The top health care stories of 2015—and why they mattered, part two


See the first part of our countdown: The No. 10 through No. 6 most important stories of 2015.

5. The presidential candidates talked health care—and the ACA debate started to change

If there is one health care takeaway from the presidential race so far, it's that the debate over the Affordable Care Act (ACA) has entered a new phase.

Republicans still say they want to repeal the law and replace it with something better. However, candidates have devoted far less time to the ACA and health care than they did in 2012, and proposals from Republicans on health care reform have embraced some aspects of the law—like subsidies and ways for people with preexisting conditions to get insurance.

What good is a value-based care network if patients can't access it?

Meanwhile, Democratic frontrunner Hillary Clinton focused many of her health care proposals on improving the ACA and making care more affordable, and voiced support for continuing to shift away from the fee-for-service payment system.

- Sam Bernstein

Read more in the Daily Briefing archives:

July 31: Donald Trump's plan: Replace the ACA with 'something terrific'

Aug. 19: Marco Rubio releases his health care plan

Oct. 14: The Democratic candidates debated nearly 10 health care topics—but barely mentioned the ACA



4. Moves and countermoves: Health care mergers and partnerships

It's been another busy year for hospital mergers, as systems worked to build more cohesive and coordinated care delivery models and differentiate themselves from others in the market—including some of the newer players, like retail clinics.

And as providers have become more consolidated, payers have made moves to do the same, with Anthem planning to acquire Cigna and Aetna planning to acquire Humana.

One of the biggest questions of 2015 (and a major story for 2016) remains how regulators will react to all these changes. We've already seen the Federal Trade Commission take steps to block several hospital mergers, and the American Medical Association and others called on the Department of Justice to block the big insurer mergers.

But while merger plans get most of the attention, there's another trend the Daily Briefing tracked this year that shows no signs of slowing down in the New Year: providers increasingly striking partnership agreements with other facilities to advance their goals.

- Josh Zeitlin

Read more in the Daily Briefing archives:

May 8: When merger talks fail: How this hospital is fighting to stay afloat

Aug. 6: Here's what would happen if the health plan mergers actually go through

Oct. 21: CEO: Why Mayo Clinic doesn't want to acquire hospitals



3. Rising drug prices became an above-the-fold issue

Even before former Turing Pharmaceuticals CEO Martin Shkreli became notorious for raising the price of the decades-old drug Daraprim by 5,400% overnight, the issue of drug costs—both for generic and brand-name drugs—was gaining more attention.

A month before the Shkreli controversy began in earnest, an August Kaiser Family Foundation poll found that drug costs had supplanted repealing the ACA as GOP voters' top health care priority. That tracks with data showing drug costs are on the rise. For instance, an Express Scripts report released in March found that prescription drug spending jumped 13% in 2014, the largest increase in more than a decade.

Doctors raised alarm, too. In July, more than 100 oncology experts called for action to reduce the rising cost of cancer treatments, which they warned were causing some patients to not take their medications.

As 2015 drew to a close, the drug price issue only seemed to pick up steam, in part because of the controversy around Shkreli. Candidates on both sides of the aisle spoke about the need to bring down drug costs, Congress held hearings on drug pricing, and the American Medical Association called for an end to direct-to-consumer pharmaceutical advertising. 

- Sam Bernstein

Read more in the Daily Briefing archives:

May 18: America's prescription drug problem: 500,000-plus people took more than $50,000 in drugs last year

Sept. 22: Hillary Clinton just unveiled her drug reform plan. Here's what you need to know.

Dec. 17: FBI arrests Turing CEO Martin Shkreli



2. The ACA survives a major court challenge—but still faces several others

The stakes were high in the Supreme Court case King v. Burwell: With subsidies to help Americans purchase and use federal exchange coverage on the line, the justices' decision would affect whether the Affordable Care Act would remain affordable for millions.

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When the Supreme Court upheld the subsidies in a 6-3 decision in June, many hospital leaders breathed a sigh of relief, as they no longer faced the threat of losing billions of dollars per year in patient revenue.

King v. Burwell represented by far the biggest remaining challenge to the ACA, but the Court is expected to release decisions in other looming cases by the end of June 2016:

  • Gobeille v. Liberty Mutual, a case that could jeopardize the utility of all-payer claims databases, which the American Hospital Association has called an "essential" tool in the shift toward value-based payments;
  • Little Sisters of the Poor v. Burwell, a case challenging the federal contraceptive coverage rules for not-for-profits that hold themselves out as religious and oppose contraception.

- Josh Zeitlin

Read more in the Daily Briefing archives:

Sep. 10: Get ready: The House GOP's lawsuit against the ACA just moved forward

Nov. 9: Here's what you need to know about Little Sisters of the Poor v. Burwell

Dec. 1: Why Gobeille v. Liberty Mutual matters for hospitals



1. The big shift away from fee-for-service

We may look back on 2015 as the year hospital payment began to fundamentally change.

HHS kicked things off in January, announcing ambitious goals for reforming Medicare payments for hospitals and physicians that would make 30% of payments through alternate payment models like ACOs and bundled payments by 2016, with the goal increasing to 50% by the end of 2018.

The department has since turned words into action, particularly with two initiatives that will launch next year: the recently finalized mandatory bundled payment program for 67 metro areas and the Next Generation ACO model. Congress joined in on the action, too, when it passed a permanent replacement for Medicare's sustainable growth rate formula, and states and private payers have taken separate steps to promote value-based payments.

Those efforts are not only changing the way hospitals are paid, but are fundamentally altering how hospitals and other providers do business. That's what made the shift away from fee-for-service our top story of 2015.

- Josh Zeitlin

Read more in the Daily Briefing archives:

Feb. 11: Lazerow: What the 'historic' commitment to accountable care really means

April 21: It's official: Mandatory bundled payments are coming. Here's are the key details.

April 27: What ACOs need to know about CMS's 'Next Generation' model

Dec. 15: The full picture on pay-for-performance penalties for FY 2016


Next in the Daily Briefing

What health care CEOs told us in 2015

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