Research Roundup - July 2017

Alaska

Feds Agree to Shore Up Alaska’s Insurance Market

By Liz Ruskin | Alaska Public Media | July 11, 2017

The U.S. Department of Health & Human Services has given the green light to the State of Alaska’s reinsurance program, which aims to lower costs for people who buy their own health insurance, according to Alaska Public Media. Alaska is the second state to get a State Innovation Waiver, under section 1332 of the Affordable Care Act. Although the federal government will now fund most of Alaska’s reinsurance program, the state designed it to avoid adding to the federal deficit.

Connecticut

Connecticut Governor Signs Consumer-Protection Drug Law

By Mark Pazniokas | Connecticut Mirror | July 10, 2017

A new Connecticut law will outlaw “gag clauses” in pharmacy benefit-manager contracts that now bar pharmacists from telling consumers when they could save money by paying out of pocket for generic drugs that can cost less than the co-pay for a covered brand-name drug, according to the Connecticut Mirror. The bill also would require insurers to give better notice to consumers regarding the cost of using out-of-network labs.

Hawaii

Hawaiians Say ‘Aloha’ to Home Care Services Funding

By Amy Baxter | Home Health Care News | July 10, 2017

A new law in Hawaii will provide funding to help families pay for the care of elderly loved ones, reports Home Health Care News. The law, which is deemed the first of its kind, aims to give financial relief to family caregivers and provide a boost for families to pay for professional in-home care services. The funding helps bridge a gap in care services for seniors living at home, but who are not qualified for Medicaid home care services or Medicare home healthcare services. Eligible families can use the money for a variety of caregiving needs, such as transportation services, personal care, respite and homemaker services.

How Western Kentucky Leveraged Medicaid Expansion to Increase Access to Healthcare

By Sarah Klein | Commonwealth Fund | July 21, 2017

Rural Western Kentucky is one of only a handful of U.S. regions to improve on a majority of measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance. The most striking gains were tied to the state’s Medicaid expansion, which added nearly 500,000 low-income adults to the program, according to a report by the Commonwealth Fund. The coverage expansion helped recruit federally qualified health centers to the region. In addition, hospitals and other providers enhanced access through school-based clinics, offering urgent and behavioral health services.

Maryland

Drug Firms Challenge Maryland Price-Gouging Law

By Erin Cox | Baltimore Sun | July 6, 2017

Drug companies asked a federal judge to throw out Maryland's new prescription drug price gouging law, saying the state's first-in-the-nation measure is both unconstitutional and vague. The law, which takes effect in October, allows the state’s Attorney General to prosecute some manufacturers that impose "unconscionable" price hikes, according to the Baltimore Sun. Passed by the General Assembly with near unanimous support earlier this year, the law only governs off-patent and generic drugs, not branded medications protected by patent laws.

Massachusetts

Massachusetts Care Still Expensive; Health Costs 2nd Highest in U.S.

By Brian Dowling | Boston Herald | July 6, 2017

Massachusetts has dropped behind Alaska when it comes to most expensive healthcare spending by state, according to the Boston Herald. Although average hospital spending and average physician spending in Massachusetts were higher than the U.S. average, growth rates were down sharply for both measures since 2009. The state lowered its spending relative to the national average for hospitals, physicians and nursing care, but saw increases in drug spending and a spike in home health spending.

State Budget Includes New Fees on Businesses to Help the State Pay for Healthcare Costs

By Priyanka Dayal McClaskey| Boston Globe | July 7, 2017

State lawmakers approved an annual budget that imposes new fees on businesses to help pay the state’s rising healthcare costs, despite rejecting a set of controversial proposals from the Governor’s office to rein in those costs, reports the Boston Globe. Advocates for the poor applauded the legislature’s decision to leave out policy changes they said would have hurt families who rely on public health coverage. But employers argued it was unfair of lawmakers to ask them to pay more without also taking steps to attack the underlying costs of the state Medicaid program. 

Michigan

Expanded Telemedicine Services Help Patients Save Money

By Jay Greene | Crain’s Detroit Business | July 9, 2017

Health plans and hospitals are expanding telemedicine services in new ways to help patients research prices and gain access to medical specialists, according to Crain’s Detroit Business. Most hospitals and health insurers in Michigan have developed telemedicine programs to create convenience and lower out-of-pocket costs for patients. They have typically started with primary care visits for such ailments as ear infections and sore throats.

Missouri

Anthem Asks Missourians to Think Twice Before Going to the ER

By Durrie Bouscaren | KRCU | July 10, 2017

Anthem Blue Cross Blue Shield, one of Missouri’s largest insurers, no longer covers emergency department visits that it deems unnecessary, reports KRCU Southeast Missouri Public Radio. The policy aims to save costs and direct patients to primary care physicians and urgent care clinics for non-emergent medical conditions. But doctors warn that patients may not seek emergency treatment when they need it if they fear being stuck with a large bill.

Ohio

How the Cleveland Clinic Grows Healthier While its Neighbors Stay Sick

By Dan Diamond | Politico | July 17, 2017

There’s an uneasy relationship between the Cleveland Clinic—the second-biggest employer in Ohio and one of the greatest hospitals in the world—and the community around it. According to Politico, the Clinic’s status as a nonprofit ensures it doesn’t have to pay tens of millions of dollars in taxes, but it is supposed to fulfill a loosely defined commitment to reinvest in its community. However, the surrounding community is poor, unhealthy and—in the words of one national neighborhood-ranking website—“barely livable.”

Price Transparency in Medicine Faces Stiff Opposition—From Hospitals and Doctors

By Rachel Bluth | Kaiser Health News | July 25, 2017

Ohio’s Healthcare Price Transparency Law did not go into effect as scheduled and faces stiff opposition from providers, according to Kaiser Health News. The law requires providers to give patients an estimate of what non-emergency services would cost before they commence treatment. Patient advocates say such transparency would be helpful for patients, allowing them to shop around for some services to hold down out-of-pocket costs, as well as prepare their household budgets for upcoming health-related spending in a time of high-deductible plans.

For more state news, please visit www.healthcarevaluehub.org/state-news/

Recent Reports

Engaging Consumers in the Quality Measurement Enterprise

By Thomas W. Concannon, et al. | RAND Corporation | 2017

This RAND Corporation report addresses concerns about making quality measurement more consumer-centered. Intended for consumer advocates and decision makers in quality measurement, the report explores the experience of consumer advocates in engaging with quality measurement, identifies barriers to effective consumer engagement and suggests ways to address those barriers.

Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Healthcare

By Eric C. Schneider, et al. |The Commonwealth Fund | July 2017

Compared to ten other high-income countries, the U.S. spends far more on healthcare and gets poorer outcomes, according to a study conducted by the Commonwealth Fund. The U.S. ranked last, or nearly last, in four out of five performance indicators—access, administrative efficiency, equity and healthcare outcomes. The top-ranked healthcare models include the United Kingdom’s National Health Service, Australia’s Single-Payer Insurance Program and the Netherlands’ Competing Private Insurers. All of these other models provide universal coverage and access, but do so in different ways.

Challenges of Measuring Quality of Community-Based Programs for Seriously Ill Individuals

By Joan Teno, Rebecca Anhang Price and Lena Makaroun | Health Affairs | July 2017

Community-based programs for people with serious illnesses are increasing in number. During this time of rapid growth, it is important to develop quality measures that can be practically implemented to promote transparency and accountability for this vulnerable population, according to a study published in Health Affairs This article outlines the challenges in measuring quality of care for seriously ill patients, offers potential solutions and calls for new research to produce quality measures that ensure accountability for the care provided to individuals and their families.

High-Cost Dual Eligibles’ Service Use Demonstrates the Need for Supportive and Palliative Models of Care

By Julie Bynum, et al. | Health Affairs | July 2017

High combined Medicare and Medicaid spending are found in two distinct groups of high-cost dual eligibles: older beneficiaries who are nearing the end of life, and younger beneficiaries with sustained need for functional supports, reports a study published in Health Affairs. Tailored approaches to each population’s distinct needs could increase the value of services provided to patients and their families, with the potential to lower costs if patients’ needs can be met with fewer stays in short-term inpatient facilities.

Qualities that Matter: Public Perceptions of Quality Reporting

By David Schleifer, et al. | Public Agenda | July 2017

There is considerable progress to be made in measuring and reporting on quality in ways that reflect what consumers need and want. To address gaps in understanding how consumers view high-quality care, provider variation on specific measures of quality, and how consumers learn about the qualities of doctors and hospitals that are important to them, Public Agenda conducted research exploring perspectives among people who have experienced type 2 diabetes care, joint replacement surgery and maternity care.

Medicare Advantage Associated with More Racial Disparity than Traditional Medicare for Hospital Readmissions

By Yue Li, et al. | Health Affairs | July 2017

A study of racial disparities in thirty-day readmissions between traditional Medicare and Medicare Advantage beneficiaries found that black traditional Medicare patients were 33 percent more likely than white patients to be readmitted, whereas black Medicare Advantage patients were 64 percent more likely than white patients to be readmitted, according to a this Health Affairs study. The findings suggest that the risk-reduction strategies adopted by Medicare Advantage plans have not been successful in lowering the markedly higher rate of readmission among black patients compared to white patients.

Getting to the Root of High Prescription Drug Prices

By Henry Waxman, et al. | Commonwealth Fund | July 10, 2017

Historic increases in prescription drug prices and spending are contributing to unsustainable healthcare costs in the United States, according to this Commonwealth Fund report. There is an increasing outcry of public support for Congress to solve this issue. This report documents the drivers of high U.S. prescription drug prices and offers a broad range of feasible policy actions, such as rebalancing incentives for price competition, prioritizing patient access and maximizing the availability of prescription cost information in clinical settings. 

State Approaches to Reducing Health Disparities

By Kate Blackman | National Conference of State Legislatures | June 2017

State legislators have pursued various policy approaches to reduce health disparities in their communities and states. Through legislative tracking, the NCSL has identified multiple strategies being pursued by states, including increasing workforce diversity, improving cultural competence in healthcare services and addressing the social determinants of health.

The Push for Clinicians to Talk More About Health Costs

By Steven Ross Johnson | Modern Healthcare | June 2, 2017

When a patient's information is entered into Cedars-Sinai Medical Center's electronic health records system, an alert pops up if a planned procedure or test is listed as unnecessary based on current evidence. These alerts have saved the hospital system $6 million in avoided healthcare costs in the first year of implementation, according to Modern Healthcare.

For more information on programs for complex patients, prescription drug prices and more, please visit www.healthcarevaluehub.org/

Commentary/News

Healthcare Value Hub Moves to Altarum

By Clark Kent | The Daily Planet | July 5, 2017

The Healthcare Value Hub has moved from Consumer Reports to Altarum, according to a source close to the negotiation. The Hub's consumer focus and work will remain the same, and people will be watching the situation closely for future Hub-Altarum collaborations.

Which Metrics on Hospital Quality Should Patients Pay Attention To?

By Austin Frakt | New York Times | July 24, 2017

A recent study by health economists at M.I.T. and Vanderbilt found that hospitals that score better on certain metrics, such as patient satisfaction scores, also have lower mortality rates. According to the New York Times, the study found that a hospital with a satisfaction score that is 10 percentage points higher has a mortality rate that is 2.8 percentage points lower and a 30-day readmission rate that is 1.9 percentage points lower.

How Are Health Systems Addressing the Social Determinants of Health?

By Josh Lee and Casey Korba | Deloitte Center for Health Solutions | July 20, 2017

The trend toward value-based care is providing an opportunity for hospitals to better align their clinical care with health-related social needs, according to a report from the Deloitte Center for Health Solutions. Environmental and social factors that impact health—including the environments in which people are born, grow, live, work and age—determine 80 percent of health outcomes, yet they are often poorly understood or integrated into treatment protocol.

Prices and Consumer Shopping

By Rachel Dolan | Health Affairs | July 19, 2017

While the path forward for health reform is now somewhat unclear, the trend of higher consumer cost sharing will likely continue. Higher deductibles and cost sharing are often touted as ways for individuals to have “skin in the game” in healthcare costs and to help consumers be better shoppers. This Health Affairs blog post synthesizes the research on shopping for healthcare services, shedding light on whether it is possible, if saves money and if consumers even want to do it.

Democrats' 'Better Deal' Would Address Drug Price Hikes

By Sarah Karlin-Smith | Politico | July 24, 2017

Congressional Democrats laid out a three-pronged approach to lower the cost of prescription drugs in the United States that aims to stop large price increases and give the federal government more power to influence what Medicare pays for medicines. According to Politico, the announcement comes as polls have increasingly found that drug pricing—not Obamacare—is the top health policy concern of both Democratic and Republican voters, and as expectations dimmed that the Trump administration would follow through on its plans to lower drug pricing by calling for government negotiations or importation of medicines from overseas.

 ‘Protect Medicare Now’ Campaign Attempts to Squash Control of Healthcare Spending

By Trudy Lieberman | HealthNewsReview | July 25, 2017

The Independent Payment Advisory Board (IPAB), is a little-known provision of the ACA that offers a pathway for Medicare to control its costs. According to HealthNewsReview, the law allows for a one-time fast track consideration of a joint resolution to dissolve the IPAB that requires action before Aug. 15, 2017. As a result, the Healthcare Leadership Council, an influential coalition of chief executives representing various healthcare interests, has swung into action with a $2 million ad campaign to repeal the IPAB.