begun to take actions in an attempt to address pricing concerns and demonstrate their ability to “self-police” — especially in the face of bad actors that have fueled hatred of the pharmaceutical industry by taking significant price increases on single-source products.


Instruction: create a high quality summary of the given input

Input:
For Low-Income Drug Users, Medi-Cal Offers A Fresh Start
 Breann Johnson stopped using heroin on Mother’s Day this year, determined to end her 13-year addiction. Days later, she began three months of residential treatment in Riverside, Calif. — all paid for by California’s Medicaid program.

Johnson, who has two young sons, said other inpatient drug rehab programs had refused to accept Medicaid, and she knew outpatient care would not be enough to break her habit.

“I couldn’t stop,” said Johnson, 28. “With my drug, you are either sick all day or you have to do it to make yourself feel better.”

As the opioid epidemic burns a path of devastation through communities across the nation, California is leading the way in revamping treatment for low-income residents like Johnson. Before this year, the state’s Medicaid program, known as Medi-Cal, covered only limited and episodic care. Now, it pays for a much broader range of treatment including expanded access to medications, inpatient beds, individual therapy and case managers.

Use Our Content This KHN story can be republished for free ( details ).

The five-year pilot project, which gives the state flexibility in its use of federal money, was approved in 2015 by the agency that oversees Medicaid. The California project officially started earlier this year. Virginia, Massachusetts and Maryland also have federal permission to expand drug treatment for Medicaid members. Other states, including West Virginia and Michigan, are seeking it.

California’s drug rehab overhaul makes it easier for Medi-Cal members to get care and improves their chances of long-term recovery, state health officials said. It also aims to reduce costs by decreasing use of emergency rooms and hospitals and keeping drug-addicted enrollees out of jail and out of the child welfare system.

“It is such a dramatic change to our substance abuse field,” said Marlies Perez, chief of the substance use disorder compliance division at the state Department of Health Care Services. “We turned off one system one day and turned on a whole new system the next.”

Health officials and service providers say that with the federal waiver they are finally able to address addiction as a chronic disease. Instead of simply getting short-term outpatient care, Medi-Cal beneficiaries can receive ongoing treatment from detoxification through recovery, tailored to their specific needs.

“The old traditional way was a rather canned approach to recovery,” said Bruce Copley, director of the Department of Alcohol and Drug Services in Santa Clara County.

The state does not yet know how much the changes will cost, because the program is open-ended: Anyone eligible for the services in the participating counties can receive them. In previous years, the state has spent about $180 million annually on drug rehabilitation for Medi-Cal beneficiaries. Perez said the state is only beginning to receive bills and is hoping to prove to the federal government that the changes will actually reduce overall costs related to substance abuse.

Drug rehab providers still fear for the future of Medicaid given the ongoing debate over health care in Washington, said Tom Eby, clinical director of Whiteside Manor, a nonprofit residential treatment center in Riverside. If his clients lost their Medicaid coverage — or the federal government ended California’s drug rehab program — it could imperil the progress being made, Eby said.

“It would go back to what it was, with these folks dying on the street,” he said.

Thirty-eight of the state’s 58 counties have joined California’s Medi-Cal pilot. Riverside and San Mateo started in February. Other counties, including Los Angeles and San Francisco, have come on board since.

The big increase in the availability of residential care is a significant aspect of the program, since it could reduce the chance of relapse or overdose for those with severe addictions. Previously, Medicaid did not cover treatment in inpatient rehab facilities with more than 16 beds. That resulted in long waiting lists. Inpatient stays typically were paid for by the county, a private insurer or the person being treated.

In Riverside County, Medi-Cal recipients used to wait more than two months for a bed. Now, many of them get one in a day or two, according to Rhyan Miller, the county’s substance abuse services program administrator.

At MFI Recovery’s women’s center in Riverside, known as A Woman’s Place, residents now have access to a licensed vocational nurse, a driver to take them to appointments and a discharge planner. They can stay 90 days (with a possible 30-day extension) and longer if they are pregnant.

Johnson said she was grateful to get in without a long wait. If she hadn’t, the Riverside woman said, “I would either be on the streets or dead.”

Brittany Stearns, another resident, said her parents had paid $48,000 for an earlier stay at a private residential treatment center to treat opioid addiction. When she relapsed three years later, the 32-year-old Palm Springs resident knew her parents wouldn’t pay for it again.

“I needed help,” said Stearns, whose 2-year-old daughter, Molly, lives with her at the center. “If Medi-Cal didn’t pay for this, I am afraid to think about where I would be.”

Johnson and Stearns both completed their residential treatment and are now getting follow-up outpatient care.

Perez, of the health care department, said that although the project is scheduled to run five years, the state does not intend to return to the old way of doing business. It hopes to persuade the federal government to continue allowing spending flexibility. “This is already impacting not only Medi-Cal but other individuals who are receiving substance abuse disorder services,” she said.

That’s because clinics have made sweeping changes to meet the new Medi-Cal requirements for participation, including the recruitment and training of new employees. Counties are also now using guidelines set by the American Society of Addiction Medicine — another condition of participation.

When the new program started, thousands of people called in to a substance abuse line for screening and referral, said Miller of Riverside County. That was up from fewer than 200 calls the previous month.

“We didn’t expect this,” he said. “It has been absolutely crazy. The sheer numbers of calls completely overwhelmed and also excited us.”

At Whiteside Manor, director Ron Vervick said the additional reimbursement from Medi-Cal enabled him to hire more counselors, drivers, nurses and intake workers. Many of the residents at Whiteside are homeless and mentally ill. In the past, he said, they didn’t get the care they needed.

One resident of Whiteside Manor, Kendall Jenkins, sought treatment in early May after years of heavy drinking and drug use that included heroin, methamphetamines and pills — “anything I could get my hands on.” A former college golfer and hotel valet, Jenkins, 30, was homeless off and on, and spent stretches living in his car. He recently left the facility, found work at a hotel and is staying in a sober-living home nearby.

Jenkins said that when he learned Medi-Cal would cover his stay at Whiteside, he felt relieved. He was able to participate in individual counseling and group therapy and said the center “saved my life.”

Though he still thinks a lot about using heroin, he knows where he would end up if he did.

“It’s not worth it,” he said. “I know I can do this.”

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Output: Breann Johnson stopped using heroin on Mother’s Day this year, determined to end her 13-year addiction. Days later, she began three months of residential treatment in Riverside, Calif. — all paid for by California’s Medicaid program.


Instruction: create a high quality summary of the given input

Input:
How Democrats learned to stop worrying and love 'Medicare for all'
 Story highlights Sanders campaigned relentlessly against the Republican bills, mostly in the Midwest and Rust Belt. Public opinion polls have begun to show more support among Democrats for single-payer.

CNN —

First, consider this: It’s the summer of 2019 and a dozen Democratic presidential candidates are gathered onstage for a debate somewhere in the Midwest. The network moderator concludes her introductions and tees up the opening question.

“Who here tonight supports moving the United States toward a single-payer, or ‘Medicare for all,’ taxpayer-funded health care system?”

Pause it there and rewind to January 2016 in Iowa. The caucuses are days away, and Hillary Clinton is fending off an unexpected challenge from Sen. Bernie Sanders. The discussion turns to single-payer, and Clinton balks.

“People who have health emergencies can’t wait for us to have a theoretical debate about some better idea that will never, ever come to pass,” she tells voters in Des Moines, explaining her campaign’s focus on preserving and expanding Obamacare, while dismissing the progressive insurgent’s more ambitious pitch.

Go back even further now to the last contested Democratic primary before that, in 2008, and recall the lone and lonely voices in favor of single-payer care. They belonged to Ohio Rep. Dennis Kucinich and former Alaska Sen. Mike Gravel. The pair combined for a delegate haul of precisely nil.

Back to the present – a decade on – and after a chaotic months-long push by Republicans to dismantle former President Barack Obama’s Affordable Care Act, the prospect of Sanders’ “Medicare-for-all” program has emerged as the hot-button centerpiece of the Democratic Party’s roiling public policy debate.

Ticket to ride

After a summer that has seen so many of the party’s most ambitious officials and brightest prospects line up in vocal support of what was so recently a fringe cause, consider again how the single-payer question will be received on a Democratic debate stage. Here’s a hint: Expect to see a lot of hands.

Still, for a party on its heels in Washington and around the country, the 2020 race is a distant star. If Democrats fail to claw back enough seats in next year’s midterm elections, the health care conversation will remain in its current state: purely hypothetical.

But as Sanders prepares to unveil his new legislation next week, the broader left is beginning to coalesce around a vision that holds up universal, government-backed health care as a core Democratic party principle. The Vermont independent’s forthcoming bill – its arrival delayed on at least three occasions by Washington’s unique rancor – has Senate cosponsors in Kamala Harris, Kirstin Gillibrand, Elizabeth Warren, Sheldon Whitehouse, Cory Booker, Jeff Merkley, and Tammy Baldwin. More Democrats could join before its unveiling on Wednesday. The House companion bill, from Michigan Rep. John Conyers, has 117 cosponsors, a little more than 60% of the entire caucus.

About half of those cosponsors signed on after House Republicans introduced their first hack at Obamacare repeal, the American Health Care Act. For the better part of five months, Democrats in both chambers, along with a coalition of liberal protesters, fought to wrest defections from the GOP line. Ultimately, it was a single vote in the Senate – delivered well after midnight on a Friday morning in late July – that signaled an improbable rearguard victory.

Thanks, President Trump

But even before Arizona Republican Sen. John McCain angled his thumb toward the floor, the effort to unwind Obama’s signature legislative feat was beginning to backfire on the GOP.

Sanders set the tone early on. About a week after House Speaker Paul Ryan unveiled the AHCA in March, he tweeted a warning.

“Never lose sight of the fact that our ultimate goal is not just playing defense,” Sanders wrote. “Our goal is a Medicare-for-all, single payer system.”

Never lose sight of the fact that our ultimate goal is not just playing defense. Our goal is a Medicare-for-all, single payer system. — Bernie Sanders (@SenSanders) March 12, 2017

Sanders campaigned relentlessly against the Republican bills, mostly in the Midwest and Rust Belt. His criticism was lacerating. In June he told a Saturday night crowd in Pittsburgh that if the GOP plan’s implementation would be “a moral outrage that this nation will never live down.” After rolling into Ohio overnight, he rose in Columbus the next day as part of a joint barnstorming effort with organizers from MoveOn.org to brand the Republican proposal “the most anti-working-class legislation ever passed in the modern history of our country.”

Not 24 hours later, Sanders’ Democratic colleagues began amassing on the steps of the Capitol in Washington; their conversation, kicked off by Booker and Georgia Rep. John Lewis, who broadcast it a Facebook Live, went viral. Hawaii Sen. Brian Schatz, now considering a bill of his own that would allow anyone to buy-in to Medicaid, and Gillibrand joined in early on.

“Health care should be a right, it should never be a privilege,” Gillibrand said, almost in passing. “We should have Medicare-for-all in this country.” One viral moment had given way to another, and Gillibrand’s office confirmed to CNN the next day that, “Yes,” she supports single-payer.

A changing dynamic

A few weeks on, in mid-July, Sanders returned to Des Moines, Iowa, for the first time since the 2016 election to water the grassroots.

“Our immediate test,” he said, was to defeat the Republican plan. “But as soon as we accomplish that, I will be introducing legislation which has gained more and more support all across this country, legislation for a Medicare for All, single-payer system.”

Robert Becker, Sanders’ 2016 Iowa campaign director, was in the hall that day. (As was top Trump adviser Kellyanne Conway, as it happened, for an unrelated event just a few hundred feet away.) Between cigarettes, and before his old boss arrived on the scene, Becker sat back and diagnosed the bubbling dynamic.

“Every time Paul Ryan, or someone who is trying to dismantle the Affordable Care Act, steps to the podium and starts talking about insurance rates and premiums getting higher and higher and higher, they’re actually making an argument for a single-payer system,” he said. “You don’t hear people on Medicare and Medicaid complaining about their co-pays.”

There were other tailwinds kicking up. Public opinion polls had begun to show hardening support among Democrats for single-payer. One notable Pew survey released in mid-June found more than half of Democrats supported such a program. Among liberals, the number jumped to 64%. Looking across party lines, the poll found that a third of Americans backed the policy, up 12 points from 2014.

When it was reported Friday that Obamacare architect and former Montana Sen. Max Baucus, hardly a progressive firebrand, now supported single-payer, saying, “We’re getting there, it’s going to happen” – there were some chuckles on the left, but little surprise.

The new normal

When it became apparent on July 17 that Senate Republicans did not have the votes to advance their own bill, the Better Care Reconciliation Act, progressive political organizations pounced.

Working Families Party national director Dan Cantor, after warning presciently that “this may well not be the last version of Trumpcare we see,” all but thanked Republicans for joining the battle.

“In the end, the biggest impact of the Republicans’ attack on healthcare may be this: It has strengthened the resolve of many, many Americans to fight for healthcare for all,” he said.

Adam Green, the Progressive Change Campaign Committee co-founder, brushed off the prospect of “small-bore technocratic tweaks,” saying it was time to offer “every American access to Medicare.”

After a subsequent, last-ditch Republican push to secure enough votes for “skinny repeal” failed, Democrats on Capitol Hill began a swift public relations counteroffensive. Their weakened status in Congress has, on this front, turned out to be a sort of gift, offering freedom to test drive a variety of ideas and, should they crash, walk away relatively unharmed.

On August 3, Michigan Sen. Debbie Stabenow launched the “Medicare at 55 Act,” a limited buy-in program. Seven Democratic colleagues attached themselves immediately, and by the end of the month, Harris, whose progressive bona fides have been called into question by activists, became the first senator to go further and formally back the Sanders plan.

“Here, I’ll break some news: I intend to co-sponsor the Medicare-for-all bill, because it’s just the right thing to do,” she said a town hall in Oakland, California, shortly after informing Sanders of her intentions. “This is about understanding, again, that health care should be a right, not a privilege. And it’s also about being smart.”

This past Thursday, Warren announced her decision in an email to supporters.

“I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans?,” she wrote. “Everything should be on the table – and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month.”

By the evening, another Senate Democrat, Connecticut’s Chris Murphy was making headlines of his own. According to a Politico report, Murphy is currently drafting a bill of his own that would put Medicare on the Obamacare exchanges and allow individuals and businesses an option to buy in.

The growing crop of bridge bills, though they might disappoint hardliners, is another leading indicator of where the party is headed. But if the Stabenow and Murphy plans would appeal to some Democrats in part for their abilities to shield less bullish colleagues from pressure on the left, they represent only a temporary solution given the enthusiasm of activists for a universal program.

As former Sanders campaign digital organizing director Claire Sandberg said in an email after the Harris announcement, activists are charged up – and the pressure will be unyielding.

“The grassroots movement for universal health care will have to push Democratic leaders to not just voice support for Medicare-for-all when the party is in the minority,” she said, “but also demand that Democrats commit to keep fighting and refuse to back down or water down the proposal when the party is back in power.”

Output: First, consider this: It's the summer of 2019 and a dozen Democratic presidential candidates are gathered onstage for a debate somewhere in the Midwest. The network moderator concludes her introductions and tees up the opening question.


Instruction: create a high quality summary of the given input

Input:
Labster to expand its education VR service following $10m round
 LABSTER: 3D STEM simulations startup Labster has picked up $10M in a Series A financing round led by British venture capital firm Balderton Capital, reports VentureBeat.

Based in Copenhagen, Denmark, Labster simulates a variety of physics, chemistry, and biology labs—from protein synthesis to the fundamentals of animal genetics—in a laptop or mobile setting, although the company is starting to support more VR headsets. The labs were created in partnerships with industry giants like Thermo Fisher Scientific and research institutions such as Auburn University.

Prices start at $9 per month for high school students and $19 for college students. Already, the simulations are being used by Harvard, MIT and other big domestic and international schools. Previously the company received about $10M in grant funding.

The recently raised money will help the company expand to more schools in the U.S. and Europe and develop new simulations. Northzone and Unity Technologies founder David Helgason also invested in this round.

Output: Danish edtech start-up Labster has raised $10m in a series A funding round led by Balderton Capital and featuring participation from Northzone and Unity Technologies founder David Helgason. Labster creates educational simulations in STEM fields for mobiles and laptops, and is also expanding into virtual reality headsets, with Harvard and the Massachusetts Institute of Technology among its clients. The latest funding will be used to expand into the US and Europe, as well as develop new simulations.


Instruction: create a high quality summary of the given input

Input:
How much flexibility should states have to experiment with paying for and delivering healthcare?
 One of the few things that Republicans and Democrats broadly agree on is that states should have some flexibility to experiment with different ways to pay for and deliver health care.

But they disagree — strongly — on how much. In fact, Republicans don’t agree with one another on this, and that dissent helped sink efforts this summer to “repeal and replace” the Affordable Care Act. Bridging these divides will help determine the success of a bipartisan effort in the Senate this month to help shore up the individual health insurance market.

“I’ve always said not all the wisdom is going to be in Washington,” said Sen. Ron Wyden (D-Oregon), the ranking Democrat on the powerful Finance Committee. “Progressive and conservative folks are going to say ‘we can do better.’”

The federal health law includes a provision that allows states to alter some of its rules if they can think of a better way to provide health care to their residents. These are known as “Section 1332 waivers,” bookmarking where they are located in the health law.

But the law strictly limits how far states can go with their experiments. It includes what are known as “guardrails.” Those limits, said Nicholas Bagley, a health law professor at the University of Michigan, “are to prevent states from undermining the Affordable Care Act goal to provide people with comprehensive coverage.”

The waivers were designed “so blue states can experiment with blue state solutions, and red states can experiment with red state solutions,” said Bagley. “But to do so and stay within the guardrails is really difficult.” For example, he said, “you can reallocate the money, but you can’t reallocate it to create losers.”

At issue is whether to broaden authority for states by revising or eliminating the “guard rails” intended to protect patients and the federal government.

Wyden, who authored the 1332 language in the ACA, is skeptical. Under the current rules, he said, “states can make changes that make health care better. But they can’t go out and make health care worse.”

It is clear that Republicans in Congress want changes to the provision. The repeal-and-replace bill that passed the House and all those considered in the Senate included some expansion of state authority to waive protections included in the health law. Bagley said the bills “would have essentially given carte blanche to states to come up with ACA alternatives without any regard to the guardrails” other than the one prohibiting additions to the federal deficit.

And Sen. Lamar Alexander (R-Tennessee), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, who is working on a bipartisan bill, said Wednesday that “Democrats will have to agree to something — more flexibility for states — that some are reluctant to support.”

So is there a compromise between Democrats who want to maintain the protections and Republicans who want states to have a freer hand?

Maybe.

David Anderson of Duke University said one possible source of agreement would be to streamline the federal approval process, starting with the guidance issued by the Obama administration in 2015 that critics said was too restrictive.

Under the rules set by the ACA, states can use waivers to adjust things like the structure of premium assistance to those with low and moderate incomes or the individual and employer requirements to have and offer coverage. But those changes must meet four key standards: States continue to provide equally comprehensive coverage to at least the same number of people, with no higher out-of-pocket costs and without costing the federal government more than it would spend under the provisions of the ACA.

The rules around the waivers also make it hard to accomplish a truly comprehensive overhaul of a state’s health care system, as states can’t use them to reach the place where most of the money funding that system comes from: tax breaks for employer-provided insurance and the federal Medicare program. Workers don’t pay taxes on the value of employer-provided insurance, which is estimated to cost the federal Treasury some $260 billion in income and payroll taxes 2017.

“If you want to reshape your state health insurance market, you’ve got to be able to grab onto the employer market or Medicare, and you can’t” using the waiver procedure, Bagley said.

States also cannot use Section 1332 to change provisions of the Medicaid and Children’s Health Insurance Program, although they can submit simultaneous waivers to each program under separate Medicaid waiver authority in the law.

So far, only two states — Hawaii and Alaska — have won federal approval for 1332 waivers under the health law.

Hawaii has had its own system for providing health coverage based on an employer requirement for coverage since the 1970s. The state’s waiver allows it to use money allocated to help small businesses afford coverage in different ways.

Alaska’s waiver, which was approved this summer, involves a “reinsurance” plan that will help spread the costs of the state’s sickest patients more widely. “By removing high-cost conditions from the risk pool, the benefits of the [reinsurance program] are shared by the entire individual health insurance market,” Lori Wing-Heier, head of the state’s insurance department, told the HELP Committee on Wednesday. In its first year, the program dropped proposed premium increases from 40 percent to “just over 7 percent,” Wing-Heier said.

Minnesota has applied for a waiver similar to Alaska’s, and approval is expected. Earlier this spring, the Department of Health and Human Services specifically invited states to apply for waivers of that type.

Other states, though, are working on proposals that would make more comprehensive changes. Iowa, for example, wants to dramatically redistribute the money available, with bigger subsidies for the middle-class customers and smaller ones for those with lower incomes. The state says that would help draw more customers into the marketplace so that the risk pool is healthier and the premiums for everyone would decrease. It would also eliminate the help lower-income people get to pay their out-of-pocket medical costs, such as deductibles and copayments.

“The Iowa waiver on its face pretty brazenly ignores the guardrails,” said Bagley.

Oklahoma, which is seeking a waiver for its own reinsurance program, is also working on a plan that would make major changes, including encouraging people to purchase insurance with higher deductibles along with a health savings account.

Part of the difficulty with the waivers is the number of hoops states must jump through to win approval, including passing legislation, seeking public comment and holding hearings around the state.

And those are not even the biggest problems, state officials say. “The part that is stifling states right now is the six-month waiting period before they receive final approval,” Alaska’s Wing-Heier told the Senate panel.

Teresa Miller, former Pennsylvania insurance commissioner, agreed at the Senate hearing, saying, “The current process is very cumbersome.”

Anderson of Duke University said one key possibility to add flexibility would be to loosen the requirement that state changes not add to the federal deficit. “Maybe they could allow for deficit neutrality over the course of the waiver rather than year by year,” he said, in which case experiments that cost money to begin with but save over time would be allowed.

Wyden said he is willing to look at any ideas to make the waivers easier to use.

But he added that the popularity of state “reinsurance” waivers that are lowering premiums shows the waiver provision is working as intended. And, he said, if GOP members try again to roll back coverage using the waiver provision “they’re going to have to roll over me, then they’re going to have to persuade people” that it meets the 1332 requirements.

Photo: dkfielding, Getty Images

Output: One of the few things that Republicans and Democrats broadly agree on is that states should have some flexibility to experiment with different ways to pay for and deliver health care.


Instruction: create a high quality summary of the given input

Input:
Access to Mental Health Care Improved After ACA
 Access to healthcare in the United States has improved for adults with moderate and severe mental illness, a new study confirms.

Most importantly, researchers note that following pasage of the Patient Protection and Affordable Care Act (ACA), fewer patients with severe mental illness went without mental health care, although gaps in access persist.

The ACA expanded health insurance to roughly 21 million Americans through insurance reforms, Medicaid expansions, and subsidies for coverage in the marketplace.

The ACA also expanded mental health coverage through mental health parity reforms and through the provision of essential health benefits, which included mental health services. Early ACA-related research found increases in mental health treatment and reductions in the number of uninsured adults with mental illness.

Building on this previous research, Elizabeth Sherrill and Gilbert Gonzales, PhD, from Vanderbilt University School of Medicine in Nashville, Tennessee, examined changes in access to care for adults by mental health status in 2012-2013, before the ACA, and in 2015, after the ACA, using data from the National Health Interview Survey.

The sample included 77,095 adults aged 18 to 64 years (51% women; mean age, 41 years). Using the Kessler 6 (K6) scale, the scores of which range from 0 to 24, with higher scores indicating more severe psychological distress, the study team classified adults as having moderate mental illness (scores from 5 to 12 points), severe mental illness (scores of 13 points or higher) or no mental illness (scores from 0 to 4 points).

In both periods, adults with severe mental illness were more likely to be unemployed, have low income, and have poor or fair health, they report.

After passage of the ACA, and after controlling for sociodemographic factors, there was a decrease in uninsured adults with no mental illness (-6.2 percentage points) and moderate (-8.5 percentage points) and severe mental illness (-9.3 percentage points).

In addition, after the ACA, there was a significant drop in the percentage of adults with moderate mental illness with no usual source of care (-3.5 percentage points), delayed medical care (-4.5 percentage points), forgone medical care (-3.3 percentage points), and forgone prescription medications (-3.6 percentage points).

For adults with severe mental illness, the ACA led to a decrease in forgone prescription medications (-6.8 percentage points) and forgone mental health care (-8.0 percentage points).

The results were published online September 6 in JAMA Psychiatry.

"We did not find improvements in having a usual source of care, delayed medical care because of cost, or seeing a mental health professional for adults with SMI [severe mental illness], which may be attributable to factors not fully addressed by the ACA, such as high cost sharing and continued shortages in mental health," the authors write.

"Future reforms should consider expanding access to care for adults with SMI, with a focus on strengthening the mental health care system," they conclude.

The study had no funding. The authors have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online September 6, 2017. Full text

Output: Access to healthcare in the United States has improved for adults with moderate and severe mental illness, a new study confirms. Most importantly, researchers note that following pasage of the Patient Protection and Affordable Care Act (ACA), fewer patients with severe mental illness went without mental health care, although gaps in access persist.


Instruction: create a high quality summary of the given input

Input:
Quality Affordable Health Care Is Within Our Reach
 At the heart of almost every conversation about health care reform is one question: “How do we make health care affordable and accessible for everyone in America?” As representatives of America’s largest employers, we believe the most important strategy for transforming our nation’s health care system is to accelerate payment and delivery reforms that share support among both Republicans and Democrats — value-based health care. This approach focuses on innovations in provider payment, delivery system redesign, and consumer engagement. Importantly, value means both higher quality and lower cost.

Why is this important in the current environment? Just look at the numbers. The U.S. spends $3 trillion, 17 percent of our GDP, on health care – twice the average of other developed nations. In 2019, the amount the federal government spends on health care will overtake the entire federal discretionary budget. In other words, we will spend more on health care than the combined budgets of the Departments of Defense, Homeland Security, Education, Energy, Justice, Commerce, State, Housing and Urban Development, Labor, Transportation, Treasury and the Environmental Protection Agency, National Science Foundation, NASA, General Services Administration and all emergency spending. This shocking statistic should be an urgent call to action to pursue all strategies that can help decrease costs and improve care, including proven value-based care models.

Value-based care needs to be at the foundation of fixing our nation’s health care system, with the federal government leveraging proven private-sector, market-based strategies. While there are several value-based approaches government programs may adopt, bundled– or episode-based– payments have proven to be highly effective. However, the Department of Health and Human Services recently announced that it is significantly reducing the use of mandatory bundled payments and will increase opportunities for voluntary participation in this model. We are optimistic that voluntary bundled payment programs will still have a positive impact on quality improvement, but such voluntary programs may only attract the highest quality providers, thus limiting system-wide cost savings.

Importantly, private-sector voluntary bundled payment programs have produced positive results in savings and outcomes. Employers such as JetBlue, Lowe’s, McKesson, and Wal-Mart have participated in the Employer Centers of Excellence Network, a bundled payment program that offers insights for the Centers for Medicare and Medicaid Services as their leaders pursue a voluntary – as opposed to a mandatory – approach.

Currently, the ECEN program includes hip and knee replacements, spine care, and bariatric surgery provided at health care systems carefully selected after a rigorous evaluation.

Under the program, negotiated prospective bundled rates cover all services rendered during the episode of care. When the payment rate is combined with the savings from fewer complications and better patient selection, the ECEN patient total cost is 10-15 percent lower than the traditional fee-for-service patient, and patient outcomes are better.

For Lowe’s, the ECEN patients had lower out-of-pocket costs, and 100 percent of the participants would recommend the program to their co-workers or family. Fewer than 1 percent of ECEN patients had to return to the hospital because of a surgery complication – compared to over 6 percent of patients who received care at their regular community hospital. Additionally, all of the ECEN patients were able to go directly home after surgery, while over 9 percent of the community patients needed care at a skilled nursing facility.

Finally, Lowe’s estimates there have been $1-2 million savings from the ECEN spine program per year. Half of patients recommended for surgery in the old model were found by ECEN providers not to be good candidates.

Employers are reorienting the health care system toward value using strategies like ECEN. However, to reach the tipping point of change where consistent high-quality care is delivered everywhere, federal programs must be equally aggressive. We need government leadership on the federal level and a commitment from the president to stand behind private-sector innovation. We need the government to leverage its influence as the largest single purchaser of health care and help break down policy barriers that hinder adoption. By incorporating the private sector innovation’s most beneficial features into Medicare and other government programs, the administration will not only save taxpayer dollars, but will also improve health outcomes for patients.

The combined impact of the private and public sectors working together to advance value-based care is exponentially greater than any one entity can accomplish themselves. We truly believe we will benefit more when we benefit together.

Annette Guarisco Fildes is the president and CEO of The ERISA Industry Committee and David Lansky is the president and CEO of the Pacific Business Group on Health.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: At the heart of almost every conversation about health care reform is one question: “How do we make health care affordable and accessible for everyone in America?” As representatives of America’s largest employers, we believe the most important strategy for transforming our nation’s health care system is to accelerate payment and delivery reforms that share support among both Republicans and Democrats — value-based health care.


Instruction: create a high quality summary of the given input

Input:
Antidote Technologies to match patients to clinical trials
 Boston-based Antidote Technologies expects it will soon be able to accelerate the development of capabilities for its trial matching platform – including precision medicine and EHR matching. That’s because the company has just entered into an agreement for an $11 million funding round led by Merck Global Health Innovation Fund, and joined by existing investors Smedvig Capital and Octopus Ventures. Regulatory clearances still need to come through, but that’s expected to happen later this year.

A lot of clinical trials are delayed or closed because of a lack of patients taking part; Antidote estimates the number at about 80 percent. The company wants to put a dent in those numbers by changing the way patients and researchers connect. With its clinical and AI prowess, Antidote has created Match, a clinical trial matching platform currently serving around 180 patient communities – JDRF, Lung Cancer Alliance, and Healthline among them – bringing new studies to millions of patients on a monthly basis.

Patients answer simple questions about their health, and the platform provides matching studies in their neighborhood.

“We are excited to back Antidote given the company’s focus on solving the critical issue of matching patients with the right clinical trials,” said Francesca Wuttke, managing director at Merck GHI. “We think the Antidote approach fits well with our focus on investing in companies that play a critical role in the new digital clinical trial management ecosystem.”

Antidote Match is based on generating structured eligibility criteria, proprietary algorithms, and machine learning. To date, the company has made 14,000 clinical trials matchable and plans to reach full coverage of US trials next year with enhanced capabilities, such as matching cancer patients to studies using mutation-level data. The company is already a participant in the Cancer Moonshot project.

This year, Antidote has made its clinical trial matching platform accessible to the pharmaceutical industry with Match API, a web and mobile app layer that allows any organization to match patients to their portfolio or program of trials and build insights. The company is also piloting the Beta of Antidote Base, a SaaS offering that enables research sites to invite local, engaged patients to participate in their studies.

“We couldn't wish for a better endorsement of Antidote’s high-scale ecosystem approach to patient engagement than this round led by Merck GHI, a fund that has a deep understanding of the problem we are solving,” said Antidote founder and CEO Pablo Graiver in a statement. “We are also grateful for the continued support from Octopus Ventures and Smedvig Capital. Antidote is excited to embark on the next stage of transforming medical research to deliver new treatments faster to the people who need them.”

Output: Healthtech firm Antidote Technologies aims to expand the reach of its platform, which uses structured eligibility criteria, proprietary algorithms and machine learning, to match eligible patients to clinical trials, to the whole of the US by next year. The Boston-based firm, which recently entered into an agreement for an $11m funding round led by Merck Global Health Innovation Fund, has so far made 14,000 clinical trials matchable, but estimates that around 80% are delayed or closed, due to a lack of participating patients.


Instruction: create a high quality summary of the given input

Input:
Nurse Staffing Levels Linked to Patient Satisfaction With Pain Management
 Hospitals with more nurses on staff and better nurse-patient communication tend to receive higher scores on patients’ satisfaction with pain management, according to new research.

The study, published online in Pain Management Nursing, analyzed results from the Hospital Consumer Assessment of Health Care Providers Systems survey from hospitals in California, Massachusetts, and New York. It examined the associations between patient perceptions of pain control and hospital staffing numbers of nurses, hospitalists, physicians, and residents. It also studied 21 other hospital-level factors that were correlated with patients’ pain management reports.

Patients’ perception of pain control improved significantly with increasing numbers of registered nurses, nursing staff, and hospitalists, but worsened with higher numbers of residents or interns. Additionally, both higher numbers of nursing staff and being treated in a nonprofit hospital decreased the likelihood of patients reporting their pain was poorly managed.

There were also several factors that made patients significantly more likely to report their pain was poorly controlled: they did not receive help as soon as they wanted, poor nurse communication, poor medication education, and being treated in a teaching hospital. Patients reported particularly low rates of pain control satisfaction if they were treated in teaching hospitals with rotating intern/resident assignments.

The researchers also determined that 79% of the variations in self-reports of pain control could be explained by just 6 predictors. Nurse staffing and nurse-patient communication were the strongest predictors of pain management perceptions among patients.

“The findings highlight the need for adequate numbers of nursing staff to achieve optimal patient satisfaction with pain management,” said lead author Judith Shindul-Rothschild, PhD, MSN, RN, in a news release from Boston College. “In addition, having a prescriber (physician or nurse practitioner) available 24/7 to offer continuity of care is essential.”

The results also point to the importance of strong communication among providers and patients in making sure that patients feel their pain needs are well managed.

“In addition to appropriate nurse staffing, our study highlights that an essential component to improve patients' satisfaction with pain management is to promote more effective collaboration among medical trainees, hospitalists, and nurses,” Shindul-Rothschild said.

Output: Hospitals with more nurses on staff and better nurse-patient communication tend to receive higher scores on patients’ satisfaction with pain management, according to new research.