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The demise of Haywood Park Community Hospital in Brownsville nearly three years ago added to an epidemic of dying hospitals across rural America, according to the Washington Post. Nearly 80 have closed since 2010, including nine in Tennessee, more than in any state but Texas. Many more are considered fragile — downstream victims of federal health policies, shifts in medical practice and the limited tolerance of distant corporate owners for empty beds and financial losses.
A Georgia-based organization, Patients for Fair Compensation, is attempting to dismantle and replace Tennessee’s medical-liability system, according to The Tennessean. The Tennessee Medical Association claims Tennessee has one of the most favorable climates for medical liability in the country, which keeps the state competitive in retaining the best physicians. Further, that the civil legal system, hospital quality improvement committees, health plan utilization and medical necessity reviews, state and federal pilot initiatives, and the state licensing boards keep physicians accountable for legitimate injuries and quality of care. Tort reforms enacted since 2008 resulted in a 40 percent drop in volume of medical-liability claims filed against physicians and a 37 percent drop in physicians’ insurance premiums.
Hawaii's prisons are grappling with rising healthcare costs brought on by an aging population of inmates, according to U.S. News & World Report. The state Department of Public Safety says age-related medical costs and a growing inmate population are driving up its $24 million healthcare budget for correctional facilities.
Gov. Bruce Rauner announced plans to revamp the state’s Medicaid program, saying the changes could save money and improve health, according to the Chicago Tribune. The plan would expand Medicare managed care programs to 80 percent of Illinois residents on Medicaid and cut the number of insurers from 12 to 7. The plan also calls for more focus on coordinating care for patients and paying doctors and hospitals based on results rather than just for services.
A staggering number of Texas patients who go to in-network emergency departments still get hit with out-of-network fees, according to WFAA. A study by the Center for Public Policy Priorities found 40 in-network hospital emergency departments (EDs) where patients with Blue Cross Blue Shield, Humana or UnitedHealthcare are almost guaranteed to get a surprise medical bill, since 95 percent of their doctors are out of network. The report also identified 23 in-network hospital EDs at which surprise billing rarely happens.
The annual Kentucky Health Issues Poll revealed the cost of healthcare continues to prevent a significant number of Kentucky adults from obtaining needed medical care, as reported in the Lane Report. The poll found that 22 percent of adults in the state reported that a person in their household delayed or missed needed care due to cost. The rate has been essentially unchanged for the past three years.
The rate at which Illinois hospitals are abstaining from managed Medicaid plan networks is being referred to as a “crisis,” according to Modern Healthcare. In 2011, the state passed a law requiring 50 percent of the state’s Medicaid population to enroll in a managed care plan by 2015. Some hospitals, however, are hesitant to be in these networks, citing unresolved issues related to issues in medical management, claim payments and credentialing of physicians.
Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.
Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.
Saint Luke’s Health System and UnitedHealthcare have launched an accountable care program to reduce healthcare costs and improve quality, according to Kansas City Business Journal. The program helps providers identify high-risk patients and increase care coordination efforts, including sharing patient records. As an incentive, if providers reduce the cost of a patient’s care and meet health outcome expectations, they split the savings with the Centers for Medicare and Medicaid Services.
A new task force, the Task Force on Responsible Retirement Reform for Local Government, has been created to address problems with pension and healthcare costs in Michigan, according to MI News. Recommendations from the task force are expected to be submitted to the Gov. Snyder in Spring of 2017. Members include subject matter experts who represent labor and management, investment managers, insurance and finance professionals and legislators.
For the second year in a row the debate over how best to address so-called ‘surprise medical bills’ has led to the introduction of legislation to prevent them, according to the Atlanta Journal-Constitution. While hospitals and physician groups remain broadly opposed to the measures, pressure from constituents has led multiple state representatives to press the issue in the legislature’s current session.
This report sets forth options and potential design features that will serve as a guide for the Department to execute a capitated program for dual-eligible beneficiaries in North Carolina, as required by the Medicaid reform bill passed in 2015, according to North Carolina's Department of Health and Human Services. The report also provides summaries on managed care programs in other states.
Wary that existing and future federal regulations won’t do enough to make healthcare affordable, a proposal by the Massachusetts governor would cap the prices many hospitals, doctors and labs are paid for the next three years, according to WBUR. Providers would be divided into three categories based on price, with lower-priced hospitals eligible for rate increases and highest-price providers ineligible for increases.
Utah has an initiative focusing on the behavioral health needs of the justice-involved population that aims to prevent individuals from cycling in and out of incarceration, according to NASHP. In 2014, Utah created the Utah Commission on Criminal and Juvenile Justice (CCJJ) to conduct a review of the state’s correctional system. It found that the state’s incarceration rate was quickly increasing. In response, Utah revised drug court eligibility to be based on risk and need and passed legislation to revise sentencing guidelines for minor drug offenses and establish treatment standards for individuals required by the judicial system to participate in behavioral health services. Utah’s experiences were discussed at NASHP’s Annual Conference.
A new analysis by Consumers Union found that California is failing to hold hospitals accountable for improving care when they report high patient infection rates. Consumers Union noted that inspectors are unable to take timely action to protect patients because the California Department of Public Health fails to share the infection data it collects from hospitals with inspectors until long after it is reported.
A push to license a new type of dental provider has stalled at the Arizona legislature, according to AZCentral. Dental therapists would operate under the supervision of licensed dentists and perform minor dental procedures. Proponents say dental therapists could provide basic dental services at lower cost and help ease the state’s dentist shortage, especially in rural and tribal communities. These “midlevel providers” are already allowed in Minnesota, Maine and Vermont and practice in tribal areas in Alaska, Oregon and Washington.
California Gov. Jerry Brown’s latest fiscal budget proposes ending a program that coordinates care for people dually eligible for both Medicaid and Medicare. The proposed budget did not include funding for its Coordinated Care Initiative (CCI) after the program failed to show evidence of saving money, according to Modern Healthcare. However, Brown said he’d like to preserve elements of the effort, including asking payers to continue to oversee benefits for dual-eligibles. Brown also hopes to continue the MLTSS program because it kept people in their homes instead of hospitals or nursing homes. In order to continue those services, new legislation would have to be drafted.
Gov. Jay Inslee and the Washington State Health Care Authority announced an agreement that ensures the state can continue transforming the Medicaid program to achieve better health, reward high-quality care and curb healthcare costs, according to the Seattle Medium. Officials said the five-year Washington State Medicaid Transformation Project provides up to $1.1 billion of incentives to reward high-quality care. It takes a patient-centered, holistic approach to care and creates partnerships with communities to address social determinants of health. The project also provides $375 million to support critical services for Medicaid clients.
New data from the New Hampshire insurance department show that prescription drug costs are rising faster than most other categories of health spending in the state, according to New Hampshire Public Radio. Pharmacies collected one in five dollars spent on healthcare in New Hampshire last year. Still, the report noted that despite their increasing price tags, high-cost drugs comprise less than 1 percent of all prescriptions for people with employer-based insurance and other group plans.
UW Health and the Marshfield Clinic Health System withdrew their membership in AboutHealth on Dec. 31, 2016, according to the La Crosse Tribune. AboutHealth was founded two-and-a-half years ago in a quest to improve healthcare and rein in costs. The alliance of Wisconsin provider groups will continue to exist with six members - Gundersen, Aspirus, Aurora Health Care, Bellin Health, ThedaCare and ProHealth Care.
Ninety-six California hospitals were cited for high rates of patient injuries and inflections, including the spread of antibiotic-resistant germs, according to The Mercury News. The penalties come as CMS begins to require that hospitals establish antibiotics protocols as a condition of receiving Medicare funding. The Hospital-Acquired Condition Reduction Program, run by HHS, tracks the rates of infections from common procedures, including hysterectomies, colon surgeries, urinary tract catheters and central line tubes and the frequency of bed sores, hip fractures, blood clots and other complications.
Cornerstone Healthcare is an example of Accountable Care (ACO) models struggling to standalone financially, according to the New York Times. The ACO experiment began as an idea to make doctors more mindful of costs and shift toward more value-based care, but many ACOs require a large upfront financial capital. Cornerstone has been acquired by Wake Forest Baptist, and it remains to be seen if the model will survive after this acquisition.
A new report from the Commonwealth Fund ranked Vermont best in the nation for healthcare access and affordability, according to Vermont Business Magazine. The state has the smallest disparity in access among income levels and is the only state in which less than ten percent of low-income individuals have delayed care due to cost in the past year.
Healthcare advocates will continue to push a bill restricting the practice of so-called ‘surprise’ medical bills in 2017, according to the Press of Atlantic City. The legislation will likely get a hearing in January as stakeholders attempt to finalize how the bill would restrict the practice. Current draft legislation ties out-of-network reimbursements to Medicare rates.
A study conducted by the University of Kentucky found that a community awareness program increased use of low-dose CT scans and prompted individuals to consider tobacco cessation, according to Kentucky Health News. A low-dose CT scan is able to detect early signs of lung cancer and is recommended for people aged 55 to 77 who are at high risk such as current smokers. Kentucky has the highest smoking rate in the country.
Indiana’s Medicaid Healthy Indiana Plan (HIP) may become a model for other state Medicaid reform efforts, according to The Atlantic. The program includes two levels of coverage.HIP Basic is available to all Hoosiers with incomes below poverty, but excludes dental and vision coverage and includes steep copays, which can saddle low-income families with high costs.HIP Plus coverage -- available to people below 138 percent of poverty -- requires enrollees to make monthly premium payments amounting to 2 percent of the beneficiary’s income. Failure to pay the monthly premium results in the removal of HIP Plus coverage and prevents the beneficiary from re-applying for six months. Seema Verma -- HIP’s primary architect -- has been appointed head of the Centers for Medicare and Medicaid Services (CMS) by President-Elect Trump.
Some hospitals are 1.5 to 2.7 times more expensive than the lowest-priced hospitals within the same region of New York State, according to Modern Healthcare. The study, funded by the NYS Health Foundation, also found that a hospital’s market leverage—its bargaining power when negotiating with insurers—is a key factor in the prices a hospital can command. Hospitals with high prices do not necessarily have higher quality scores and those with lower prices do not necessarily have lower quality score.
A federal law requiring the U.S. Health and Human Services Department (HHS) to consider integrating and expanding the use of video conferencing for rural populations to access medical care was originally developed in New Mexico, according to the Silver City Sun-News.
Bills for commercial insurers in southeast Wisconsin increased at half the rate as the national average, according to Milwaukee Business Journal. It has been suggested that lower increases can be attributed to the competitive market of six healthcare systems at the time of the study.
The Colorado Health Foundation released a report that focuses on rural communities and highlights barriers Coloradans face in their pursuit of health, including poverty, unhealthy food options, and lack of access to healthcare. The report discusses possible solutions emerging from rural communities to overcome these health challenges.
A Minnesota nonprofit issued a report identifying the highest-cost health clinics in the state in an effort to help consumers, according to the Star Tribune. Minnesota Community Measurement used claims data from the state’s largest health plans to find clinics with the highest prices and highest utilization rates. The report found that overall the total cost of care increased 5.6 percent overall from 2014 to 2015, while the total cost of pharmacy spending increased 9.3 percent.
More than 500 community members, legislators, members of the business community, and representatives from fields including public health, healthcare, law enforcement, education, and academia gathered today at the Rhode Island Department of Health (RIDOH) 2016 Health Equity Summit to discuss the steps necessary to build healthier communities and a healthier Rhode Island. The theme of the 2016 Summit was Health Equity in Action: Justice and Health for All. The event's 10 breakout sessions focused on, among other issues, health systems transformation, housing, community-police partnerships, food systems, behavioral health, climate change, and education.
The policy ideas promoted by republican leaders thus far are unlikely to result in stable, affordable, high-quality coverage choices, according to this op-ed in The Agenda. A requirement to purchase insurance is critical to maintaining a stable market. As Rhode Island’s health commissioner, Christopher Koller found that state-mandated benefits were not a major driver in healthcare costs, comprising of only 10 percent of premiums costs. The success in reaching relatively low premium rate hikes required extensive rate reviews and regulation by the state.
The Iowa Department of Health and Welfare released goals for the third year of its Statewide Healthcare Innovation Plan (SHIP), including expanding the patient-centered medical home (PCMH) model to new primary care clinics and implementing virtual PCMHs, integrating the statewide health information technology (HIT) plan with the SHIP HIT plan, operationalizing data reporting, expanding analysis on progress moving toward paying for value over volume and reducing overall healthcare costs. An analysis conducted in the second year of the SHIP estimates that over the three year testing period of the model, Idaho will save $89.56 million.
A recent poll found that twenty percent of adult Ohioans reported they or a family member put off medical care due to cost in the previous year, according to Columbus Business First. Affordability varied by income and education level, with individuals without a college degree and earning just above the eligibility level for Medicaid struggling the most to pay for needed care.
Rhode Island has received a five-year federal grant to further transform the state’s Medicaid program prioritizing quality over quantity, according to Rhode Island Public Radio. The money will go to promoting care coordination, expanding the use of electronic medical records, hiring additional staff and providing better training to the future workforce. The existing initiative is estimated to have already saved the state $100 million.
Massachusetts will launch a new public-private partnership that will advise Governor Baker’s Administration on how it can use technology to improve healthcare quality and reduce costs across Massachusetts, according to HealthcareITNews.
In June 2016, the state Legislature passed a statute creating a reinsurance fund to offset health insurance premiums for Alaskans, according to the Health Affairs Blog. Funding will be generated from a tax on insurers. According to JDSupra Business Advisor, the reinsurance program decreased the 2017 rate increases from more than 40 percent to just 8 percent.
New Jersey hospitals are pushing back against efforts to pass legislation capping the amount that they can charge for involuntary out-of-network services, according to Modern Healthcare. A study commissioned by for-profit hospital operator CarePoint Health estimated that the law would lead to operating losses at 48 percent to 70 percent of hospitals, depending on how high the cap was set. “Hospitals live off the margins from these out-of-network payments,” said the lead author of the study. But other analyses have found that New Jersey has some of the highest hospital rates in the nation. Several states, including California, Connecticut, Florida and New York, have passed legislation to protect patients from surprise bills and require health plans and hospitals to set up an arbitration process to work out any billing issues.
Primary care physicians have been participating in Blue Cross Blue Shield of Georgia’s value-based, patient-centered program for three years and have delivered significant successes, according to SavannahNow. BCBS of Georgia’s data identified a 2 percent higher rate of care for diabetic patients, a 3.5-percent better rate of cervical and breast cancer screenings, and a 4.5-percent increase in patients taking their cholesterol, blood pressure and diabetes medications as prescribed.
At-risk patients may experience better health outcomes and fewer emergency department visits when supported by a mobile healthcare team, according to Modern Healthcare. A preliminary study of such a program in Florida found a 19 percent decrease in monthly emergency room costs per patient. A similar program called Community Paramedics launched in California with a focus on patients requiring mental health services and is expecting to evaluate the success early next year, according to California Healthline.
The Texas Health and Human Services Commission is being sued after providing drug pricing data to two Texas Senate committee heads, according to Modern Healthcare. The Texas Attorney General claims the disclosure was required under Texas law, yet Pfizer insists the action violated federal law.
The State of Washington is using its size to improve the quality and affordability of healthcare that their employees and dependents receive, according to Harvard Business Review. Washington’s Health Care Authority (HCA) is applying supply-chain tools to purchase high-quality surgical “bundles” defined by Washington’s multi-stakeholder collaborative. A bundle is a package of care, offered at a single price, that covers the total cost of treating a specific condition.
The second-largest investor-owned hospital company, CHS, is selling two of its 158 hospitals to MultiCare Health System, according to Modern Healthcare. The move comes after 38 small and rural hospitals were spun off to create an independent company, Quorum Health Corp in April.
Iris Plans, an innovator in Advance Care Planning (ACP) for people with serious medical conditions, has partnered with the University of Utah Health Plans to improve the quality of care and member experience while lowering cost, according to EconoTimes. Iris Plans connects healthcare professionals to people with serious medical conditions, along with their families, to provide disease education, resolve conflicts, and help people document which future healthcare decisions are best aligned with their goals and preferences. These documents are then sent to their doctors’ offices to ensure they receive the care they need.
Consumers shopping on the exchange for health insurance will face a myriad of challenges this year, according to the National Federation of Independent Business. Choice of providers has decreased from nine last year to five. Further, insurers have dramatically increased rates, the most staggering is Humana’s 67.5 percent rate hike.
For the first time in a decade, the share of Arizona residents in high-deductible health plans has not increased, according to AZCentral. A survey of 130,000 employees found 43 percent of workers enrolled in high-deductible plans, down from 45 percent the year prior. Analysts question whether Arizona workers have reached a limit on the affordability of plans that require substantial cost sharing.
Hepatitis C is the most expensive condition treated in Medicaid, due to blockbuster drug prices, according to the Albuquerque Journal. New Mexico’s total spending for prescription drugs has risen by 54 percent in two years, with Hepatitis C drugs accounting for nearly two-thirds of the 2016 pharmaceutical drug expenses. Last year the New Mexico Department of Human Services developed a hepatitis C action plan with the goal of treating all Medicaid patients with hepatitis C within a decade while being financially responsible.
One out of six Massachusetts hospitals received poor grades on safety measures in ratings released from the Leapfrog Group, according to BizJournals. Medical harm transparency is important for patients to know how well hospitals protect them from injuries and infections.
Illinois has received a million dollar grant meant to strengthen the state’s mental health coverage, according to NBC Chicago. The money will go to improving the state's data tracking and consumer analysis and supporting education and awareness for consumers on how to navigate mental health insurance coverage.
A coalition of pharmacy societies has released a new framework for mapping medication therapy management services to the SNOMED CT codes used for EHR documentation, interoperability efforts, and quality reporting. Unlike ICD-10, which is primarily geared toward recording diagnoses and procedures, SNOMED CT attempts to capture a more holistic view of the patient and his or her experiences, including socioeconomic data, medication use, lifestyle behaviors and family history.
Starling Physicians will partner with Aetna to participate in an oncology medical home model designed to improve patient experience by enhancing delivery of quality and value in cancer care. The model will be centered around the whole person, with evidence-based, integrated and personalized medical care, with a focus on quality and safety; and enhanced access to care.
The new plan, proposed by Governor Mark Dayton, would reduce health insurance premiums by 25 percent for Minnesotans who don’t qualify for subsidies, according to CBS Minnesota. The plan is being introduced after plans were approved for rate increases of 55 percent for 2017.
Vermont’s Green Mountain Care Board approved an all-payer waiver, according to the Burlington Free Press. Under an all-payer model, providers are paid set amounts for care, rather than being paid per test, service or procedure.Proponents believe the initiative will more effectively manage chronic diseases and save VT $10 billion over the next 10 years.
The Medicaid program is seeking federal authority to charge co-payments to enrollees, except for pregnant women and children, according to Las Cruces Sun-News. New Mexico has one of the highest Medicaid enrollment rates in the country. The Secretary of the Human Services Department suggested these fees could help maintain Medicaid spending by steering patients away from wasteful spending.
California’s Office of the Patient Advocate released its annual report cards on health plans and medical groups. The report cards assign ratings to the largest HMOs and PPOs in the state, as well as over 200 physician groups, based on quality of care and patient experience.
A new report released by the NEHI concluded that hospitals across the Greater Boston Area are performing Community Health Needs Assessments independently. The report further suggested that a greater impact would be made if the hospitals could join efforts and work collaboratively. The hospitals agreed on the greatest health issues but lacked clarity on how to address these issues.
A Rural Hospital Stabilization Grant from the state of Georgia has funded a Mobile Integrated Healthcare Program at Crisp Regional Hospital that has reduced readmissions within 30 days of discharge from 35 to just 4, according to WALB News 10. The results stem from targeting “frequent flyers” -- people who frequently call 911 for non-emergencies -- and by providing unsolicited EMT visits to ensure these patients are taking care of themselves, such as taking their medication properly. The grant is set to expire in December 2016, but the hospital plans to continue the program.
In a study released earlier this year, researchers looked at charges at 20 Florida hospitals during the three months before the negative publicity and again during the same three month period the following year. There was no evidence that negative publicity resulted in any reduction in charges. Instead, the charges were significantly higher following the publicity. In addition, the 20 hospitals studied were less likely than other Florida hospitals to achieve three or more stars in the quality metrics system used by CMS.
The Montana Healthcare Foundation has announced a new statewide initiative aimed at improving the coordination of medical, mental health and substance abuse services. The organization plans to distribute grants totaling more than three million dollars in order to make “integrated behavioral health” services widely available in the state.
The Kansas Healthcare Collaborative—a coalition of providers founded by the Kansas Hospital Association—will continue to lead statewide hospital patient safety improvement efforts. The partnership between the Health Research & Educational Trust and 31 state hospital associations is geared toward reducing patient harm and readmissions.
The FTC recommended Tennessee regulators reject the proposed merger of two large regional health systems currently operating in several states including Tennessee, according to Modern Healthcare. FTC official Mark Seidman said the deal would cause an anticompetitive healthcare climate in the state, leading to higher prices and lower quality of care for patients, although the health systems claim the opposite.
Yavapai Regional Medical Center is paying the federal government $5.9 million to settle a whistleblower claim that the hospital system inflated Medicare payments, according to AZCentral. The U.S. attorney for Arizona said the payments were inflated as a result of the hospital reporting inflated average hourly wages it paid employees from 2006 to 2009.
The Federal Trade Commission (FTC) recommended Virginia regulators reject the proposed merger of two large regional health systems. according to Modern Healthcare. FTC official Mark Seidman said the deal would cause an anticompetitive healthcare climate in the state, leading to higher prices and lower quality of care for patients.
The state of Washington will partner with CMS on a five-year Medicaid demonstration waiver to continue implementing the Healthier Washington plan through regional Accountable Communities of Health. The project is part of Washington’s effort to focus on prevention and proactive management of physical and mental health issues and control costs. The waiver will provide $1.1 billion in funding for these reform strategies and $375 million for services, including supportive housing and supported employment services for Medicaid enrollees.
Missouri’ Foundation for Health’s pilot program Show Me Healthy Housing continues to expand in size and scope. The program gave its first program-related investment of $1.5 million to Corporation for Supportive Housing (CSH). The Show Me Healthy Housing program offers permanent, affordable supportive housing for people with disabilities, serious health conditions, and histories of homelessness. The philosophy of supportive housing showed great promise in reducing Medicaid costs and improving health outcomes.
Maryland is halfway through the five-year pilot program from CMS to control rising healthcare costs, according to The Baltimore Sun. The initiative shifted hospitals’ payment incentives from quantity to quality by ensuring the patient's health. Maryland has until the end of the year to submit a plan on how the state will expand this program.
As of Oct. 1, 2016, a new policy may put thousands of children at risk for missing vaccines, according to Crain’s Chicago Business. The Illinois Department of Public Health told doctors that the Children’s Health Insurance Plan (CHIP) would no longer cover the vaccines for low-income families for free. Doctors will have to privately order the vaccines and wait to be reimbursed by the state.
Vermont has received preliminary approval from the federal government for its plan to establish an all-payer reimbursement system for healthcare providers, according to Modern Healthcare. The system is modeled on Accountable Care Organizations and would replace traditional fee-for-service reimbursement with payments based on global rates that apply to Medicare, Medicaid, and private insurers.
Iowa’s largest carrier in the individual market—Wellmark Blue Cross and Blue Shield—is entering the state exchange for the first time, according to Healthinsurance.org. However, United plans will no longer be available on the state exchange, which could be a blow to consumers since United provided one of the lowest-cost silver plans in the exchange. The Iowa Insurance Division has approved rate increases for the four carriers offering exchange plans in 2017 ranging from 19 percent (Medica) to 42.6 percent (Wellmark).
The High Value Healthcare Collaborative —a provider network focused on improving healthcare value through data and collaboration—won an award from the Center for Medicare and Medicaid Innovation to investigate best practice care models on how to engage patients in shared decision making. The program fell short on achieving the outlined goals on producing savings on healthcare costs and emergency department and inpatient hospital admissions.
The High Value Healthcare Collaborative —a provider network focused on improving healthcare value through data and collaboration—won an award from the Center for Medicare and Medicaid Innovation to implement a sepsis bundled payment in 23 facilities as a part of the two-year improvement project. The overall goal was to improve inpatient acute care bundle adherence for severe sepsis and/or septic shock by 5% over three years to achieve a $12.4M cost savings to Medicare (prorated to $9.9M to exclude partial year in 2015). By 2014 the project reduced costs by 7.7 percent and sub-acute nursing care by 7 percent.
A new California law requires the state Department of Public Health to break down demographic data it collects by ethnicity or ancestry for Native Hawaiian, Asian, and Pacific-Islander groups reports NBC. The bill will better expose disparities in healthcare and will enable researchers, policymakers and advocates to better identify, track and address health disparities that affect specific ethnic groups.
New legislation will provide Californians strong consumer protections against getting unexpected out-of-network medical bills, according to the San Francisco Chronicle. Unlike New York’s law, California’s law require insurers to reimburse these out-of-network providers at 125 percent of the rate Medicare pays, or at the insurer’s average contracted rate, whichever is greater.The bill goes into effect July 2017 and included seven other healthcare consumer protection measures.
The latest legislative effort to protect consumers from surprise out-of-network charges remains slow to make progress following stakeholder meetings held in August, according to NJ Spotlight. The bill, SB1285, would ensure that patients are given accurate information about what is and is not covered by their insurance. Despite strong support from patient advocates, insurers have voiced concerns about the bill and the binding arbitration process that it contains for resolving disputes.
The Federal Transit Administration awarded more than $180,000 to fund the Bridge to Integration Project, which aims to improve healthcare access and outcomes and lower healthcare costs for the most at-risk populations. The program plans to implement a coordination software system to allow more efficient and effective coordination of transportation resources.
As part of the Rides to Wellness Demonstration and Innovative Coordinated Access and Mobility Grants, the Iowa Department of Transportation received $130,560 for the Delaware County Connections Program, a rural transit service that will improve healthcare access for people with low incomes, older adults and individuals with intellectual challenges. The project focuses on rides to wellness activities at senior centers, farmers markets and support groups and aims to increase access to care, improve health outcomes and reduce healthcare costs.
Premiums for individual health plans offered by Blue Cross under the Affordable Care Act will rise by an average 58.4 percent in 2017, according to the Independent Record. Auditor and Insurance Commissioner Monica Lindeen has called the increase “unreasonable” but lacks the authority to reject the proposed rate increase.
Governor Steve Bullock has announced a new coordinated healthcare payment system in partnership with the Centers for Medicare and Medicaid Services that will begin on Jan. 1, 2017. Providers who agree to participate in the five-year pilot program, known as Comprehensive Primary Care Plus, will be paid based on health outcomes rather than for every service they provide.
General Dynamics Health Solutions developed a data analytics application to measure each healthcare provider’s success reports ComputerWorld. The application constructs the risk-adjusted cost curve for each provider and also collects eligibility and enrollment status, provider demographics, tax files, and client data from multiple sources. Then, the application identifies incidents of care from claims data and calculates quality scores based on claims and clinical data. In addition, providers receive report cards showing high cost areas by facility. The program has helped save $720 million in Medicaid costs since 2012.
The US Department of Transportation awarded more than $1.8 million to fund three public transportation programs in Michigan. The programs aim to provide better access to care, promote better health outcomes, and lower healthcare costs for the most at-risk communities in the state. The money will be divided between efforts to expand a coordination software and scheduling software, as well as develop a mobility management program.
Beginning January 2017, the Hawaii Medical Service Association will pay physicians a standard monthly rate per patient in an effort to promote high-quality care, according to Politico Pro. In addition, twenty percent of the payments will be based on the quality of care and preventive services provided to consumers. A pilot program with 100 primary doctors was launched in April.
In light of the recent price increases for Epi-Pen, the Maryland Citizens’ Health Initiative is pushing Maryland lawmakers to addressing the rising cost of drugs. According to the Washington Post, the group wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the attorney general authority to take legal action. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
A Maryland-based healthcare advocacy group is pushing Maryland lawmakers to address the rising cost of drugs, according to The Washington Post. The Maryland Citizens’ Health Initiative wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the Attorney General the authority to take legal action against price gouging. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
Physician-owned hospitals in Texas experienced significant pre-ACA increases in the formation, physician ownership and physical capacity of physician-owned hospitals in anticipation of changing policies, according to Health Affairs. After ACA implementation, hospitals generated revenue by leveraging their assets; for example, increasing the number of staffed beds and surgeries performed per operating room. Researchers also found that ACA restrictions effectively eliminated the formation of new physician-owned hospitals.
A new study by WalletHub identified Louisiana as the second-worst state for healthcare cost and quality, according to New Orleans City Business. Specifically, the state ranked 34th for healthcare access, 37th for healthcare costs, and 51 for health outcomes.
Maryland second in overall health rankings, according to WalletHub. The rankings evaluated 50 states and D.C. across three metrics, including health costs, access and outcomes. Maryland ranked first in health costs.
A new free mobile application, "FH Cost Lookup CT," enables both insured and uninsured consumers to estimate the region-specific costs of medical and dental procedures, reports Healthcare Finance. The app was launched by FAIR Health and funded by a grant from the Connecticut Health Foundation. The application is available in both English and Spanish, includes region-specific costs in neighboring states of New York, Massachusetts and Rhode Island, and provides educational articles to explain the fundamentals of health coverage. It is driven by healthcare prices from FAIR Health’s database of more than 21 billion claims for privately billed medical and dental procedures since 2002.
The University of Illinois Hospital & Health Sciences System in Chicago is testing a possible solution to “super utilizers” of healthcare According to the Chicago Tribune. The pilot program puts chronically homeless emergency department users in subsidized housing and to provide them with case managers to help handle a range of needs. Being a “super-utilizer” isn’t a requirement for the program but participants must be chronically homeless and have severe medical needs.
The Oregon Health Authority has released its first quarterly report into the progress the state has made in reforming its Medicaid program, according to Herald and News. In 2012 Oregon launched a major health reform initiative and established 16 Coordinated Care Organizations to manage the Oregon Health Plan. The report shows that the Coordinated Care Organizations are financially stable and have made improvements in the cost and quality of care.
Arkansas is shifting to value-based care models reports HealthLeaders. Specifically, value-based reforms are taking hold throughout the state’s provider and payer market, including the patient-centered medical home, which has become the dominant primary care physician-practice model. In addition, commercial payers and the state’s Medicaid program are operating bundled payment reimbursement and private option Medicaid expansion through the ACA influenced the sharpest decline of uninsured patient rates in the US (22.5% in 2013 to 9.6% in 2015).
The Colorado Health Foundation, in partnership with the Colorado Health Institute, published the 2016 Colorado Health Report Card. It evaluates the current status of population health, healthcare delivery, and health coverage in Colorado and provides a benchmark for measuring progress on some of the most pressing health issues across 38 key health indicators and through five life stages.
Washington’s Insurance Commissioner released a statement promising to propose similar legislation in 2017 to California’s law that protects consumers from surprise out-of-network medical bills, according to KING 5. The California bill guarantees patients who visit an in-network hospital do not face out-of-network charges and creates a process for doctors and insurance companies to handle price disagreements without involving the consumer.
D.C.’s Insurance Commission has ordered CareFirst BlueCross BlueShield to rebate $51 million in excess profits to the more than 200,000 subscribers with D.C.-based CareFirst contracts, according to Washington Business Journal. The average refund will be more than $200 per subscriber, but will vary depending on the amount paid in premiums.
Reducing overuse of 28 low-value services, such as spinal injections and imaging for non-specific head and lower-back pain could lower overall healthcare spending, according to a recent RAND study. Spending on the 28 low-value medical services accounted for 0.5% of total spending.
In an attempt to better reach high-risk patients, Texas providers have started connecting with patients via text message, according to the Dallas Morning News. The initiative, in addition to the transportation programs already in place, is expected to decrease no-show rates for office visits.
A Health Affairs study explored network adequacy for insurance plans sold inside and outside insurance marketplaces. The study found that timely access to primary care providers is challenging, including long wait times and difficulty securing an appointment with a provider. In addition, these challenges are attributable to errors and inconsistencies in provider network directory.
Patients who are more involved in the self-management of their health are less likely to be hospitalized or to develop chronic conditions compared to less “activated” patients, according to a new study in Health Services Research. Researchers analyzed the behavior of nearly 100,000 patients at Fairview Health Services in Minnesota, an innovation-focused Accountable Care Organization (ACO).
Integrating medical homes and accountable care with physical and mental health had mixed effects on quality of care and costs, according to a study released in JAMA. The study included nearly 114,000 adults who received care at 113 Utah practices from 2003-2005 and had yearly encounters with the practices through 2013. Compared with patients in traditional practices, patients in the study had better adherence to diabetes care and substantial reductions in emergency department visits, hospital admissions, and primary care visits. However, there was no difference in urgent care or specialty physician visits. The investment costs of the program were lower than the reduction in payments received by the delivery system; however, the implementation of the team-based care was still resource intensive.
Hospitals in Mount Sinai Health System have agreed to pay nearly $3 million to settle a possible suit alleging that they held onto Medicare and Medicaid overpayments, according to Modern Healthcare. The alleged overpayments originated in 2009-2010 when the hospitals were part of Continuum Health Partners. A whistleblower email and a comptroller audit alerted the health system to the potential overpayment, but the health system did not return all the money until well beyond the government’s allowed time frame.
A pilot program aimed at improving rural healthcare has provided insights into the problems caused by a lack of coordination and communication, according to the Valdosta Daily Times. The program, which received $6 million in funding and involves seven hospital systems, employs a hub-and-spoke model in which public health departments, nursing homes and other organizations collaborate and share information with hospitals, who serve as center of care.
Washington is the first state in the nation to formally review, certify and advocate the use of aids to help patients make decisions about their care, according to a press release by the Washington State Health Care Authority. The HCA announced the certification of four patient decision aids (PDAs), which help consumers gain access to reliable information so they can talk with their providers before making decisions about their care. In 2007, Washington was the first state to pass legislation regarding shared decision making, which provided that if a provider used a certified PDA as part of the informed consent process, there is a presumption that informed consent has been given and obtained. A Health Affairs study found that PDAs were linked to significantly lower hip and knee surgery rates and costs, since patients have a better sense of the anticipated likelihood of benefit from a procedure and alternative, less invasive options.
The merger between two Chicago-area health systems is being challenged by the Federal Trade Commission, citing concerns over higher prices for insured customers, according to Modern Healthcare.
Arizona is one of several states that will be hardest hit by some of the nations largest insurers leaving select marketplace markets, according to Kaiser Health News. The departure of Aetna, UnitedHealthcare and Humana has emboldened concerns that the lack of competition in the marketplace will lead to growing premiums and smaller provider networks.
Alabama Receives More than $1 Million from HHS to Improve Community Health Centers. Alabama has been awarded fourteen grants totaling $1.2 million from the Department of Health and Human Services, according to the Birmingham Business Journal. The money will be used by the state to invest in quality improvements at its community health centers.
After being approved by a key committee, a bill that would have required drug companies to justify treatment costs and price hikes was pulled by its author, according to Kaiser Health News. California state Sen. Ed Hernandez (D-West Covina) said that he introduced the bill “with the intention of shedding light on the reasons precipitating skyrocketing drug prices.” But subsequent amendments by an Assembly committee made it difficult to accomplish this goal, he said in a statement.
Florida doctors from Health First have settled a nearly $350 million antitrust suit, according to Modern Healthcare. Omni Healthcare alleged that Health First had participated in an illegal “hospital monopoly” by acquiring Melbourne Internal Medicine Associates in 2013. Health First faces other lawsuits claiming that they have participated in anticompetitive behavior.
Already paying among the highest healthcare costs in the United States, residents of Colorado’s mountain communities are facing another wave of high costs: pharmaceutical drug prices spiraling out of control, according to the Rocky Mountain Post. Mountain residents have historically paid more in almost every category of healthcare, with the exception of prescription drugs. However, the prices of many common prescription drugs, including insulin and EpiPens, have spiked in recent years. Observers say that creates further hardship – and the real risk people will not be able to afford critical and life-saving medications.
The Washington Health Alliance released a report that reveals that a patient’s location can influence the treatment or services he or she receives. The report covers the entire state of Washington and includes results for 22 tests and treatments in five categories (ear/throat, ortho-/neurosurgery, diagnostic tests, obstetrics/gynecology, and special topics). The report also divides results by age range and gender, which can reveal additional variation.
According to a study published in Health Affairs that looked at access to primary care providers across neighborhoods in Philadelphia, the odds of being in a area with low access to primary care providers was twenty-eight times greater in neighborhoods that had a high proportion of African Americans. This study highlights that even in densely populated cities primary care provider supply can vary greatly.
Maryland’s largest insurance provider, CareFirst, is unjustly doubling the rate increases originally proposed in May, according to this op-ed in the Baltimore Sun. The new rate filing requests a 28 percent jump for its HMO and 37 percent for its PPO business. State advocates question the legality, fairness and validity of the filing that will impact Marylanders who are paying more than the average American, for health insurance already.
The Commonwealth Fund released a case study that examines programs that aim to improve outcomes and reduce costs of care for patients with complex needs. The case study discussed the On Lok program in California. On Lok members are older and frailer than the Medicare population as a whole, yet their readmission rate is about half the average among Medicare beneficiaries. On Lok members accrued lower costs in the last six months of life than other Medicare beneficiaries in San Francisco with one or more chronic conditions.
According to a recent report by the Colorado Health Institute, a single-payer healthcare proposal on Colorado’s ballot this fall would not raise enough money to cover the program’s costs. ColoradoCare would see a $253 million deficit in the first year, and the deficit would grow as costs outpaced revenue. A ten percent payroll tax is expected to bring in $25 million annually, but this added funding would fall short without additional tax increases. However, the plan would make Colorado the first state to achieve universal coverage.
Blue Cross and Blue Shield of Illinois and the largest independent physician practice in Chicago, DuPage Medical Group, will launch a new value-based care model, according to HIT Consultant. The model ties payment to quality and performance measures, and the model will provide quality and cost data to inform population health management decisions.
State of Reform reports that the Washington Health Care Authority’s (HCA) new 1115 Medicaid waiver application is seeking to tie 30 percent of its healthcare purchases to value-based arrangements by next year, and 90 percent by 2019. HCA will implement seven performance measures that complement the waiver process. HCA will withhold one percent of a managed care plan’s premiums based on their performance against these measures which can be earned back by producing favorable scores for quality, patient experience, and cost of care.
For 2017, Humana’s monthly exchange premiums are expecting to increase, on average, by 43 percent, according to Mississippi News Now. Rate increases are likely a result of growing healthcare and prescription drug costs, higher use of inpatient services, and the phasing out of premium stabilization programs implemented by the Affordable Care Act, according to the article.
A Texas hospital group generated an average savings of $284 per joint replacement in a demonstration that features a bundled payment for joint replacements, according to The Commonwealth Fund. Physician were guaranteed Medicare payment rates and offered bonuses of up to 25 percent. Program success relied on physician engagement, which was achieved through establishing individual and group gainsharing thresholds supported by transparency for physician level cost and quality data.
New Jersey was one of fourteen states recently selected by the Centers for Medicare and Medicaid Services to participate in a five-year program aimed at overhauling the way in which healthcare providers are paid by insurers, according to NJ Spotlight. The Comprehensive Primary Care Plus (CPC+) program builds on an existing initiative in allowing Medicare and participating private insurers to pay providers according to one of two different value-based payment models. The project is expected to impact as many as 20,000 physicians and 3.5 million patients nationwide.
A 2013 study by the Anchorage School District found that the majority of state spending increases went to healthcare and pensions and that health spending was more than double the national median despite below-average utilization levels. The dramatic increase in spending is primarily associated with the increasing price of goods and services, according to Alaska Dispatch News.
Blue Cross Blue Shield, a leading insurer on the Illinois’ exchange, is seeking increases as high as 45 percent for individual health plans beginning in 2017, according to Crain’s Chicago Business. The Illinois Department of Insurance has until August 23 to review proposed hikes.
For months Advocate Healthcare and Northshore University Health system have been seeking to combine services but have been halted by the FTC. According to Modern Healthcare, both health systems say that the FTC has no economic or factual basis to challenge the proposed merger. The FTC continues to file appeals blocking the merger.
The New York State health department has released a plan that will expand and improve access to primary care medical homes across the state, according to a United Hospital Fund Press Release. The plan hopes to guide New York in adopting a delivery model that improves quality and value of care. The adoption of this model is also in line with New York City’s Take Care New York 2020 goals.
The Connecticut Health Policy Project released a report and training module aimed toward students, interns, and volunteers that discusses the basics of health policy. The report gives an overview of public insurance, private insurance, the uninsured, healthcare financing, healthcare reform, and the role of states.
Healthcare in Wisconsin is dramatically more expensive compared to Minnesota. Wisconsin's costs are inflating faster as well, according to a report by Citizen Action of Wisconsin. Deductibles stayed stagnant in Minnesota but increased by 46 percent in Wisconsin in 2016. The report calls for increased rate review authority, expanding Medicaid to enhance Medicaid funds, and end the sale of substandard non-Affordable Care Act-compliant health plans.
The Commonwealth Fund’s study of over 9,000 low-income adults in Kentucky, Arkansas, and Texas revealed that low-income adults in Kentucky and Arkansas received more primary and preventative care, visited emergency departments less often and reported better health than their counterparts in Texas. The report aimed to answer how the Medicaid expansion under the Affordable Care Act has affected beneficiaries’ use of health care services and their health status.
According to The Wall Street Journal, Minuteman Health of Massachusetts, a health co-op, has filed a lawsuit against the Obama administration over the Affordable Care Act’s risk adjustment formula. Similar lawsuits across the nation have been filed stating that the administration mishandled the program and created an inaccurate formula that overly rewards big insurers.
According to Modern Healthcare, a court has ruled that the Evergreen Health Cooperative, which serves more than 39,000 patients, must pay its $24 million risk adjustment payment while it continues to challenge the current methodology put in place by the ACA.
A report by the Colorado Division of Insurance evaluated the total cost of healthcare for commercially fully insured Coloradans in nine geographic rating areas currently in effect for ACA health plans. The report found that regional costs vary significantly for inpatient, outpatient, professional services, and pharmacy, with cost differentials of up to 36 percent. The report also confirms that health insurance for Colorado’s western and rural communities are the highest in Colorado.
State regulators have appointed thirteen healthcare professionals to assess the viability of telemedicine, according to Health News Florida. The board will look at how out-of-state doctors could participate and the rate at which the physicians will be reimbursed by insurance companies. The board will spend a year composing these recommendations.
The large settlement was reached after a whistleblowing alleged violations of the Stark self-referral law when the Lexington Medical Center acquired physician practices and then paid the doctors to make referrals to the Medical Center, according to Modern Healthcare. Several similar settlements have been reached in the last year, including providers in Toumey, South Carolina and in Florida.
Accountable Care Organizations not only saved Iowans money but also reduced hospital admissions by more than 22 percent, according to the Business Record. Under the ACO model, providers are rewarded for improving the quality of care and effectively managing costs. The number of health systems participating in the program has grown, from eight in 2014 to 13 in 2015.
The Office of Financial Management announced the Center for Health Systems Effectiveness at Oregon Health & Science University will develop and operate Washington’s All-Payer Claims Database, according to Onpoint Health Data. The project will increase transparency and improve quality in healthcare by collecting, integrating and enhancing claims data, benchmarking performance, identifying value in purchasing strategies, and promoting competition based on quality and cost.
The Integrated Healthcare Association reported the launch of a new online tool that for the first time brings together data on clinical quality, costs and hospital utilization for commercial insurance, Medicare and Medi-Cal. The California Regional Health Care Cost & Quality Atlas will provide data to assess geographic and insurance product type performance variation. Highlighting variation in healthcare quality and cost across California may provide opportunities to provide better care and lower costs.
Beginning June 1, 2016, Medicaid expansion will allow residents with incomes up to 138 percent of the federal poverty level to enroll in Medicaid. More than $1 billion over a decade may be saved by the state of Louisiana as a result of federal matching funds provided by the expansion, according to CNBC.
According to Crain’s New York Business, the State Health Information Network has nearly half the population of New York State signed up to have their health records shared among most of the state’s healthcare centers. The project, which began in 2006, is expected to accrue savings of more than triple the annual $70 million dollar operating cost.
On the heels of two years of average rate increases at 4 percent, consumers in California and likely several other states, will be hit with a double digit increase in premiums in 2017, according to Kaiser Health News. According to Peter Lee, executive director of Covered California, prices for 2017 reflect the rising cost of care, not efforts by insurers to increase their profits.
Massachusetts has been awarded a waiver from HHS that could help prevent health insurance premium spikes for the next year, according to the Boston Herald. The waiver lets businesses continue using rating factors that may not align with the Affordable Care Act.
The proposed mergers between four of the nation’s five largest health insurers could lead to higher premiums and less choice for consumers, according to a report by the nonprofit Georgians for a Health Future. The report considers the impact the mergers would have on competition as well as potential policy remedies that would mitigate its impact should it eventually be approved.
The Northwest Health Law Advocates and Washington Community Action Network released a report that discusses how community members can become involved in regional decision making and recommends ways in which regional entities can engage consumers after the creation of Accountable Communities of Health (ACHs) in Washington.
A 2012 law required insurers and third party payers to provide a website to members with prices and the member’s estimated cost sharing for health care services. Health Care for All Massachusetts assessed the tools from the state’s largest three insurers to create a report card comparing how well the tools aid in decision-making, accessibility and comprehensiveness.
A state-hired consulting firm presented a plan to Connecticut’s Health Care Cabinet that called for the largest reorganization and consolidation of health-related state agencies in two decades, according to The Connecticut Mirror. The proposal urged the creation of the Connecticut Health Authority, which would absorb the responsibilities of more than six state agencies and would create a quasi-independent oversight agency, the Office of Health Reform. The Office of Health Reform would track and limit healthcare cost increases. The proposal also called for the creation of “consumer care organizations” -- networks of healthcare providers that would receive large payments based on the total number of consumers using the services in its network. Providers in consumer care organizations would be paid based on the quality of their care.
The Mountain Xpress reports that a newly formed partnership between UnitedHealthcare and an Accountable Care Organization provides an opportunity for patients to have access to healthcare services and continued care coordination between organizations. The collaboration is meant to provide patients with access to services that will better equip them to manage chronic health conditions.
As hospitals move toward value-based payment models, they are increasingly investing in primary care, according to the Star Tribune. Primary care is seen as the linchpin of population-based health strategies that emphasize improved access and care coordination.
A slew of rural community hospitals in Tennessee are shutting down due to strained financing, according to the Knoxville News Sentinel. In states such as Tennessee where Medicaid eligibility has not been expanded to more income levels, rural hospitals are struggling because of a decrease in their federal reimbursement rates. Although at least eight rural Tennessee hospitals have closed or merged since 2013, five have been replaced by other satellite campuses of health systems or other clinics trying to fill the community's health services niche.
Montana has adopted a “transparent pricing” model for its state employees health plan that Gov. Steve Bullock claims will save taxpayers $25 million by the end of 2018, according to the Billings Gazette. Under the new model the state will anchor prices to Medicare reimbursement rates and then pay a multiple of that rate to all providers. Nine of the state’s ten largest hospitals have already agreed to participate in the new system.
Oregon’s commercial health insurers can pay widely different amounts for the same procedure, according to a new report from the Oregon Health Authority. The report shows that for 46 common procedures, reimbursement rates can more than triple depending on the location of service and health plan being used. The first-of-its-kind report was made possible by a 2015 law that required insurers to report the median cost of payments made to hospitals.
A new report from the Richard M. Fairbanks School of Public Health reveals the cost of the opioid epidemic, in human, fiscal, and collateral terms. Indiana has seen a large increase in the number of overdose deaths and babies born dependent on drugs their mother took during pregnancy. The report concludes that opioid-related issues are putting a strain on police departments, other government services, employers and taxpayers. It cites the sharp increase in emergency care, which imposes a large financial cost and harms a hospital’s ability to deliver timely care. The report recommends a focus on prevention, including better information-sharing among health care providers.
A review of Community Health Needs Assessments that were performed by nonprofit hospitals in Georgia has offered insights into how hospitals are approaching their community benefit obligations under the Affordable Care Act. The report from Georgia Watch, a consumer advocacy group, reviewed 38 initial assessments that were conducted in 2012 and 2013.
According to the Philly Voice, the massive healthcare system merger of Jefferson and Aria Health is complete. With the merger of the two systems, the combined organizations now consists of 23,000 employees, including more than 10,000 doctors and nurses.
The U.S. Justice Department has brought the largest criminal case of healthcare fraud ever against individual suspects, according to NPR. The indictments accuse three Miami-Dade County healthcare workers of leading "a complex and profitable health care fraud scheme that resulted in staggering losses — in excess of $1 billion," said Special Agent in Charge George L. Piro of the FBI's Miami field office.
The Commonwealth Fund released a case study that examined MedStar Washington Hospital Center’s Medical House Call Program. The program features teams of geriatricians, nurse practitioners, and social workers who make house calls to patients too sick or weak to visit a primary care physician. The case study found that the program increased the continuity of care, adherence to care plans, and respect for patients’ care preferences at end of life. Early results suggested that the model could reduce Medicare spending for the highest-risk patients by 20 percent or more.
Hospitals must provide a payment estimate for scheduled elective procedures, tests, or services to patients who request it at least three days in advance of a schedule service, according to the Virginia Chapter of the American Association of Healthcare Administrative Management. The law, which went into effect July 1, 2016, aims to improve price transparency of medical services. The new law shouldn’t be too burdensome for providers, given that patients must request the information, according to an article in the Journal of Health Care Finance.
California’s penalty system for medical errors has failed to bring about a significant reduction in such incidents, according to The San Diego Union-Tribune. California has issued 354 administrative penalties, which run from $75,000 to $125,000 per incident, to 192 of the state’s 495 general and psychiatric hospitals. California is the only state that issues penalties and news releases for immediate jeopardy errors. Learn more about medical harm here.
The Idaho Health Quality Planning Commission released its 2016 Annual Report that provided recommendations for improving access to healthcare related data. The Commission has already taken steps to identify the data currently available and being utilized and identified the major gaps—including the lack of access to a hospital discharge database or an all payer claims database, limiting the ability of Idaho to analyze costs in the state. The Commission is also exploring what role they can plan in the implementation of a strategic plan for combating prescription drug abuse.
Hawaii’s vision for health transformation includes better health, better care, reduced costs and reduced disparities across the state, according to the State Health Innovation Plan. The plan focuses on the two more significant gaps identified in the Hawaiian healthcare system: awareness, diagnosis and treatment of behavioral health and poor oral health. Hawaii hopes the initiatives will generate savings, specifically for Medicaid and the Children’s Health Insurance Program by reducing preventable hospitalizations, readmissions and emergency department visits.
According to an article in the Baltimore Sun, Maryland hospitals are changing the way they deliver care. Hospitals are going to begin focusing on a community-based healthcare model that includes service coordination and disease prevention. Many advocacy groups support this change, and Maryland has launched a website that directs consumers to their hospital’s initiatives.
Low-income and at-risk populations often need services and support outside the scope of a single state agency in order to live productive, healthy lives, according to a NASHP report. State health policymakers could learn how to combine funding streams to meet health and social needs by using Virginia’s Children’s Services Act as a guide.
Oregon Health Plan’s pay-for-performance program has continued to produce positive results in its third year of operation, according to a new report. Fifteen out of sixteen coordinated care organizations earned 100% of the quality incentives available to them under the program as metrics showed continued improvement in areas such as hospital readmissions, ER use, and patient satisfaction.
Two public nonprofit health systems filed a lawsuit against the state’s Medicaid program to recover up to $20 million in Medicaid reimbursement payments, according to Modern Healthcare. The systems claim they have been underpaid due to funding formulas that unevenly distribute reimbursement among providers.
The physician recipient of the largest value of gifts from industry entities in 2014 earned more than $28.5 million, according to Propublica. Critics cite these expenses—meals, speaking engagements and trips—as drivers in the cost of drugs, according to AZFamily.com.
Philadelphia has become the first major city in the U.S. to approve a 1.5 cent per ounce tax on sugary and diet beverages, according to the Philadelphia Inquirer. Exempt products include baby formula and beverages that are more than 50 percent fruit, vegetables, or milk. The tax is slated to begin Jan. 1, 2017, and is expected to raise $91 million dollars that would help support programs such as citywide pre-K education.
Price growth has been larger in multi-hospital systems compared to smaller hospital systems and independent hospitals other hospitals in California, according to new research in the Journal of Health Care Organization, Provision, and Financing. Although prices grew in all hospitals in the study, multi-hospital systems charges grew substantially more between the years of 2004-2013 (113% vs. 70%). The findings bolster fears that pending mergers may result in serious consumer harms.
More than half of the states have disclosed just how much higher their healthcare premiums could be next year under the Affordable Care Act, and some of the potential increases are jaw-dropping. But Illinois residents won't get their first look at proposed 2017 premiums until Aug. 1, and that has consumer advocates frustrated, according to a Chicago Tribune report.
North Carolina's largest healthcare system, Carolinas HealthCare System, has kept medical costs high and suppressed competition by illegally imposing certain requirements on insurers with which it contracts, according to Modern Healthcare. The alleged restrictions include barring insurers from offering tiered networks that include competing hospitals in the top tier.
The Texas Medical Association’s Task Force on Balance Billing has begun to pressure insurers to broaden their networks to cut down on balance billing. Insurers have been increasingly limiting their network sizes to manage losses. As a result, physicians are less effectively negotiating rates with insurers.
New standardized emergency codes released by the Texas Hospital Association are intended to boost safety, reduce errors, encourage transparency, meet national recommendations, and reduce confusion for providers practicing at many locations.The codes are voluntary for individual hospitals to implement.
The state’s 1115 waiver in 2014 that reduced eligibility limits for Medicaid resulted in approximately 80,000 people losing coverage, according to the Commonwealth Fund. Independent evaluators will be looking into the impact of this policy on those who maintained as well as those who lost coverage.
In Pennsylvania, Geisinger Health Plan has requested a rate increase of 40 percent for 2017, according to The New York Times. Geisinger has been lauded as a model that provided high quality care at low costs but, David Feinberg, president of Geisinger, has said that the health plan was losing $30 million a year with coverage being sold on the federal exchange. The article addresses the rising health plan costs that are occurring throughout the country.
North Carolina has finalized a Medicaid Waiver plan and submitted it to the Centers for Medicare and Medicaid Services, according to the North Carolina Department of Health and Human Services. The plan includes paying for improved patient outcomes, clinically integrating physician and behavioral health, components addressing social, cultural and environmental barriers to health and tying payments to quality measures, among other things.
The Vermont governor signed the prescription drug transparency bill that will make Vermont the first state to require pharmaceutical companies to justify why their drug prices go up, according to VTDigger. Vermont’s new law will require pharmaceutical manufacturers to justify why the “total wholesale cost” of specific prescription drugs go up in a given year. The data on the cost of the drug would come from the state’s Medicaid program.
CareFirst BlueCross BlueShield is forcing Evergreen Health Cooperative to pay nearly $22 million dollars in risk adjustment costs. Risk adjustment fees are a provision in the ACA that requires insurers who take on healthier patients to pay insurers who have sicker patients. In the Baltimore Business Journal Peter Beilenson, CEO of Evergreen, stated that with such a rapidly growing population they cannot know what sort of sickness is in the population.
The Iowa Department of Human Services reported on the major accomplishments of the first year of SIM activities, including incorporating major concepts into the managed care organizations contract, completing all-vendor contracts and hiring efforts, receiving approval on the 2016 Operational Plan and awarding six Community Care Coalition (C3) systems. The report also includes some data that will ultimately be used as a baseline for future work.
Missouri approved a bill which includes a provision giving the state agency authority to review any proposed rate increase before it affects consumers who buy insurance through the ACA marketplace, according to News-Leader. The notification also gives consumers the chance to comment on the rate hike proposals. The Missouri Health Insurance Rate Transparency Act allows the agency to determine reasonable rate increases and request a change if the increase is unreasonable.
The Missouri Department of Insurance issued an order prohibiting the proposed Aetna-Humana merged company from selling plans in the individual, small group and all group and some individual Medicare Advantage markets, according to Healthcare Finance. Missouri is the first state to take steps to limit the merged company from competing in the local insurance market.
Advocate Health Care successfully used a combination of individual and group incentives to increase care coordination and cost-effectiveness, according to The Commonwealth Fund. Monetary and non-monetary incentives, such as performance feedback and plaques, served as powerful motivators for physicians.
For individuals in North Carolina buying a low cost silver plan in the health-insurance marketplace, they can expect to pay an average of 20.6 percent more according to an article in the Winston Salem Journal. Many factors contribute to the increase, most notably, lack of competition within the state and increased costs of medical services and drugs.
A study in the May edition of Health Affairs evaluated the power of market concentration in correlation with rising costs in the New York and California markets. The study found that increased hospital and medical group concentration exhibited an increase in premiums in both states. The results showed a difference in health plan concentration exhibiting a positive correlation in premium growth in New York but a negative association in California.
The unanticipated costs of providing healthcare to customers on the state's online exchange has prompted large insurers to seek rate increases of up to 30 percent while one insurer decided not to offer individual plans at all, according to the Baltimore Sun. UnitedHealthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.
A Health Affairs blog post analysed current price variation among providers and ongoing efforts within the state to decrease this unwanted variation. While Massachusetts is a leader throughout the country in taking the necessary steps to curb rising healthcare costs, more work needs to be done to reduce this variation.
Both chambers of the Missouri legislature overwhelmingly passed a health insurance rate review bill, according to The Missouri Times. The advancement was cheered by Missouri Health Care for All, who believe the bill will bring more transparency to insurance premiums. The law gives the Missouri Department of Insurance, Financial Institutions and Professional Registration a chance to determine if a rate hike is unreasonable ahead of time, notify the insurer and request a change. If the insurer moves forward with a rate that has been deemed unreasonable, the agency can make the determination public. But it cannot reject those increases, according to St. Louis Public Radio.
On May 10, 2016, the Ohio Department of Insurance approved the merger of Aetna and Humana with little public notice, according to a press release by the Universal Health Care Action Network. No hearings were held on the matter, despite requests from consumer advocates. The merger would result in the combined entity controlling approximately half of the Medicare Advantage market in Ohio.
Much is left to be desired in terms of publicly reporting medical errors in Arizona hospitals, according to Tucson.com. Not only does Arizona lack a database of serious medical errors, hospitals are not required to report these errors to the state, the process of reviewing a medical error is not made public, and Arizona laws makes it difficult to sue, especially emergency department physicians.
Florida has the least expensive health services, but the cost of health services varies widely throughout the state, according to a Health Affairs study examining price variation. The study compared overall price levels by state and price variation within states. The authors found that there was sometimes more than a threefold variation in healthcare prices. In Florida, for example, the price of a pregnancy ultrasound varied from $180 in Orlando to $457 in Jacksonville.
The New Mexico Department of Health submitted its Health System Innovation Final Design for the SIM Model Design Cooperative Agreement. The state aims to use patient-centered medical homes to improve alignment of clinical, behavioral and oral healthcare, in addition to social services to improve population health.
Healthcare prices vary significantly, sometimes threefold within the state, according to an analysis of 240 common medical services in 41 states and D.C. published in Health Affairs. The report identified Alaska as the most costly state, followed by Wisconsin, North Dakota, New Hampshire and Minnesota. Prices varied between cities in the same state, and some services vary more than others. The report suggests the price variation is due to market dynamics, such as lack of transparency, market power, or the availability of alternative treatments or providers.
Healthcare prices vary significantly, sometimes by 300% within a state, according to an analysis on 240 common medical services in 41 states in Health Affairs. The report identified Arizona as having the second lowest average prices compared to the national average price, preceded only by Florida. Prices varied between cities in the same state, and some services vary more than others. The report suggests the variation is due to market dynamics, such as lack of transparency, market power, or the availability of alternative treatments.
Healthcare prices vary significantly, as much as threefold within a state, according to an analysis on 240 common medical services in 41 states and DC in Health Affairs. The report identified Alaska as the most costly state, followed by Wisconsin, North Dakota, New Hampshire and Minnesota. Prices varied between cities in the same state, and some services vary more than others. The report suggests the variation is due to market dynamics, such as lack of transparency, market power, or the availability of alternative treatments.
Costs of some medical services in Charlotte are 20% higher than the national average, according to The Charlotte Observer. Charlotte’s average prices for certain procedures, especially imaging services such as CT scans and MRI tests, were higher than the state average and higher than prices in Raleigh. The study, published in Health Affairs by HCCI researchers and economists, is part of a push for greater healthcare transparency.
Georgia Governor Nathan Deal signed legislation aimed at improving the accuracy and usability of provider directories. The law, which was supported by consumer advocate organizations, will require health plans to maintain up-to-date provider directories for their plan participants.
A new report released by the de Blasio administration outlines strategies to strengthen the city’s 11-hospital system and stabilize the hospitals’ finances, according to Crain’s New York Business. New York City Health and its hospitals have lagged behind its peers in high quality care and revenue. De Blasio hopes that with this plan the city can avoid potential layoffs and hospital closures that have plagued NYC in the past.
Minnesota progressives and elected officials in the state's Democratic Farmer-Labor party are yearning to get back to the future with MinnesotaCare, the state's public insurance program for low-to-moderate income residents who earn too much to qualify for Medicaid, according to the XPostFactoid Blog. Prior to ACA implementation, MinnesotaCare was available to Minnesotans with incomes up to 275% of the Federal Poverty Level. In 2015, the plan was converted under the ACA into a Basic Health Plan, which qualified it for federal funding but cut off eligibility at 200% FPL. Former enrollees above that income level were sent to the ACA marketplace, where both premiums and out-of-pocket costs are considerably higher. A task force appointed by the governor recommended in mid-January that the state seek an ACA innovation waiver to restore MinnesotaCare eligibility to 275% FPL, with funding equivalent to the cost of federal marketplace subsidies for enrollees up to that income threshold.
Research comparing prices for common medical procedures between thirty-three hospitals has exposed substantial price variation between facilities, according to the Maine Heritage Policy Center. Little variation in prices can be attributed to geographic location or hospital size.
A new United Hospital Fund report examines the performance of New York’s accountable care organizations in the second year of the federal Medicare Shared Savings Program, finding that they lag the national experience on cost savings but outperform it on quality results.
Once people understand the magnitude of unnecessary, harmful or wasteful care, they are much more willing to support interventions to stem unneeded care through greater physician oversight and possibly increased patient cost sharing, according to a new report from the nonprofit Center for Healthcare Decisions. The report is a product of the Doing What Works project that informs the work of the Statewide Workgroup on Reducing Overuse, a collaboration of California’s three largest healthcare purchasers—Medi-Cal, Covered California and CalPERS—committed to improving the quality and affordability of health insurance.
Projects have been launched in New Jersey to improve the integration of behavioral and physical healthcare in publicly financed programs, according to a Health Affairs blog post. Through this process, many stakeholders have come to recognize that one of the most significant barriers to success is the lack of a clear understanding of the state’s licensing rules and financing mechanisms. The Nicholson Foundation commissioned a detailed report with findings and recommendations with respect to improving New Jersey’s regulations on licensure and reimbursement.
Florida is now the second state behind New York to shield consumers from expensive surprise medical bills, as Governor Rick Scott signed into law legislation that would protect patients from balance-billing in both emergency and non-emergency hospital situations, according to The Consumerist
The measure, introduced last fall and passed by the state’s legislature last month, aims to put a stop to unfair and unexpected out-of-network charges that affect nearly 30% of privately insured Americans.
The results of a year-long study have detailed the factors driving the high costs associated with the state’s fragmented mental healthcare system, according to the New Jersey Business Journal. This work (which has not yet been published), conducted by Jeffrey Brenner of the Camden Coalition of Healthcare Providers, focused on the interactions between housing security, police interactions, chronic conditions, ER visits, and mental health. This effort is part of a collaboration involving five New Jersey health systems that aims to identify and address shortcomings in the delivery of mental health care.
With the Affordable Care Act’s expansion of coverage, hospitals in Oregon are earning huge profits, allowing them to invest aggressively across the state, according to an editorial in Willamette Week. At the same time, critics contend hospitals are abusing their nonprofit status by falling short of their commitment to provide community benefits such as charity care.
The lead sponsor of a Massachusetts bill calling for some of the nation’s most sweeping steps to control prescription drug costs scrapped a controversial provision that would have capped prices on treatments for critical illnesses such as hepatitis C, according to the Boston Globe. “It’s nearly impossible for policy makers, regulators and regular consumers to know the true markup on drug prices,” the Hub’s Lynn Quincy said, suggesting the factors that go into calculating drug prices have long been “shrouded in secrecy” in the United States.
An independent analysis of Colorado's proposed universal health care system by the Colorado Health Institute estimates it would cover 83 percent of residents and create a massive new entity that would dwarf most U.S. corporations.
Moving into a realm usually reserved for healthcare regulators, Covered California Thursday unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb its cost and increase transparency for consumers, according to California Healthline. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards.
Arkansas is one of the few states that has fully embraced rewarding primary care clinics for controlling costs while hitting quality targets reports the Times Record. These rewards also extend to orthopedic surgeons, obstetricians, and other providers. Between 2013 and 2014, Medicaid costs declined for primary care patients, hospitals reduced readmissions for complications after congestive heart failure, and several physicians cut out unnecessary tests and antibiotics after tonsil surgery.
Budgetary shortfalls are expected to be balanced, at least in part, by newly expanded sin taxes for cigarettes and alcohol, according to KPLC. The cigarette tax is anticipated to bring in $46 million next year.
Maine hospitals continue to show progress in reducing the incidence of healthcare-associated infections (HAIs), although opportunities for improvement remain, according to the Maine Quality Forum. Recommendations made by the Maine Quality Forum include reviewing the HAI quality measures, developing a regional conference to focus attention on HAI prevention and expanding antibiotic stewardship efforts among others.
A bill to reauthorize Medicaid expansion was signed into law by Governor Hassan on April 5, 2016. The law requires hospitals and insurance companies to pay a fee to the state which will be used to fund Medicaid as federal funding for the program recedes, according to the Union Leader.
New Hampshire is considered a national leader in health cost transparency. NHHealthCost.org has put a spotlight on how much more a patient may pay for the same healthcare service and it has prompted insurance companies to design new health plans that pass savings on to members who get care in reduced cost settings, according to the Concord Monitor. This not only helps consumers but also employers seeking ways to hold down the cost of employee coverage. Now, uncertainty over the U.S. Supreme Court’s Gobeille v. Liberty Mutual decision could threaten the state’s transparency efforts.
The Vermont House of Representatives approved $310,000 in state and federal funding to study the potential expansion of the state’s Dr. Dynasaur Medicaid program to cover all individuals up to age 26. The funding was applauded by the Dr. Dynasaur 2.0 Coalition, comprised of 15 Vermont consumer advocacy organizations, labor unions, healthcare providers and small business groups. The study is to be presented to the legislature no later than January 15, 2017 and will examine the impacts the expansion would have on premiums, tax payers, employers, the health care system, and the economy.
Massachusetts is debating a bill that would move healthcare coverage from private companies to a single-payer system where the state would insure all of its citizens, according to an article in Townhall. Despite the passage of the Affordable Care Act in 2010 many Massachusetts citizens still do not have healthcare coverage. Neighboring state Vermont has tried similar legislation, though lawmakers decided that it was ultimately not the time for Vermont to become a single payer state.
March marked the 12th month of the legislature not being able to pass a budget, according to the News-Gazette. Because of this and previous years of underfunding, Illinois has racked up more than $2.8 billion worth of unpaid claims to its state employee group insurance program.
Many Connecticut residents still don’t know that by the end of this year, Anthem Insurance Co. and Cigna may merge, forcing us all into a dire situation, according to Frances Padilla of the Universal Health Care Foundation of Connecticut. Mergers are justified on the basis of increased efficiency and opportunity for innovation, but past experience doesn’t uphold those claims. They should be carefully questioned, because they can be expected to increase health insurance premiums, and cause deductibles, co-pays, and co-insurance out-of-pocket costs to spike.
The General Assembly passed a bill that would allow an individual or corporation to receive a state tax credit for donating money to a rural health care organization, according to Georgia Health News. The rural health donation language was tacked on to Senate Bill 258, which dealt with general tax assessments.
New York hospital mergers could result in price increases greater than 20 percent and increased market concentration with little improvement in quality, according to a Manhattan Institute report. In addition, the study found that lower mortality rates were present in systems with less concentrated markets.
Nearly all Massachusetts adults have health insurance, but being insured is no guarantee patients can afford health care or even find someone to provide it, according to the Boston Globe. A report from the Urban Institute found that despite the state’s landmark healthcare overhaul, the report found, cost and access remain problems for a significant share of residents.
Bangor Daily News: Maine Community Health Options plans to raise premiums and draw on reserves after suffering a loss of $31 million in 2015. The insurer has also set aside $43 million in reserves to cover projected losses for 2016. MCHO was the only co-op in the country to turn a profit in 2014, its first year of operations. Its membership has grown dramatically since then; hospital and medical payments grew by 138 percent last year, compared to a 71 percent growth in revenue from premiums. To deal with the losses, MCHO plans to cut administrative costs and raise rates, according to MCHO spokesman Michael Gendreau.
The Washington Post reports Indiana’s approach to Medicaid With Healthy Indiana, enrollees can choose basic coverage that requires no monthly fee but excludes dental and vision. Or they can pay a monthly fee for enhanced coverage with those benefits. What is not clear is whether Healthy Indiana is paying off for the state and worth modeling in others.
The VT Digger: The Vermont House of Representatives passed a bill that expands oversight of the Shumlin administration’s healthcare reform plans. The bill tells state officials that they can only enter into an agreement with the federal government to set up a so-called all-payer model if the current Medicare system is protected. The legislation also includes dozens of consumer protection provisions.
The Colorado Division of Insurance is using its authority to issue guidance in the form of bulletins to enact new consumer protections for network adequacy and provider directories. The finalized bulletin includes standards for appointment wait times, travel distance, and provider-to-enrollee ratios by specialty or service type. The directory standards bulletin will soon be finalized.
New health rankings list Johnson County as the healthiest in Kansas and Wyandotte County as the least healthy, according to the Kansas Health Institute. Two analyses show the rank of counties by health outcomes and by health factors. An analysis by the Robert Wood Johnson Foundation identified meaningful gaps where policymakers can address the variation occurring among counties.
Blue Cross Blue Shield of Kansas City has been chosen to participate in the Kansas Comprehensive Primary Care Plus Initiative, according to Health Leaders Media. The initiative will launch in January 2017.
Denver Business Journal: Legislators in Colorado agree that greater transparency would help consumers understand what they are paying to hospitals, physicians and drug companies and, in turn, to try to bend the upward cost curve of care. However, they send a seemingly conflicting message and voted down a bill that would allow such transparency.
The Houston Chronicle: Of the 1.3 million Texans who signed up for health insurance in the Affordable Care Act’s 2016 enrollment period, nearly half were new customers, a good sign in the nation’s least insured state.
Controversy surrounding the rollout of Horizon Blue Cross Blue Shield’s tiered OMNIA health plans has continued to grow, leading lawmakers to consider ways of ensuring such networks are designed in a manner that is transparent and evidence-based, according to NJ Spotlight. When the plans debuted, they promised lower out-of-pocket costs to patients through the establishment of two tiers of providers. Although more than 200,000 people have since signed up for the low-cost plans, hospitals excluded from Tier 1 (the lower cost tier) have complained that the selection process was unfair and that such networks will ultimately harm both consumers and their bottom line.
Denver Business Journal: There is a strong correlation between social factors and health outcomes through the state and country, said Janna West Kowalski, a Colorado-based community coach with the County Health Rankings and Roadmaps program. Those factors help to explain why some metro-area counties rank with Pitkin and Eagle counties as the healthiest in the state, while others such as Adams and Denver counties rank in the bottom half of Colorado areas.
WFPL Public Radio: A new poll shows more lower-income adults have become eligible for insurance since the implementation of the Affordable Care Act and the expansion of Medicaid. In 2013, before the expansion took effect, more than three in 10 adults earning less than 200 percent of the federal poverty level were uninsured.Uninsured rates are now about the same for all Kentucky adults regardless of income, according to the poll.
The United Health Foundation released a report focused on preventative healthcare with Utah ranking as average with mixed scores in various thematic prevention measures, including annual dental visits, healthcare coverage, dedicated healthcare providers, cholesterol checks and colorectal cancer screenings. Utah ranked 27th overall with a score based on access to health care, immunizations, and chronic disease prevention, according to the report.
Kentucky Health News: As the new administration of Gov. Matt Bevin continues to move toward dismantling the state's Kynect health-insurance exchange, it has launched an online portal for Kentuckians to apply for Medicaid and other public assistance called Benefind. Benefind also provides an access point for the Kentucky Children’s Health Insurance Program.
Intermountain Healthcare, a nonprofit health system in Salt Lake City, is promising to sharply cut costs rather than pass them on, according to The New York Times. Its new health plan, SelectHealth Share, is guaranteeing to hold yearly rate increases to one-third to one-half less than what many employers across the country typically face. Under the Intermountain plan, employees also are required to take more responsibility for their health by agreeing to participate in programs like a health risk assessment or have a health screening like a cholesterol check or colonoscopy if they are over 50.
State lawmakers are pushing for a law that would require medical providers to provide patients with a “good-faith and reasonable” estimate of a procedure’s cost, including how much insurance would cover and what the patient’s share would be, according to the Columbus Dispatch. The bill, which has bipartisan support, would require the changes as early as January of next year and represents the state’s most significant effort on price transparency in years.
An electronic database central to a project intended to coordinate healthcare for some of the system's most expensive patients is a "work in progress" nearly one year into the three-year program, according to Crain's Detroit Business. The system, called Care Bridge, is supposed to seamlessly transfer patient information among health plans, mental health organizations and physicians for people who qualify for both Medicaid and Medicare—known as "dual-eligible" patients.
Savings of $90 million could be achieved annually by preventing non-emergency visits to emergency departments (EDs), according to the first report released by the state's Department of Health using data from the state's APCD, HealthFactsRI. The report found that potentially preventable ED visits are common among Medicare (71%) and Medicaid (70%) recipients compared to people privately insured (46%). The top three potentially preventable reasons for ED visits included upper respiratory infections, low back pain and abdominal pain.
The public-private partnerships the state has developed to keep Louisiana's former charity hospitals operating could crumble if the state is forced to cut funding to the Department of Health and Hospitals, according to the Time-Picaqune. The cuts have been fiercely fought by private-public partnership hospitals. Should these cuts take place, hospitals claim they would no longer be able to provide care to the poor, including the newly eligible through the Medicaid expansion that occurred in July 2016.
Modern Healthcare reports that Virginia submitted an 1115F managed care waiver. If approved, the waiver will transition blind, elderly and disabled people into capitated health plans. It will also enable the state to use federal Medicaid funding to create financial incentives for providers to pursue delivery-system reforms, including infrastructure development, system redesign, and clinical-outcome and population-focused improvements.
Focus on Hospitals, the Missouri Hospital Association’s consumer-focused website, offers pricing data for participating Missouri hospitals. The launch of pricing data is concurrent with a complete revision of Missouri’s hospital quality transparency program. In reality, only 80% of hospitals in the state are participating, according to the Kansas City Business Journal.
Vermont has laid out the critical components of the state’s conception of an all-payer model, according to a report from the National Academy for State Health Policy. Vermont’s approach distinguishes itself by setting spending targets for almost all services – not just hospital care.
More than half of adults in Kansas say healthcare costs are a major problem in their state and more than three in five believe state costs have increased in the last two years, according to a report by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health. Kansans perceive their costs as reasonable; however, one quarter of adults believe they do not get the value of care they pay for, and another quarter claim financial difficulties paying for prescription drugs. Florida, New Jersey, Ohio, Oregon, Texas and Wisconsin were surveyed in addition to Kansas.
A bill introduced to the Hawaii legislature classifies homelessness as a medical condition with hopes of using Medicaid funds to provide housing options, according to Tech Times. Proponents expect that providing stable housing will ameliorate expensive health conditions such as diabetes and mental health problems.
Florida Gov. Rick Scott made a pitch for his hospital transparency legislation that would require hospitals to disclose what they charge for their services, according to FloridaPolitics.com. In May, Scott created the Commission on Healthcare and Hospital Funding to look at ways government spending on healthcare can be more efficient. Scott and the board heard from Floridians who reported price gouging, and Scott said his proposal would attempt to put a stop to that.
A bipartisan coalition of prominent Colorado leaders kicked off a campaign Thursday to defeat a ballot measure to create a publicly-financed, comprehensive, Medicare-like health system, according to Colorado Public Radio. The measure is opposed by current Gov. John Hickenlooper and former Gov. Bill Ritter, both Democrats.
Minnesotans with a chronic disease spent an average of $12,800 a year on healthcare in 2012, roughly eight times the amount spent by those without such a condition. The finding was revealed in a report by the Minnesota Department of Health and was made possible by a 2014 law allowing the agency to use Minnesota's All Payer Claims Database for analyses pertaining to the cost and quality of care.
Recent reports that underscore persistent variations in healthcare prices charged by different Massachusetts hospitals have led to renewed calls for greater transparency around what patients pay for medical services. The Massachusetts Legislature has mandated the creation of a price and quality transparency website but the state’s Center for Health Information and Analysis is having difficulty identifying what healthcare data consumers need in a price transparency tool.
Governor Chris Christie vetoed a bill that would have allowed nonprofit hospitals to keep their tax exemptions in exchange for regular payments to the municipalities in which they reside, according to Modern Healthcare. The bill was drafted after a state tax court pulled Morristown Medical Center’s property tax exemption, saying it operated in many ways like a for-profit business. Hospital supporters worry that the failure to pass similar legislation will lead more municipalities to pursue lawsuits attempting to take property taxes from non-profit hospitals.
Despite a high cost of living, the cost of health insurance in Hawaii ranks the state among the top ten most affordable, according to the Huffington Post. The health system is also ranked in the top three in the United States by the Commonwealth Fund.
Under the administration of Governor John Kasich, Ohio has taken steps to move the state towards value-based purchasing and other key health policies, according to a case study conducted by the Urban Institute that examined state stewardship of healthcare. State stewardship is defined as the active pursuit of system-wide improvements in health that go beyond traditional public health and purchasing efforts. The Urban Institute also profiled Colorado, Minnesota, Oregon, and Vermont in order to provide a broad overview of how states are approaching healthcare stewardship.
The Massachusetts Health Policy Commission released its 2015 Cost Trends Report. The report contains comprehensive data on the commonwealth’s healthcare spending across all private and public payers, detailed analyses of multi-year spending trends, and key insights about the strengths and weaknesses of the healthcare delivery system across Massachusetts’ communities. The report offers 13 major recommendations, including a reduction in unwarranted variation in provider prices, enabling consumers to make high-value choices, enhanced transparency of drug prices and spending and advancing alternative payment methods.
A partnership between insurer Molina Healthcare of Michigan and mental health provider Common Ground in Bloomfield Hills, Mich., is tackling arguably the most expensive and chronically ill patients in the healthcare system: those who are dually enrolled in the Medicare and Medicaid programs, according to Crain's Detroit Business. The partnership seeks to provide quality alternatives to psychiatric inpatient hospitalization, while ensuring people are still admitted to the hospital when needed.
The Utah Department of Health released a summary report on healthcare costs based on data from the state’s all-payer claims database. The report examines health claims information including per capita costs, total payments made per claim type and amounts paid by insurers and its members.
The 80th percentile rule, a consumer protection measure that requires insurance companies to pay 80 percent of the reasonable market rate for a healthcare service, was enacted in 2004 to help protect consumers from surprise out-of-network bills. But, because the market is so small, the 80th percentile rule essentially allows specialists to name the price that insurers are then required to pay.According to Alaska Public Media, providers continue to raise reimbursement rates, driving up healthcare spending in the state.
The first year of Maryland’s experimental rate setting system in which the state has shifted away from traditional fee-for-service to global budgets has shown encouraging early outcomes, according to AIS Health. Results showed that costs were contained and quality of care improved but utilization of services and per capita spending for Medicare patients was still very high. The next steps include fixing these shortcomings and expanding the all payer payment model beyond only hospitals.
Hospital costs are approximately 25 percent of billed charges, according to the state’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS). In 2015 AHCCCS introduced a website that aggregates publicly available information on hospitals and providing online comparative information on the performance of its contracted acute care health plans.
Consumer advocates are putting pressure on regulators in California and several other key states to examine proposed insurer mega-mergers between Anthem/Cigna and Aetna/Humana to prevent consumers from being left with fewer choices and higher costs, according to the Los Angeles Times. Another deal, Centene's $6.8-billion acquisition of Health Net, also would affect consumers in the state. California Insurance Commissioner Dave Jones has expressed alarm about industry consolidation for years, and doubts consumers will benefit going forward. "I do have concerns about the merger activity in the health insurance market," says Jones. "States are the most critical regulator of health insurance markets," said David Balto, a former policy director at the Federal Trade Commission and an attorney for the Coalition to Protect Patient Choice. "They can protect consumers from narrowing networks and premium increases and impose a wide variety of other conditions."
Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford. A significant share of people who had problems paying medical bills say that the issue was charges for providers they did not know were out of network. New York state has a solution to this problem that bears watching, according to a Wall Street Journal blog post by Drew Altman.
Health Affairs Blog: As part of the legislation to pass Medicaid expansion in Michigan, the state required the Michigan Department of Health and Human Services to submit two 1115 waiver applications. The first waiver, submitted on Nov. 8, 2013, included a number of provisions, notably, the establishment of a cost-sharing structure connected to a health savings account for most recipients. The second waiver request was submitted to CMS in September 2015 in order to continue the Healthy Michigan Plan beyond April 30, 2016.
The Colorado Health Foundation, in partnership with the Colorado Health Institute, published a Colorado Health Report Card. It evaluates the current status of population health, healthcare delivery, and health coverage in Colorado and provides a benchmark for measuring progress on some of the most pressing health issues across 38 key health indicators and through five life stages.
In response to the introduction of a bill proposing repeal of CON Laws, the FTC and DOJ Antitrust Division jointly filed a statement urging states to repeal or reform of their CON laws, according to the Federal Trade Commission. Opponents of the CON law say they harm consumers by creating barriers to expansion, limits to consumer choice, and stifling innovation. CON laws may also deny consumers the benefit of an effective remedy for antitrust violations and can facilitate anticompetitive agreements. According to the joint statement, arguments favoring CON laws have not been supported by evidence.
Virginia Health Information (VHI) analyzed health waste within Virginia using the MedInsight Health Waste Calculator. VHI reported the amount of wasteful spending by geographic region and compared it to the state average. For 43 measures, the report shows service use and spending by geographic region.
The Louisiana Health Information Exchange provides real-time clinical data across more than 300 providers, according to the 2015 annual report from the Louisiana Health Care Quality Forum. These data, among other things, are used to track ED utilization which can be used to reduce costs and improve outcomes through initiatives such as care management. The state also implemented a statewide patient portal connecting all patients and providers on a single, unified platform.
Healthcare hyperinflation is a long term trend within the state, according to a report by Citizen Action of Wisconsin. Large group health insurance premiums and deductibles have tripled since 2000, with regional rates of inflation ranging from 170% in Madison to 365% in Green Bay, and the major variations in relative cost within regions for different types of insurance suggest the numbers measure underlying medical costs and distortions in the insurance market.
The Federal Trade Commission moved to block a pending merger between two of the biggest competing hospital systems on the North Shore: Advocate Health Care and NorthShore University Healthsystem. The FTC states that the impending merger would likely result in decreased competition and ultimately harm the consumer. Advocate and NorthShore are likely to oppose this block and request an administrative proceeding.
A coalition of consumer groups, healthcare providers and unions urged Florida's insurance regulator Wednesday to reject the two proposed mergers among health insurance giants over concerns that less competition will mean higher rates, less choice and lower quality of care for Floridians.
This Huffington Post article by James Knickman of the New York State Health Foundation evaluates the results of a new groundbreaking study on hospital spending and price variations and what it means for New York. The study finds that many parts of the state have low hospital spending compared to national averages, but other parts have much higher spending, prices vary widely within a community, and prices are higher when there is less competition from other hospitals in the same community.
The Atlantic: Matt Bevin campaigned on a health-care pledge that would undo the work of his predecessor: to dismantle Kentucky’s popular insurance exchange and change up the even more popular Medicaid expansion. But as the Republican governor’s campaigning morphs into actual governing, he could find that pledge hard to stick to: not only because hundreds of thousands of Kentuckians now have insurance but also because his plans could be costly—and no one seems to know who would pay for all of it.
Maine released a SIM Core Measures dashboard that shows trends on core healthcare measures selected by a statewide group of healthcare leaders. The state also releases an annual report analyzing the data. Compared to the control group, one of MaineCare’s Health Homes succeeded in decreasing non-emergent emergency department use and a smaller percent increase in facility outpatient clinic costs, according to the first annual report. However, the population also faced increased care fragmentation, decreased pediatric access to primary care, and mixed results relating to provider engagement of patients. The MaineCare Behavioral Health Homes showed notable cost avoidance compared to the control group, and differed in quality only by the level of fragmentation in care. While the experimental group’s fragmentation stayed stagnant, the control group experienced significantly less fragmentation, which benefits the consumer.
In an effort to spark innovation for improving health and curbing healthcare costs, the Rhode Island Working Group for Healthcare Innovation issued a series of recommendations, including creating an Office of Health Policy to set and oversee statewide health policy goals, establishing a spending target, expanding the state’s healthcare analytic capabilities, and aligning policies around alternative payment models, population health, and health information technology, among other priorities.
A new survey of Massachusetts residents finds that about one in six did not get healthcare they said they needed in 2015 because of the cost. The survey from the state’s Center for Health Information and Analysis highlights a trend showing more people have high-deductible plans in which insurance covers less care and patients pay more out of pocket.
New research shows that while the healthcare marketplace in Minnesota is lower cost for those who are a part of the Medicare program, those privately insured pay more for their care reports The StarTribune. This research calls into question the long held belief that the region is an area that should be modeled in many areas of federal health policy. The Minnesota Hospital Association disputes this recent research claiming that the research focused too closely on the list prices and did not take into account the long-term quality and cost metrics.
A bill intended to prevent costly surprise medical bills is on hold following resistance from the healthcare and insurance industries, according to The Record. Advocates argue that as a result patients will continue to be on the hook for excessive bills.
Health Affairs Blog: The Foundation for a Healthy Kentucky held its second healthcare price transparency symposium on October 16. This convening occurred a year after the foundation’s first symposium, in which state and national speakers discussed the need for price transparency in the collective effort of healthcare leaders to meet the unmet healthcare needs of Kentuckians through policy work. These symposia are part of the foundation’s broader Promoting Responsive Health Policy initiative, which has the goal of making policy more responsive to the health and healthcare needs of Kentuckians. Since the first price transparency symposium, the state of Kentucky has engaged the University of Kentucky in a process of creating a Kentucky-based and -designed all-payer claims database (APCD).
The Office of the Insurance Commissioner revised Washington's network adequacy rules in 2014 and added concrete distance standards, established provider ratios for primary care physicians, and defined allowable wait times, according to Washington Healthcare News. The rules apply to all health insurance plans issued in Washington, not just ACA plans. The OIC’s 2017-2023 Strategic Plan affirms that it will “monitor how narrow networks affect access” and maintain its network standards.
Madison Memorial Hospital’s acquisition of the Rexburg Medical Center clinic is going to bring little change to patients, including no changes to prices or services, according to EastIdahoNews.com. Similar acquisitions are occurring across the country, the result of the perceived growing importance of integration, primary care physicians, and changes in payment systems that no longer reward providers based on the volume of services provided.
A new guide from the United Hospital Fund distills information about the State’s value-based payment roadmap for several critical audiences, including healthcare providers, health plans, policymakers, and other Medicaid stakeholders. Navigating the New York State Value-Based Payment Roadmap frames the State’s plans to transform the way it finances healthcare services, moving from volume- to value-based payments—a payment transition broadly recognized as essential for delivery system reform.
A task force appointed by Gov. Robert Bentley today recommended that the governor and the Legislature find a way to provide health insurance for Alabamians without coverage, according to AL.com. The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the "coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians."
From 2011-2013, per capita cost growth trends were very low, according to the Wakely Consulting Group. Utilization trends were generally low, unit cost trends were generally moderate (with outpatient facility being the highest), and pharmacy unit costs were very low—likely a short term trend and the result of improvements in contracting.
The Colorado Commission on Affordable Health Care recently released a report that studies the challenges Colorado faces on health care spending and the primary drivers of rising health care costs. The analysis shows that Colorado’s personal health expenditures increased 327 percent over the past two decades, compared to 216 percent in the US. Spending in Colorado also more than doubled from 2000 although cumulative inflation was only 33.3 percent since 2000.
National Public Radio: Results are in from the first year of a bold change to the way hospitals get paid in Maryland, and so far the experiment to rein in healthcare costs seems to be working. Maryland phased out fee-for-service payments to hospitals in favor of a fixed pot of money each year (Global Budgets). A report in the latest New England Journal of Medicine says the experiment saved an estimated $116 million in 2014, the first year it was in operation.
Consumers in Maine have known for some time that there’s a lot of information about healthcare. However, it has often been difficult to use available data to make meaningful decisions about the quality and price of various medical procedures. The quest for meaningful comparisons became easier last week. The Maine Health Data Organization, or MHDO, launched a new website, CompareMaine.org.
Reducing emergency department (ED) visits for issues that could be treated in a doctor’s office or similar setting could result in over $800 million in annual cost savings for Colorado, according to a report from the Center for Improving Value in Health Care. The report highlights the primary reasons given for non-emergent ED visits, including the available appointment at a doctor was too far out, after hours care was necessary, patients were directed to an ED by a physician, and the ED was more convenient.
The Washington Post reports that Virginia's certificate-of-public-need law, which requires the state health commissioner's pre-approval for hospital expansions, surgery centers and certain medical services, will likely be at the center of a partisan showdown in the upcoming legislative session.
Covered California health plans with narrow hospital networks typically do not trade quality of care for lower costs, according to a report by the California HealthCare Foundation, FierceHealthPayer reports.
Crain's Detroit Business: Michigan struggles with whether or not to require state health insurers to contribute claims data into an all-payer claims database, in part because of concerns about how it would be paid for and also because there isn't agreement on whether such databases save patients money.
Drawing on examples from several states, this report explores the pros and cons of a public utility model for healthcare for Connecticut.
Six different Pennsylvania health insurance companies proposed rate hikes of more than 25 percent for 2016. In October these rates were approved at a much lower rates, reported LancasterOnline, and the companies were asked to phase in these rate adjustments over the next few years as they are generally financially strong enough to accommodate the lower rates. The state insurance commissioner encouraged state residents to shop the market for the plans that best fit their needs.
Several healthcare issues exist across the state, including significant financial barriers, such as high copays and deductibles, preventing residents from accessing the care they need, according to the Rhode Island Department of Health. Other issues include an inadequate number of primary care physicians and the limited existence of data on the race, ethnicity and primary languages of patients. Based on these findings, the department recommended exploring uniform data collection and identification of strategies to address cost barriers that prevent patients from receiving needed care in a timely fashion.
When it comes to keeping members healthy—not just treating them when they’re sick—the Oregon Health Authority knows it can pay to be flexible, according to the author of this blog post. Oregon’s 1115 Medicaid demonstration project is allowing Coordinated Care Organizations to pay for non-medical services that improve the health of their members. Spending on ‘flexible services’ such as temporary housing and home improvements is aimed at addressing the social determinants of health that fall outside the scope of traditional medical care.
Connecticut Health I-Team: Federal investigators have found that Medicare officials rarely enforce rules for private insurance plans intended to make sure beneficiaries will be able to see a doctor when they need care. It's a problem many Connecticut seniors know too well. In 2013, UnitedHealthcare, the nation's largest health insurance company, dropped hundreds of healthcare providers from its Connecticut Medicare Advantage plan, including 1,200 doctors at the Yale Medical Group and Yale-New Haven Hospital. Medicare Advantage beneficiaries scrambled to find new insurance or new doctors while the Fairfield and Hartford counties medical associations went to court to try to stop the terminations.
Associated Press: Consumers who purchase insurance through MNSure—Minnesota’s state-run insurance exchange—could experience rate hikes between 14 and 49 percent. In response, state regulators and lawmakers have begun looking into methods to reign in these price increases in an individual market that is smaller and more expensive than both regulators and insurance companies expected.
Several insurers in Arizona will eliminate their PPO plans, focusing instead on HMO plans in an effort to cut losses associated with taking on more high-risk, high-cost patients, according AZCentral. In 2014, insurance companies reported losses of ranging from $16 million to $90 million in the individual market.
This Deseret News editorial focuses on the possibility of healthcare transformation and overall economic development in the state of Utah. The author praises the collaborative work between different stakeholders to continue their work in value-based care and other progressive health transformation ideas in the state.
Massachusetts is unique in their commitment to tracking statewide health spending but the state will miss a self-imposed annual healthcare spending target, according to public radio station WBUR. A report from Attorney General Maura Healey finds little change in problems that have been contributing to high costs for years: some hospitals are paid a lot more than others, patients prefer the expensive hospitals and efforts to change the way we pay for healthcare have not yet done much to shift spending.
Older Korean American patients may have significant disparities in preventable hospitalizations, which suggests poor access to or poor quality of primary healthcare, according to an article in Preventing Chronic Disease. Improving primary care for Korean Americans may prevent unnecessary hospitalizations, improve quality of life for Korean Americans with chronic illness, and reduce healthcare costs.
Most D.C. residents who buy health insurance through the District’s online marketplace will see 4 percent premium increases in 2016, compared to Maryland, where the most popular plan will cost on average 26 percent more starting in January 2016, according to The Washington Post.
As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This Annals of Family Medicine study assessed direct personnel costs to practices associated with the staffing necessary to deliver PCMH function in Colorado ($9,658 per month) and Utah ($7,691 per month). Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.
This NYSHealth-funded report, prepared by the APCD Council, examines the issues related to the development of regulations and policies for an all-payer database (APD) in New York State. It also offers recommendations for State policymakers on the choices before them and seeks to preserve an expansive vision for the APDand the extent of its powers. The report captures lessons learned from other states that have developed, or are developing, similar systems and highlights the perspectives of key stakeholders in New York.
Louisiana’s market experienced the largest drop in the country in competition among commercial insurers between 2010-2013, according to an analysis by the AMA featured in Becker’s Hospital Review. Louisiana also ranked in the 10 least competitive HMO and PPO markets in the United States.
Crains Detroit Business: Michigan's 12 accountable care organizations (ACOs) fared better than national averages in saving Medicare money, generating profits of their own and improving quality, according to data for 2014 from CMS and interviews with ACO executives. The article does not assess why this group did so well.
According to an article by the Valley News, by 2015 two co-ops—Community Health Options and Minuteman Health—will expand into New Hampshire. In total, there will be four new plan options for residents to choose from, compared to the one new plan introduced in the year prior. This increase in insurance competition could be an important factor in bringing down the cost of premiums.
The Green Mountain Care Board has approved all 14 of Vermont’s private hospital budgets for 2016, with only minor changes. The approved 3.5 percent aggregate increase in hospital patient revenue is slightly below the aggregate request of 3.6 percent—which was the target set by the board. The increase is well below the average annual increase for the past 15 years of 6.8 percent, however, that the growth rate is a significant increase over the 1.5 percent increase approved two years ago.
Hawaii has the second least competitive commercial health insurance markets in the U.S., according to AMA Wire. The only other state with a less competitive insurance market is Alabama. Lack of competition is a concern for providers who believe less competition may result in higher premiums for patients.
Health News Florida: A House Republican on Friday proposed creation of a program that would offer financial help to dentists who practice in underserved areas. The bill (HB 139), filed by Rep. Travis Cummings, R-Orange Park, will be considered during the 2016 legislative session and follows years of discussion about a lack of dentists in some low-income parts of the state.
Hospitals know what they are paid by insurers, but it bears little relationship to their costs, according to The New York Times. In fact, hospitals don’t know what things cost. Utah is getting answers, information that is not only saving money but also improving care. New data systems allow the University of Utah Healthcare to measure what they spend, lower costs and improve outcomes.
The Baltimore Sun: CareFirst BlueCross BlueShield, the state's largest insurer, is raising rates up to 26 percent on average after absorbing more than $100 million in losses incurred as more older and sicker patients received coverage under federal healthcare reform. The Maryland Insurance Administration announced Friday that it approved new premium rates for CareFirst and four other insurance companies that sell plans to individuals and small businesses on the state's exchange.
Merger talks are heating up in metro Atlanta, with Northside Hospital and Gwinnett Medical Center beginning talks to merge operations, according to Georgia Health News. The merger talks follow the recent aggressive moves of Marietta-based WellStar Health System. WellStar has begun talks to buy Tenet Healthcare’s five hospitals in metro Atlanta after earlier abandoning a proposed deal with Emory Healthcare. WellStar also has a proposed deal in place to acquire West Georgia Health.
Philadelphia Inquirer: Massachusetts’ lawmakers are considering a law that imposes price limits on some of the most expensive medications and would make Massachusetts the first state to cap drug prices. New York, California and Pennsylvania are also considering similar bills. Critics of this bill argue that this will not likely reduce total spending as effective prescription drugs often help hold down overall spending in ways that are not always immediately apparent.
The Connecticut Mirror: The financial condition of Connecticut’s hospitals, and how they’ve fared under the federal health law, has been a source of dispute among state lawmakers. Hospitals have faced repeated funding cuts and increased taxes in recent state budgets. This article looks at recently released financial data from the 2014 fiscal year, the first after the major coverage expansion provisions of the health law took effect.
Hartford Courant: Most insurance companies selling health plans in the state's individual market will get to raise customers' premiums in 2016, but not by as much as they proposed, and ConnectiCare Benefits—the largest carrier in the state's insurance exchange—will have to lower rates, according to decisions released by the Connecticut Insurance Department.
A National Healthcare Quality and Disparities Report by the Agency for Healthcare Research and Quality identified Texas as a poorly performing state based on 200 criteria, according to The Dallas Observer. Texas falls significantly below the national average in such categories as patient safety, healthy living, HIV/AIDS, and nursing homes.
Jeffrey Brenner and the Camden Coalition of Healthcare Providers analyzed local hospital claims data and discovered that a small percentage of patients were responsible for a substantial proportion of hospital costs, according to this Health Affairs blog post. Building upon this work, New Jersey subsequently launched a Medicaid Accountable Care Organization Demonstration Project — the Camden Coalition of Healthcare Providers, the Healthy Greater Newark ACO, and the Trenton Health Team.
Starting in 2016, Capital BlueCross will offer telehealth services to their members. This offering through American Well will cost members $39 per visit and is touted to make routine care more convenient. The plan joins UnitedHealthcare and MultiCare Health Systems, which currently offer their members and patients telehealth visits for under $50.
New Mexico will become the latest state to institute an all-payer claims database(APCD), a move intended to increase healthcare price transparency for consumers, according to FierceHealthPayer. Staff at the State Human Services Department expect to award a contract early next month for a consultant to help the agency plan an all-payer claims database.
The Maryland Citizens’ Health Initiative Education Fund (MCHI) collaborated with local health improvement coalitions, health departments, hospitals, local community and faith leaders, and the Maryland Hospital Association to hold eleven regional public forums over a seven-month period about health system transformation. This MCHI report to the state’s Health Services Cost Review Commission’s Consumer Outreach Task Force provides recommendations for continued and expanded consumer outreach strategies. Click here to download the MCHI report.
Kentucky Health News: A report released by the Foundation for a Healthy Kentucky and the University of Kentucky College of Public Health examined the relationship between health, income and education and found that poverty and lower education was consistently associated with poorer health outcomes.
The University of Arkansas for Medical Sciences was one of 21 institutions nationwide to receive funding from the Department of Health and Human Services, Advanced Nursing Education program, reports Arkansas Business. The awarded amount of $1.9 million will be invested in the Geriatric Advanced Practice program which is currently training 16 students with 15 to 20 more expected to enroll each of the next few years. The goal of this program is to train nurse practitioners to assist those older adults who have to manage at least one chronic condition, as well as improving access to care for those living in more rural areas.
Rochester’s NBC affiliate KTTC reports on a Mayo Clinic pilot program to expand telemedicine services in rural southeast Minnesota. The program uses telemedicine kiosks with advanced diagnostic tools that enable providers to evaluate and communicate with patients in rural areas of the state. The state legislature recently required private insurance companies to reimburse providers for telemedicine services and legislators from rural Minnesota have sent a letter to Congress pushing for reimbursement for Medicare patients.
The Washington State Multi-Payer Medical Home Reimbursement Pilot tested a payment method for the patient-centered medical home (PCMH) model intended to reduce emergency department and hospitalization rates, according to an article published in Population Health Management. The study found that the data reporting and payment methods were insufficient to realize the potential of the PCMH population health approach; specifically, the study found that data for population health interventions must (1) define the population; (2) be accessible to healthcare providers; and (3) have an all-inclusive perspective to describe the health needs of an entire population. Further, payment methods must create incentives that work across the health system and support infrastructure development for population health interventions, including integrated information exchange between primary care, specialty care, EDs and hospitals.
Pennsylvania’s healthcare system is below average in the value of care provided reports Philly.com. Healthcare spending per person in the state is at least $900 more than the national average. The article suggests that the state look to successful reform programs in states like Arkansas, Maryland and Massachusetts in order to improve healthcare value.
Minnesota Public Radio: More than one million emergency department (ED) visits and more than 70,000 hospital admissions in Minnesota possibly could have been prevented, according to a study by the Minnesota Department of Health. Researchers found $1.9 billion potentially preventable ED visits and hospital admissions in 2012. They said about two-thirds of ED visits likely could have been avoided if patients had better access to preventative care or better-coordinated healthcare.
Healthcare For All, a leading health advocacy organization in Massachusetts, released an evaluation that analyzed the criteria for accessibility, comprehensiveness and guiding decisions for the required price transparency regulations enacted in 2012. Doctors, hospitals, and health insurers are all required to provide cost estimates upon request and Healthcare for All evaluated the top three insurers in the state and found that there is a still a lot of space for improvement in all three websites.
Health Affairs Blog: The proposed change of incentives has the potential to positively alter hospital workplace culture by halting the current revenue-based push to do more — an effort that invariably trickles down to doctors. Maryland’s framework has the potential to break these vicious cycles and replace them with virtuous ones leading to greater quality and health.
After being enacted and implemented in 2009, Tennessee’s all-payer claims database (APCD) ceased operations in October 2011 when the contract with the original contractor lapsed, according to the Tennessee Department of Health Care and Financing (HCFA). The APCD was transferred to a newly-created HCFA, which procured a new ACPD vendor on Nov. 1, 2013. In 2015, all payers and insurers began submitting data again including, historical data since Jan. 1, 2012, and ongoing data on a prospective basis. By statute, the Tennessee Health Information Committee oversees and approves the data management, reporting, and research activities of the APCD and may impose penalties on payers that fail to comply with their obligations.
Arkansas state legislators met with the U.S. Department of Health and Human Services and The Stephen Group—a healthcare consulting group—to discuss the direction of the Arkansas Healthcare Payment Improvement Initiative, reports Little Rock’s ABC affiliate KATV. The Stephen Group, who was hired by the State Legislator to assess the AHCPII program, reported that the work being done by the AHCPII is innovative, but the state should look to successes in other states to address some high-cost areas.
A report by the Health Care Incentives Improvement Institute has scored Texas as an F for the third time in a row, according to Healthcare Daily. There has been little movement to improve the failing grade, a few bills failed in 2013 and no transparency bills were filed in 2015. The Texas Hospital Association provides chargemaster prices on txpricepoint.org; however, the tool is likely to be useful to consumers who rarely pay chargemaster price as a result of insurance-provider negotiations.
A report from Duke University Law School found that around 35 percent of people in Pennsylvania have inadequate access to primary care. The report finds that Pennsylvania could save between $6.4 billion and $12.7 billion dollars each year if greater practice autonomy was allowed. The research concludes that Pennsylvania should follow the lead of the 21 other states and the District of Columbia in authorizing full practice autonomy for nurse practitioners.
In 2008, following several years of capped enrollment, Oregon was able to enroll 10,000 additional people in its Medicaid program. Due to overwhelming demand, applicants were selected using a lottery system. The result of this unique process was effectively a randomized controlled study that allowed researchers to examine the impact Medicaid coverage had on the health and behavior of randomly selected individuals. This Health Affairs policy brief summarizes results from the Oregon Health Insurance Experiment as well as their implications for the ACA’s Medicaid expansion.
The Health Insurance Commissioner, adopted measures to reduce the use of fee-for-service payment as a payment methodology. The plan, based on the recommendations of the state’s Alternative Payment Methodology Committee, include the approved use of total cost of care budget models, limited scope of service budget models, episode-based (bundled) payments, infrastructure payments and pay-for-performance payments for 2016-2017, and other non-fee-for-service payments. Additional details are left to be addressed by the Alternative Payment Methodology Advisory Committee.
Hospitals in the Chicago area are trending toward consolidation and the number of independent health systems continues to decline, according to Healthcare Dive. Independent hospitals are facing the reality that in order to survive they need to team up with bigger health systems. Hospitals are having trouble filling beds because insurance companies seem to prefer larger health systems.
2,700 doctors were outed by Open Payments, receiving a total of $9.6 million in gifts from pharmaceutical and medical device companies between August 2013 and December 2014, according to GoLocalProv News. While proponents of industry-provider relationships suggest these interactions can drive innovation in care; opponents suggest these gifts may drive overutilization of expensive brand medications and treatments.
Jacob Kuriyan, founder of Physmark Inc., which creates software designed to reduce healthcare costs, analyzed New Mexico’s Medicaid database and identified changes that could save taxpayers more than $200 million, reports the Albuquerque Journal. These ideas include reducing the amount Medicaid pays for those without chronic disease by 10 percent - which would save the program around $67 million—and altering Medicaid fee-for-service program provider payments to be more in line with Medicare payments. Additionally Kuriyan suggests that the state should expand cost-containment strategies used in some areas of the state to narrow the state’s wide regional price variations.
This article by Mid-Missouri Public Radio describes the impact of the ACA on rural residents of the state, who tend to be a little older, sicker and poorer than their urban counterparts, a combination that previously put health insurance out of reach for many.
The four main areas of focus for Idaho’s State Healthcare Innovation Plan, include telehealth, Medicaid’s move toward managed care, suicide prevention and advanced care planning, according to the Health Quality Planning Commission. The Commission also noted successes for the Idaho Health Data Exchange including a 76 percent increase in participation by clinicians.
Green Bay Press Gazette: A program in Green Bay, called the Parks Prescription Program aims to promote healthier lifestyles through physical activity, raise awareness of the dangers of childhood obesity and increase use of city parks in partnership with children's healthcare providers. Doctors that participate in the program screen patients ages 6 to 13 for excessive weight and will write “prescriptions" for those who could benefit from more activity to participate in the Green Bay Parks Department's free, 10-week Summer Playground Program.
Cleveland Plain Dealer: Independence at Home, a Medicare pilot program that considered the cost saving possibilities of delivering primary care at home, was tested at the Cleveland Clinic. According to data released from the Centers for Medicare and Medicaid Services (CMS), the program saved about $25 million in healthcare spending for the 8,400 patients enrolled during its first year. The Cleveland Clinic plans to expand the in-home care model.
Health policy discussions in Colorado and across the nation are increasingly turning to the subject of network adequacy—the narrower networks that are one result of price-based competition in the insurance market.
The Colorado Health Institute has published a new report titled Narrow Networks in Colorado: Balancing Access and Affordability. It is the first in a series of reports planned on the subject of network adequacy.
Albuquerque Business First: The New Mexico Department of Health has been paying close attention to the rise of telehealth and convened a summit on the topic in mid June. At the summit, the CEO of Net Medical Xpress stated that telehealth could be successful with proper partnerships with public organizations and the private sector. The experts attending the summit concluded that telehealth access provides significant benefits to patient care and can lower the patient costs.
Matthew Valenta of the Colorado Consumer Health Initiative calls for more scrutiny of proposed rates by insurance companies and points to several market wide factors that the state's Division of Insurance should consider when evaluating insurer rate requests.
Amid criticism of wasteful spending and mismanagement, the North Carolina Senate has proposed to strip Medicaid administration from the state Department of Health and Human Services and instead, have a “Health Benefits Authority” with leadership appointed by the Senate, according to a News & Observer article. The newly created group would contract with three providers, establishing six state regions with two local providers each. The measure is designed to save money by switching from fee-for-service payments to global budgeting and is expected to stimulate much debate.
This report—published in the American Journal of Managed Care—focuses on the early perceptions held by stakeholders directly impacted by the AHCPII during its early stages of implementation. Providers were initially skeptical about the impact that the program would have, however after participating they realized that there were many positives that came from the changes. The primary benefit noticed by providers was their ability to generate savings under both the PCMH and episode based payment initiatives. Finally Arkansas payers who were involved in the implementation of the initiatives believe that the effort and challenges were worth while.
Cleveland Plain Dealer: Cuyahoga county department of public health released an initiative called HIP-C, or Health Improvement Partnership-Cuyahoga. HIP-C's most difficult goal, though, will be in changing the prevailing attitude, which holds that individual behavior change is enough to turn around the health of a community.
Since passage of the Affordable Care Act more than 13,000 people in New Mexico have received tax credits to assist in purchasing health insurance, while the uninsurance rate decreased from 20 percent in 2013 to 15 percent in 2014, according to KRWG.org. In addition, more than $68,000 has been returned to consumers after insurers failed to meet the federally mandated 80/20 medical loss ratio requirement. The U.S. Department of Health & Human Services also highlights New Mexico's investment of $7 million into rate review and $144 million into community health centers.
The Federal Trade Commission (FTC) submitted comments on the New York Senate Bill 2647 and Assembly Bill 2888. The FTC claims this legislation would allow for the collaboration of providers beyond the reasonable standard established by antitrust laws. These collaborations may result in reduced competition and higher costs for consumers.
After two years with its regulatory hands tied, the Florida Office of Insurance Regulation is free this year to challenge insurers again — in a market seeing double digit hikes, according to the Miami Herald. A 2013 law barred the Florida Office of Insurance Regulation from regulating proposed rates in Affordable Care Act plans, stating that the state office could not have a final say over federal laws and regulations such as the ACA. That law expired this year.
St. Louis Post-Dispatch: Missouri is one of the few states that does not allow its insurance regulators to review and approve health plan prices before they can be sold. As a result, local health advocates are planning for the first time to conduct that review themselves.
The Universal Healthcare Action Network Ohio released a survey report titled Community Health Workers: At the Heart of Transforming Ohio’s Healthcare Delivery System. The survey, conducted in 2013-14, explored how community health workers were being utilized throughout Ohio. The results show that community health workers are effective in their work because of their knowledge of the communities in which they work.
Iowa’s Medicaid expansion waiver, which requires beneficiaries to pay premiums and cost-sharing, has collected modest sums so far, according to Modern Healthcare. Other states have explored replicating this design. However, critics, backed by a number of studies, warn that imposing cost sharing on Medicaid beneficiaries discourages people from signing up for coverage and from seeking needed care.
Medicaid’s Medical Home Collaborative resulted in a savings of $22 per member per month or a total of $2.4 million each year, according to the Preliminary Report and the Final Recommendations. Among the other findings, practices with strong follow-up were successful with reducing readmissions and use of emergency departments, but continued research needs to establish whether the program experienced short terms savings at a long term expense.
Patients are spending fewer days than ever in the hospital, with the total number of days sliding by 14 percent during the past five years, according to a report by the Pennsylvania Healthcare Cost Containment Council.
The fifth installment of a Robert Wood Johnson Foundation-funded evaluation of the AHCPII, this Health Affairs blog post highlight new episodes of care that the state added to its bundled payment program as well as highlighting the AHCPII’s desire to add more conditions. Additionally, the authors point to other states, including Ohio, Rhode Island and Tennessee, that are pursuing similar episodic payment programs. This blog post also links to the Statewide Tracking Report.
A new North Carolina law requires pharmacists to notify the prescribing physician when a biosimilar drug is substituted for a more expensive brand name biologic drug, according to North Carolina Health News. According to critics, the law -- similar to ones passed in a few other states -- could stifle development of potentially cheaper biosimilar drugs by creating additional barriers to market entry. [See the Hub’s Research Brief No. 5, Rx Costs: A Primer for Healthcare Advocates for more information on the impact of biologic specialty drugs on healthcare spending.]
Insurance plans offered through California's Marketplace have narrower networks than comparable commercial plans. However, there does not appear to be a substantive difference in access to in-network hospitals, according to a study published in the May edition of the journal Health Affairs. More surprisingly, depending on the measure of hospital quality used, the Marketplace plans have networks with comparable or even higher average quality than the networks of commercial counterparts.
Portland Press Herald: The Maine legislature failed to override a veto by Gov. LePage of a bill that would have capped the extra amounts some health insurance plans charge for smokers. Legislators were worried that such a bill would make coverage too costly for consumers who smoke in Maine.
Beginning May 1, Oregon consumers can see proposed rates for 2016 individual and small employer health insurance plans.
Health insurance companies submitted rate requests to the Department of Consumer and Business Services, Insurance Division on April 30. The division must approve any rates before they can be charged to policyholders. Click here to see news release from the Oregon Department of Consumer and Business Services.
The Houston Chronicle: Not only do the vast majority of Texans think having insurance is important for them and their families, seven in 10 also want health coverage for everyone else.
And they are willing to dig into their pockets to pay for it.
Iowa and Missouri share a border, but the states have taken very different approaches to Medicaid expansion, according to the Cedar Rapids Gazette. Iowa has expanded it while Missouri has not, costing that state's hospitals money and harming the quality of life for its residents, according to a Families USA report. The report estimated that if Missouri had extended Medicaid in 2014 it would have saved an estimated $385 million in uncompensated care costs by 2022.
This assessment fulfills the commitment made in April 2014 by the Division of Public Health leadership to better understand the health issues of Idahoans, the underlying factors impacting health and the resources needed to fill the remaining gaps, according to Get Healthy Idaho. The top issues for leaders in the health system included healthcare access, obesity, heart disease and stroke, vaccine preventable diseases, exercise and suicide. The report covers demographics and social determinants of health, leading causes of death, leading health indicators, health professional shortage areas, and a community health assessment.
House Bill 2468 will enable state regulators hold insurers accountable for delivering access to needed healthcare services through provider networks. The bill passed the Oregon Senate today and is on its way to Gov. Brown’s desk. Read news release from OSPIRG.
According to a Triangle Business Journal article, House Bill 839 has been introduced to require pharmaceutical manufacturers to publicly report cost and utilization information. California and Massachusetts have introduced similar bills.
Modern Healthcare: The Medical Center of Central Georgia agreed to pay the federal government $20 million to settle allegations that it improperly billed short-stay admissions as inpatient rather than outpatient visits.
The former state-owned charity hospital system transitioned to a private-public partnership model, referred to as the Alliance of Partnership Hospitals, beginning in April 2012. According to this legislative update, the Alliance touts improvements including the reduction in ED wait times, increase in outpatient visits, and reduction in costs per patient day, among other things.
The Washington state legislature passed a bill to establish a fully functional All-Payer Claims Database (APCD). The bill now heads to Gov. Jay Inslee for his signature into law. The bill had strong support among businesses, health-care providers and patient organizations and corrects issues in a 2014 APCD law. Among the problems with the existing law was that it lacked a requirement that all health insurers submit data.
Minnesota’s obesity rate has held level since 2008 according to Minneapolis NBC affiliate KARE11. This story attributes these results to the Statewide Health Improvement Program (SHIP) that was a part of the state’s 2008 healthcare reform.
Catalyst for Payment Reform and the New York State Health Foundation released the Scorecard on New York Payment Reform.
Intermountain Healthcare introduced a new telemedicine system that enables rural hospitals to consult with specialists in its larger, urban hospitals, according to television station KSL. The tool has proven to be valuable for diagnosing illnesses and gives patients the flexibility to be treated in their local hospital.
A report released in April by Trust for America's Health found that Georgia ranks 37th among states in per capita spending on public health. Georgia has a heavy disease burden, including high rates of HIV, hypertension, diabetes, tuberculosis and low-birth weight babies. The state also has large percentages of people living in poverty and without health insurance. The report said federal funding for public health has remained relatively flat for years.
Albuquerque Journal: The New Mexico state legislature passed a law that limits non-compete clauses between hospitals and providers. The law went into effect July 1, 2015, and allows providers to remain in communities where they have created significant relationships with patients by allowing them to move more freely from one practice to another. The New Mexico Medical Society believes that this law will help to improve patient continuity of care.
This April 2015 report published by the University of Washington evaluates seven value-based payment reform programs in Washington, Oregon, Pennsylvania, Maine, New Hampshire and Massachusetts. All of these states were pushing to transition to value-based payment. The researchers found that value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers and purchasers. Examples of such successful coalitions include the Washington Health Alliance.
Georgia Health News: Wellness programs could potentially help lower costs for employers however there is still controversy surrounding their implementation. In Georgia, many workplaces are turning to programs that stress nutrition and exercise as a means to the number of employees with diabetes.
New York Times: Taking a stand against the rapidly expanding use of telemedicine, the Texas Medical Board voted Friday to sharply restrict the practice in the state, siding with organizations representing doctors over the objections of industry representatives who said the new rules would reduce access to medical care at a time of increasing demand.
The Atlanta Journal-Constitution: A growing number of primary care providers in Georgia are partnering with insurers, hospitals and specialists to improve patient health outcomes by better coordinating care. Launched in 2013, this Blue Cross program is experimenting with paying doctors based on how patients fare rather than the traditional model of reimbursing for every service, test and office visit. Called Enhanced Personal Healthcare, the program has nearly 1,000 providers participating.
This BMJ report analyzed hospital admissions from 2004, two years prior to health reform, to 2009, two years after implementation. The report found that expanding health insurance coverage did not result in fewer hospitalizations or change disparities in admission rates between different races.
Indiana has added 939 providers, including 335 physicians, to the networks of the Healthy Indiana Plan and other Medicaid programs since the Centers for Medicare and Medicaid Services approved the state's alternative Medicaid expansion plan in January 2015. The Healthy Indiana Plan reimburses providers at Medicare rates, and the state raised reimbursements on average by 25 percent for those treating the traditional Medicaid population. More information here.
The State Journal: According to a report released by KYHealthNow, more Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services since the launch of kyhealthnow. The report showed Kentucky is moving towards meeting the wide-ranging goals laid out in the initiative, which was launched in February 2014.
The Alaska Health Care Commission is a state advisory body that makes policy recommendations to reduce health costs, improve quality, and drive positive outcomes throughout the state. It does so by conducting independent analyses, consulting with healthcare payers, providers and patients, and identifying opportunities for driving system improvement. While no one questions the fact that Alaska faces enormous health spending challenges and the need to control spending, short-term budget cuts may rule the day.
The legislation would empower consumers to take personal responsibility for their own healthcare costs by improving access to healthcare prices.
Medical prices are often hidden until patients receive a bill, and many bills contain extra charges and surprise fees. Senate Bill 891 addresses these problems by requiring Oregon healthcare facilities to post their prices publicly, both at the facility and online, and to provide real-time price estimates for consumers on request.
“With Oregonians picking up an ever-greater portion of their own healthcare costs in the form of higher deductibles and coinsurance, it’s more important than ever for consumers to know the price of healthcare up front,” said OSPIRG Healthcare Advocate Jesse O’Brien. “We all know that healthcare still costs too much. The least we can do is make sure healthcare facilities post their prices, like any other business.”
Research shows that a lack of public information on the price and quality of healthcare services hampers competition and contributes to excessive spending by consumers, insurers, taxpayers, employers and other payers. The Institute of Medicine estimates that inflated prices due to lack of competition and excessive price variation cause $105 billion in waste in healthcare spending each year.
SB 891 will start addressing these problems by doing the following:
As a physician, I think my patients deserve to know the price for healthcare services so they can be empowered to make better-informed decisions,” said Senator Steiner Hayward. “Senate Bill 891 will strengthen the doctor-patient relationship by enabling physicians to start a dialog with patients about value in healthcare.”
“Senate Bill 891 is about personal responsibility,” said Senator Boquist. “If we want Oregonians to have the tools they need to take charge of their own healthcare, we must take action to make sure consumers can access accurate, actionable information about healthcare prices.”
For more information about SB 891, check OSPIRG’s fact sheet, available at http://bit.ly/1wRNBMF
Starting this month, the Community Health Centers of Benton and Linn Counties are taking part in a one-year pilot program that pays them a flat monthly rate for providing a full range of services to the 6,322 Oregon Health Plan members assigned to the county-run clinics in Corvallis, Monroe and Lebanon.
Rather than billing OHP (Oregon’s version of Medicaid, the federal insurance program for the poor and disabled) on a fee-for-service basis, the Community Health Centers will receive a single payment each month from the InterCommunity Health Network, the regional coordinated care organization for Linn, Benton and Lincoln counties.
The clinics are to receive payments ranging from $15 to $86.36 a month for each assigned patient, depending on which risk-weighted rate group the patient falls into. The estimated revenue for the clinic is $170,041 a month, or just over $2 million for the year, though the amount will be adjusted periodically as the numbers and types of OHP patients change.
IHN is providing an additional $400,000 or so to cover most of the cost of salary and benefits ($408,000) to add the equivalent of five full-time staff members for the clinics, and the two parties have agreed to a set of benchmarks to measure how well the system is meeting goals for access, quality of care and utilization.
Click here for more information.
New Mexico’s NurseAdvice is a free 24/7 call line staffed by nurses that patients can call when they are experiencing a medical issue. The call line provides patients with multiple advantages including increasing access for those living in rural areas and advising patients on whether or not they should go to the emergency room. NurseAdvice is also one of the least expensive technologies that can be used to reach a patient in their home. KRQE—a CBS-affiliated television station in Albuquerque—reports that during an April emergency preparedness summit in Atlanta, the CDC recommended NurseAdvice as a national model for other states moving forward.
With healthcare payers increasingly relying on narrow provider networks to contain costs and achieve quality, the California Department of Insurance is beefing up its network adequacy standards and aiming to improve the accuracy of provider directories. State bills also have been filed to protect consumers from out-of-network billing (AB 533, Bonta) and to improve provider directories for plans regulated by both the Department of Insurance and Department of Managed Healthcare (SB 137, Hernandez). Click here for news article.
Portland Press Herald: Hospitals in Maine have begun feeding patients locally sourced, healthy foods as an effort to increase patient experience. At least ten hospitals across the state have been working with local farms and Maine fisherman to create healthy menus and attract patients through better food.
Albuquerque’s CBS affiliate KRQE reported on the difficulty that many in New Mexico are having in paying and understanding their medical bills. Think New Mexico, a state advocacy group, believes that lack of transparency causes patients in New Mexico to pay hundreds of dollars extra each year in medical costs. Advocacy group Costs of Care argues that it is “inexcusable that [consumers] cannot get at least basic information about price and quality in healthcare.” There are currently competing legislative bills addressing healthcare cost transparency—one proposed by Think New Mexico and the other by the New Mexico Hospital Association—being discussed. Healthcare systems have stated that they must first figure out how to make the billing process cleaner.
In October 2014, the Foundation for Healthy Kentucky convened over 60 Kentucky leaders in government, business, policy and healthcare, along with experts from national organizations , including Consumers Union, to explore ways to bring credible, objective cost and value information to consumers and others. This Foundation’s report recommends that the Commonwealth of Kentucky establish an All-Payer Claims Database as a necessary tool to change the way healthcare is delivered. Click here for the full report and executive summary.
The Georgia Rural Hospital Stabilization Committee released a final report recommending including the establishment of a four-site pilot program, based on an integrated “hub and spoke” model, to relieve cost pressures on emergency departments and ensure that the best, most efficient treatment is received by patients. The committee also recommended increased support for telemedicine for rural hospitals.
A partnership of statewide consumer and healthcare advocacy groups today applauded the filing of legislation in the Texas House of Representatives to protect patients from getting surprise medical bills after health emergencies.
Statewide consumer and healthcare advocacy groups applauded the filing of HB 1638 legislation in the Texas House of Representatives to protect patients from receiving surprise medical bills from services at emergency rooms. Leaders of AARP, Consumers Union, National Multiple Sclerosis Society, Center for Public Policy Priorities, and the American Cancer Society Cancer Action Network are calling on lawmakers to hold hearings on HB 1638 and to pass the measure.
The first report measured Medicare savings produced by Vermont’s Blueprint for Health and similar primary care reform efforts in seven other states. Of the eight states, Vermont’s savings were the most dramatic and the Blueprint was one of only two reform efforts that actually achieved slower growth in total Medicare spending. The savings in Vermont were driven mainly by better managed care that reduced the need for acute care such as hospitalizations, according to the study.
A second report focused on the Support and Services at Home (SASH) program, which is part of the Blueprint for Health. The report used two control groups, one in upstate New York and one in Vermont, and concluded that by the second year the SASH program resulted in an average $2,197 per member annual savings to Medicare compared to similar, non-SASH-enrolled New Yorkers, and an average $1,756 per member annual savings to Medicare compared to similar non-SASH-enrolled Vermonters.
This state profile for New Jersey (PDF) was prepared to assist the state with identifying key issues and opportunities under the Center for Medicare and Medicaid Improvement’s State Innovation Models program. Pulling together information from a wide range of data sources, the profile provides a state-level overview of key healthcare indicators, with comparisons to national averages.
A recent webinar describes preliminary findings from an analysis of Oregon's Coordinated Care Organizations (CCOs), which are the state's version of Accountable Care Organizations (ACOs) for Medicaid. The webinar explores the organizational structures and operational approaches of Oregon's CCOs and examine how CCOs—and the variation among them—impact healthcare access, use, quality, and costs. Findings: Use and expense for primary care services increased; Use and expense for specialty care services decreased; Pharmacy use decreased but expense increased. No significant changes for MH, ED or IP. The webinar can be accessed by clicking here.
Tandigm Health, Innovative Wellness Alliance and Holy Redeemer Health System entered an agreement that aims to bring the organizations closer to a population health model reports Modern Healthcare. The agreement will allow the organizations to share the risk of managing patients without entering a formal merger while allowing them to further implement value-based care. Furthermore, it allows the systems to take advantage of each other’s strengths further expanding the services they can offer without drastically increasing costs.
This is a test of the state news section. Is this a static page or part of a working filtered news system?
A recent evaluation published by the Association of Healthcare Journalists found that recently released price information associated with the Healthcare Cost Reduction and Transparency Act of 2013 is not consumer friendly. The author found that, although there is a search function and access to information such as the top 20 imaging procedures and outpatients surgical procedures, there are limited descriptions or explanations available on how to navigate the information. Blue Cross Blue Shield of North Carolina released a price transparency tool of their own that demonstrates the wide variation in payments to providers for the same procedures.
In 2012, according to a New York Times analysis of Medicare data released last year, more than twice the number of nuclear stress tests, echocardiograms and vascular ultrasounds were ordered per Medicare beneficiary in doctor’s offices in Florida than in Massachusetts—leading some to call Florida an epicenter of Medicare abuse. This story explores reasons for high volume in Florida.
In an effort to improve care coordination for the most at-risk South Carolinians, the General Assembly implemented the Medicaid Accountability and Quality Improvement Initiative provision to require that chronically ill and high-use patients be designated a healthcare point of contact and for providers to develop individualized care plans, according to South Carolina’s Medicaid Program, Health Connections. Support extends beyond standard medical issues and into other factors that influence a person’s health, including housing, transportation and food security.
A New York Times analysis finds big swings in Colorado Marketplace premiums. While all states show some pricing volatility, Colorado singled out for having the most.
This report from the Woodrow Wilson School at Princeton University examines how the state of Minnesota could use Section 1332 of the Affordable Care Act to advance health reform. The Minnesota Department of Human Services and MNsure--the state's health insurance marketplace--have expressed an interest in using a Section 1332 waiver to pursue a triple aim of improving patient experience and population health, while reducing per capita costs. This report explores the possibilities that such a waiver could unlock.
This report from the AHCPII focuses on the results of the PCMH and Episode Based Payments initiatives. The PCMH initiative resulted in over 70% of the state’s healthcare providers participating, 80% of all eligible Medicaid beneficiaries enrolling in a PCMH, an increase in accessibility, a reduction in hospital admissions, a reduction in emergency room costs, and a decrease in total costs. During the time period studied the episode based payment initiative resulted in reduced use of unnecessary antibiotics, a reduction in the Medicaid growth rate by 2% to 3%, and a further reduction in the cost of care. The report concludes that the as the AHCPII moves forward in moving the delivery of more care to value-based models, more providers and payers will become involved.
The Alaska Health Care Commission releases a yearly report used to alter the original 5-year strategic plan, or roadmap, for strengthening Alaska’s healthcare system. Several strategies were recommended for improving value in Alaska’s healthcare system including creating a robust prescription drug program, increasing price and quality transparency, paying for value, engaging employers, and focusing on prevention and seriously ill patients.
This working paper by Mark Shepard identified adverse selection implications associated with plans covering prestigious academic hospitals. As a result, plans may limit networks and challenge these prestigious hospitals to lower prices.
The Rhode Island Commission for Health Advocacy and Equity created this report to evaluate the impact of health disparities in Rhode Island and offer recommendations about how to improve health equity. In developing this report, Commission members partnered with ex-officio members, HEALTH, the Providence Plan, and the community to prepare background material about Rhode Island demographics and social factors, conduct an online survey about health in the state and review health disparities data.
This Health Affairs blog post is the fourth in a series of posts from the Robert Wood Johnson Foundation that focuses on the Arkansas payment delivery reform. This post further focuses on the participation of some of the state’s largest self-insured employers and the impact that this involvement has had on the program. The support of Walmart, the State and Public School Employee Plans and the State University System Health Plan has greatly benefited the PCMH initiative and it is expected that more large self-insured employers will participate in the effective PCMH program. Additionally Walmart, the Blue Cross Blue Shield Employee Pan, and around ten other employers participated and encouraged expansion of the episode based payment initiative. With these successes, however there are still philosophical and structural barriers to greater self-insured participation.
A study of California’s Hospital Fair Pricing Act, passed in 2006 (the act aims to protect uninsured patients from paying hospital gross charges) found that from 2004 to 2012, the net price paid by uninsured patients shrank from 6 percent higher than Medicare prices to 68 percent lower than Medicare prices. Another study found that although the bill did not require hospitals to provide free care for very low income patients, after it was enacted, hospitals re-examined their pricing overall and 97% established free care policies. The authors of both studies recommend that policymakers in other states study this model as a way to regulate for-profit hospitals to protect uninsured patients.
Much of the healthcare in Minnesota is provided by hospitals and insurers that are classified as nonprofit. This Star Tribune commentary finds the excess of revenue over expenses at these nonprofits is “eye-popping.” The authors argues that Minnesota needs a state standard that separates actual charitable activities from those that more closely resemble business promotion.
The North Carolina Department of Health and Human Services announced that the state’s 2010 smoking ban in restaurants and bars has improved air quality by 89 percent, decreased average weekly emergency department visits for heart attack by 21 percent, and had no negative impact on bar or restaurant income. A separate announcement celebrated the continued decline in cigarette smoking among North Carolina students; however, found a dramatic and concerning trend in the increased use of electronic cigarettes and other non-cigarette tobacco products.
A law effective Jan. 1, 2015, promotes price transparency for consumers, according to Becker’s Hospital Review. The law states that doctors who use outside pathologists or laboratories are required to disclose the actual amount charged for the services to patients. S.B. 1630 helps to protect patients from inflated healthcare costs and surprise medical bills.
Vermont was supposed to be the first state for a single-payer healthcare system in the United States. After the bill was defeated in 2014, Governor Peter Shulmin declared that it was not the right time for Vermont to become a single payer state, according to an article in Politico.
Mathematica Policy Research found that the National Capital Region, which includes Virginia, has a complex hospital market with multiple overlapping submarkets. The hospital sector, especially in Northern Virginia, is characterized by significant geographic segmentation. In addition, fee for service is still dominant, and accountable care organization activity is nascent and scattered.
Cost variations exists across the state, especially in the small group market, according to report by Citizen Action of Wisconsin. Other key points includes the lack of correlation between quality and health insurance costs and cost rankings of premiums by city.
Lucinda Jesson, the commissioner of the Minnesota Department of Human Services, stated in the Star Tribune that the DHS was able to save over $1 billion and created greater transparency and value in Minnesota healthcare purchasing—which works state wide to develop common strategies for performance measurement, promote greater transparency of healthcare costs, and creating greater accountability for healthcare results. This story explores what actions have been taken to achieve these reductions and what additional steps are being taken.
The Star Tribune reported on an analysis that finds dramatic spending variations depending on the clinics that Minnesotans choose—from $269 to $826 per patient—even after adjusting for sicker or more problematic patients. The analysis, by MN Community Measurement, a non-profit agency formed a decade ago to compare clinics by the cost and quality of care, was billed as a major advance in the consumer healthcare movement.Clinics have previously been ranked on their costs for individual procedures, such as colonoscopies. But that approach doesn’t take into account which clinics are least expensive overall, perhaps because they had fewer medical errors or could deliver quality care with fewer procedures.
Washington released a Common Measure Set, which will create a common way of tracking health and healthcare performance, as well as inform public and private healthcare purchasers. The state approved 52 measures for inclusion in the “starter set”; these measures are divided into three categories: Population, Clinical, and Healthcare Costs. Washington acknowledged that the topics identified were of significant importance, but readily available measurement/public reporting and/or nationally vetted measures did not yet exist. The lack of a robust infrastructure in Washington to enable cost-effective aggregation of clinical data for public reporting was a particularly rate-limiting element of the work.
In December 2014, Gov. Jay Inslees announced that Washington received a $65 million federal grant to fund an effort to deliver more efficient healthcare. The four-year Center for Medicare and Medicaid Innovation grant will help implement the Healthier Washington program. This initiative will create incentives designed to promote price transparency and integrated care as a way to improve health outcomes for consumers in Washington. Read more
This report from the Pennsylvania Healthcare Cost Containment Council reported the cost impact that so-called “super-utilizers”—patients who are admitted to the hospital 5+ times in a year—have on the healthcare system.
New York state announced the approval of a $100 million State Innovations Model Testing Grant from the Centers for Medicare and Medicaid Innovation. The funding will go towards New York’s Health Innovation Plan, a strategy to increase transparency, implement payment reform that encourages service quality over quantity, and to support the state’s Health Prevention Agenda by promoting access to primary care and community based resources.
Most D.C. metro area hospitals are sticking to fee-for-service reimbursement strategies and plan to attract patients by building urgent care centers and freestanding emergency departments in affluent areas, according to a report from the JKTG Foundation for Health and Policy. Some hospitals, however, are using these ambulatory service centers to position themselves for population health management under value-based payment.
This report by the Trust for America’s Health, financed by the Prevention and Public Health Fund, details public health and prevention activities around the state.
The Health Policy Institute of Ohio created a Health Policy Value Dashboard that lays out the different value incentives in Ohio healthcare.
The Alaska Health Care Commission published a policy brief summarizing the benefits,concerns and key provisions included in legislation that would institute and all-payer claims database (APCD). The benefits of an APCD included increased value and improved health outcomes, utilization and cost analyses and clinical quality improvement initiatives. Concerns revolved around data privacy and security and the cost of establishing and operating an APCD.
This report, completed yearly, tracks the progress of the state’s healthcare system and the impact of the recent health reform measures. In 2013, at the time of this survey, coverage remained high with 95 percent of Massachusetts adults participating in health plans. Affordability challenges continued to exist at levels observed in 2006, with one in five adults reporting problems paying medical bills. Reported access to healthcare slightly declined since the implementation of health reform; however reported healthcare quality increased. The report identifies the single greatest opportunity for the healthcare system is to address the burden of healthcare costs, especially for low-income families.
The fourth rate report by the New Hampshire Insurance Department found that high provider reimbursements were a major insurance premium cost driver. Premiums increased three percent from 2012-2013, partly curbed due to a consumers shift towards products with higher deductibles. The report also found claims are trending away from inpatient, outpatient, and pharmacy services and towards professional services. Although services are moving away from hospitals, rate changes for inpatient and outpatient services remain high. These findings are consistent with findings from previous years.
The California Dept. of Managed Healthcare released the final report of a "Non-Routine Survey" of Blue Shield of California that found significant inaccuracies in the provider director for the health plan's narrow network. The report revealed that "a significant percentage (18.2%) of the physicians listed in the directory were not at the location listed in the Provider Directory and that a significant percentage (8.8%) were not willing to accept members enrolled in the Blue Shield's Covered California products, despite being listed on the website as doing so." A non-routine survey of Anthem Blue Cross made similar findings: that a significant percentage (12.5%) of the physicians listed in the directory were not at the location listed, and a significant percentage (12.8%) were not willing to accept patients enrolled in the Plan’s Covered California products….” The report is available here.
NPR covers how the price transparency measures included in the 2012 reform requiring private insurers to post price estimates online, such as the tool available through Harvard Pilgrim Healthcare. These tools allow consumers to browse price differences among providers. As a result, patients with the incentive to shop now have resources to utilize when trying to spend less.
This study examined Florida’s 2006 Medicaid Reform, which mandated that Medicaid beneficiaries switch from the state’s FFS system to (1) insurer-owned plans, (2) hospital-owned plans, or (3) physician-owned plans. The study found that insurer-owned plans reduced costs by 7-12% in all markets, but insurers in different markets reduced costs in different ways. The results suggest that insurers have leverage in how they reduce costs, but that competition with provider plans may restrict their options.
This Governing article summarizes the transparency measures beginning in October 2014 as a result of the 2012 reform aiming to implement cost controls. Private insurers are required to post price estimates for services online and physicians must provide price estimates to consumers who ask. Concerns remain as to how accurate these prices are and how patients may be responsible for additional hidden fees. At this time, price information is only required to be available to plan members, compared to New Hampshire’s practice of comparing between insurers as well. Quality measures are a critical next step in transforming these cost estimates to value measures.
The Center on Budget and Policy Priorities reported that a 2012 Mathematica evaluation of Indiana’s existing HIP waiver showed that the required POWER account contributions (that is, the premiums under HIP) effectively restrict HIP enrollment. The evaluation found that over a five-year period from 2008 to 2012, some 17 percent of those found eligible for the program — or over 21,000 people — never enrolled because they didn’t pay the initial premium. Moreover, at the time of the evaluation, HIP covered people with incomes up to 200 percent of the poverty line, but 69 percent of those who didn’t enroll because of non-payment of the initial premium had incomes below 100 percent of the poverty line. And of those who did enroll, 12 percent subsequently lost coverage because they failed to pay premiums, with 58 percent of those being people with incomes below the poverty line.
The Colorado Health Foundation announced its support of a ten-year commitment to a community-level collaborative approach to address healthcare costs through delivery system and payment reform. The delivery system and payment reform initiative will focus on accelerating the “Triple Aim” of healthcare: better health for our population, better care for individuals and lower costs for all.
This Health Affairs blog post is the third post in a series by the Robert Wood Johnson Foundation that focuses on the payment and delivery reforms in Arkansas. This post focuses on the participation of Blue Cross Blue Shield (BCBS) and QualChoice - two private insurance companies located in Arkansas - in the creation and implementation of the AHCPII. This post identifies that BCBS had previously experimented with PCMH models and showed significant success in the pilot programs, therefore making the a good partner in the creation of this measure. Furthermore, BCBS and QualChoice’s participation in the episode based payment initiative has made the results more impactful than if the state run Medicare program attempted this initiative on their own.
California Gov. Jerry Brown signed legislation to boost oversight of so-called “narrow networks” and other business practices that affect timely access to care. Many patients in the state found it difficult to find a doctor or get an appointment in a timely way.
The law requires the California Department of Managed Healthcare to review Medi-Cal managed-care plans and plans sold through Covered California annually for compliance with standards related to timely access, network adequacy, continuity of care and quality management. Consumer groups supported the measure; health plans said it wasn’t necessary.
This story found that an emergency room visit to an out-of-network hospital resulted in even higher bills than if the patient had been uninsured.
This Boston Globe article reflects on the dynamics between the Greater Boston Interfaith Organization, a consumer group, and Massachusetts hospitals as they navigate health reform. Both groups are working together to achieve high quality, affordable care. The author suggests these kinds of engagement and collaboration are necessary in meeting the new state mandated limits on healthcare cost growth.
New regulations that took effect in July 2013 direct Texas insurers to – for the first time – publish PPO plan out-of-network service data by network hospital for specific hospital-based physician types, including emergency room doctors.
According to an article by Capital New York, many New York health insurance companies asked for double digit rate increases for 2015, but the state dramatically reduced most requests. This follows on the heels of a tamping down on 2014 rate requests. As highlighted by a Kaiser Family Foundation study on 2014-2015 premium changes, these rate reductions have prevented significant price increases for New York consumers.
The State Health Commissioner announced the launch of the redesigned NYS Health Profiles Website. This tool allows consumers to explore and compare quality measurements of area hospitals, home care organizations, nursing homes and physicians.
As required by the AccessRx Act of 2004, the District of Columbia Department of Health reported that in 2014, pharmaceutical and device manufacturers spent $22.6 million on gift expenses, $7.9 million on advertising expenses and $65.1 million on aggregate expenses. Advertising expenses increased by $2.2 million compared to 2013, while the publicly reportable gift expenses decreased by $7.9 million. The findings suggest there may be a shift away from payments captured by the federal Sunshine Act and publicized in the database Open Payments and toward more confidential practices.
New York Times: An increasing number of Texans are choosing to use urgent care centers that are popping up in strip malls and shopping districts—and is problematic for Texas hospitals. Hospitals say they are competing with the clinics for the same pool of insured Texans, at a time when they are also getting less money to cover the cost of treating uninsured patients.
Healthcare IT News announced North Carolina’s step towards transparency with the passage of the Healthcare Cost Reduction and Transparency Act of 2013. This legislation calls for the creation of a website that will publicly display the most current price information from Medicare, Medicaid, and the largest private insurers. The legislation also limits hospital's ability to take extraordinary measures to collect reimbursement of unpaid medical bills due to new limits on putting liens on residences and garnishing wages. Additionally, provider network directories must be maintained online, and available to consumers in many forms. At the time of passage, Maine and Massachusetts were the only other states publicly publishing price data.
Denver Post: The Colorado Commission on Affordable Healthcare began its work last Friday, Aug. 22. The commission, which was created by Senate Bill 187, is tasked with looking at the growing healthcare costs in Colorado for the next three years. Through its analysis of a wide variety of healthcare costs, the commission must make recommendations to the legislature. Follow @cchipolicy and #COCostComm on Twitter for updates.
The individual market has been dominated by Anthem Blue Cross Blue Shield, according to a report by the New Hampshire Insurance Department. From 2013 to 2014, market share of the insurance giant rose from 84 percent to 92 percent. The lack of competition among insurance plans heightens concerns that premiums may continue to go unconstrained.
This Commonwealth Fund report focuses on the AHCPII and the lessons and insights gained since the program’s inception in 2011. The general, the report’s authors find that progress is best gained through an inclusive and deliberative process facilitated by committed leadership, a shared agreement on root problems and opportunities for improvement, and strategy grounded in the state’s particular healthcare landscape.
The Missouri Department of Insurance announced that it had reached a settlement with the Anthem BlueCross BlueShield of Missouri family of insurers to return a record $7.8 million to some consumers for charging them more for “substantially equivalent health plans” sold to other Missouri consumers. Missouri is the only state where oversight agencies can only protect health insurance consumers by conducting these market conduct reviews “after the fact.”
Milwaukee Journal Sentinel: Six of the largest health systems in Wisconsin created a partnership with the goal of improving healthcare quality and lowering costs. The six health systems are to share best practices for improving quality and eliminating waste. The new partnership hopes to contract with health insurers, and the statewide network could appeal to national and government employers. The six health systems now belong to the narrow networks of Anthem Blue Cross and Blue Shield in Wisconsin.
The three CareFirst carriers in Maryland received approval to increase premium rates by 9.8 percent (CareFirst BlueChoice, Inc.) or 16.2 percent (CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.), on average − substantial reductions from the 22.8 percent and 30.2 percent increases those companies requested for 2015, according to a news release from the Maryland Insurance Administration.
OSPIRG Foundation report analyzed the impact of health insurance rate review on 2015 premiums for Oregon individuals, families, and small businesses. The report revealed that one insurer made a major error in its initial filing, and some insurers overstated trends in medical costs. The report noted that the DOI review ensured that provider savings from reductions in uncompensated care (due to the expansion of health coverage under the ACA) were passed along to policyholders.
The Connecticut Health Policy Project released a report that examines how much Connecticut spends on health care. The report discusses Connecticut health spending and projected growth rates. The report also covers who pays the health care costs, where each health care dollar is spent, and what factors are driving health care costs, both nationally and in Connecticut.
Dr. Sanjeev Arora, a hepatologist at the University of New Mexico in Albuquerque, has developed Project ECHO, a solution for patients with hepatitis C that could help transform healthcare, according to The New York Times. A team of specialists used video conferencing to provide weekly training to primary care providers on managing patients with hepatitis C, removing the cost and travel barrier for New Mexicans living in remote areas. A Health Affairs study found that the primary care clinicians achieved better cure rates and their patients experienced fewer serious adverse events.
This Health Affairs blog post is a second in a series funded by the Robert Wood Johnson Foundation focusing on the development of Arkansas’ PCMH model. Additionally the post discusses the key aspects of the model, which include—payment structure, shared savings structure, quality metrics, payer involvement, provider participation, and legislative and regulatory alignment.
The Commonwealth Fund named Vermont as one of the top ranking states for improving healthcare access, quality, outcomes and lowering costs in the five years preceding implementation of the Affordable Care Act’s major coverage provisions, according to Vermont Biz.
This report by the California Healthcare Foundation and the Robert Wood Johnson Foundation found price transparency in New Hampshire has been successful, not in stimulating consumer shopping directly, but by drawing attention to the variation in prices and fostering changes in benefit design. The lack of insurer competition in the state is likely a significant limitation of the state’s transparency efforts. While the consumers have access to information that promotes shopping, there are few alternatives for consumers to choose from.
New York announced the CMS approval of a Medicaid waiver to fund the Delivery System Reform Incentive Payment (DSRIP) program. This Medicaid waiver restructures the Medicaid program using the state’s Medicaid Redesign Team’s recommendation and $8 billion in reinvestments to reward milestones in system transformation, clinical management and population health. Although planning began in 2014, key delivery reforms will launch in 2015 creating 25 Performing Provider Systems (PPSs)—networks of providers who will be held accountable for health outcomes—that aim to reduce avoidable hospital use by 25 percent within the first five years.
The District’s healthcare exchange, D.C. Health Link, is significantly different than any other state exchange, according to The Washington Post. It is signing up young adults at the highest rate of any exchange, about 46 percent. In addition, only 15 percent of those signing up for coverage qualify for government assistance. District residents are picking platinum, gold, silver, and bronze plans almost equally in contrast to the rest of the nation where the silver plan is by far the most commonly chosen plan (63 percent).
Health insurance coverage has been pivotal for keeping Hawaiians healthier than the average American, according to the LA Times. Hawaiians live longer, die less frequently from common diseases, such as breast and colon cancers, and pay less for their care compared to other Americans. For many residents, having health insurance prevents skipping needed care, encourages early detection and treatment of medical issues and allows for thorough follow-up care.
Four of Alaska’s cities are included in the list of places with the most costly care, according to Alaska Dispatch News. For example, in Anchorage, the cost for an eye exam was 72 percent higher than the national average, a physical was 63 percent higher, and a teeth cleaning was 42 percent higher. Rising costs are blamed on a variety of issues, such as increasing salaries, rents, and shipping.
This report, funded by the Connecticut Health Foundation, identifies opportunities to influence the design, development and governance of Connecticut’s APCD to maximize its usefulness specific to patient safety and health equity/disparities researchers, and consumers. Key findings include: (1) APCDs are providing consumers access to patient safety and quality reports to make informed healthcare decisions, (2) health equity/disparities researchers are working together in data, cost, and quality collaboratives, (3) NIH is funding health data research using the APCD, (4) state cost and quality councils are utilizing APCD data to regulate hospital performance and reimbursement, (5) APCDs are predominantly operating within state agencies, independent of health insurance exchanges, and (6) opportunities for engaging stakeholders to influence the design and implementation of Connecticut’s APCD.
Los Angeles Times: Maine is one of the healthiest states in the U.S. as a result of a highly personalized, collaborative medical system created in the 1970s. This article examines the system of community-based, coordinated care in Maine and its positive impact on the quality and value of care that residents receive.
This Health Affairs blog post is the first in a series of post describing a Robert Wood Johnson Foundation-funded evaluation of payment and delivery reform in the state of Arkansas. This post focuses on the basics of the state's patient-center medical home and episode-based payment initiatives. This post provides significant detail as to how the episode based payment is operated and how it is significantly different from the previous fee-for-service payment models.
The Emergency Medical Services and Surprise Bills Law was passed to require disclosure and restrictions on the amounts consumers can be charged for surprise medical bills. The measure aims to address the issue of surprise medical bills, as described in this New York Times article, and will go into effect on March 31, 2015. Addressing the issue of surprise medical bills is of interest in many states and this Consumers Union case study of New York’s work can be used by other state advocates to achieve similar legislation. [More information and resources on surprise medical bills can be found here.]
The Florida Agency for Health Care Administration published the Florida Healthcare Expenditures report for calendar year 2012. The report found that total personal healthcare expenditures increased 3.1 percent between 2011 and 2012, down from a 3.4 percent increase between 2010 and 2011. This is the second smallest annual increase since the 1993 inception of the report.
The Star Tribune reported that “healthcare homes” – open for enrollment to any Minnesota resident—which were passed as part of the state’s 2008 health reforms, have reduced medical costs while improving the quality of care. This story highlights research done by the University of Minnesota on the impact these “healthcare homes” have on providers and patients.
In February 2015, the Washington Health Alliance published a report that found that the state’s hospital readmission rates for patients with commercial insurance is 8.7 percent, which amounts to $446 million in additional health system and hospital costs. Readmissions can lead to more tests and treatment which can increase medical risk for consumers. The researchers suggest that the high readmissions rates in the state could be reduced through better coordination of care by primary care doctors.
The New York State Health Foundation’s Healthcare Costs and Spending in New York State report provides a wide variety of graphics depicting New York healthcare costs and spending. According to the report, New York is the second largest state spender on health expenditures at $163 billion every year. New Yorkers have experienced significant increases in premiums over the last ten years to accommodate the increased spending, with private insurance spending increasing faster than public. This, however, does not mean public spending is under control. In 2009, New York ranked third among states in per-enrollee Medicaid spending.
According to an allwell press release, three new healthcare organizations are participating in “allwell,” an accountable care organization. Participating members are looking to improve healthcare quality, coordinate care and generate cost savings. The original ACO was created in 2011 and generated positive results.
The New York State Department of Health 2013 Managed Long-Term Care Report reviews the 38 pre-existing NYS- certified managed long-term care plans. These plans target the chronically ill and disabled and receive a monthly risk-adjusted capitated payment to cover health and social services, including home care, personal care, transportation and skilled nursing facilities. Since the implementation of MLTC plans in 2004, enrollment has steadily increased and now covers more than 120,000 New Yorkers, 90 percent of whom reside in New York City. Enrollee satisfaction rated high, with 84 percent of respondents rating their health plan as good or excellent, although the report includes an underwhelming 27 percent response rate.
On January 10, 2014, the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services that will improve patient health and reduce costs.
The New York State Health Innovation Plan outlines health goals for 2013-2017 that includes continued adoption of best practices and outcomes, achieving high standards for quality and consumer experience, generating upwards of $5 billion in savings from prevention interventions, limiting unit price increases, and reducing unnecessary care. To reach these goals, New York aimed to utilize strategies coined the five pillars: access, care management, increasing transparency, value-based insurance design and community health, with an additional focus on investment in the workforce, health information technologies and metrics for quality, patient satisfaction and cost-effectiveness.
The New Hampshire Department of Health and Human Services produced this report to outline their plan to transform the current long term services and supports system with a 2013 State Innovation Model design grant. The plans include establishing a health home model, coordinating services and providing more control to individuals over the services they receive.
By focusing on patients that are in need of or at risk of needing long term services and supports, the State has the opportunity to tackle a high cost group, accounting for 64% of the state’s total Medicaid budget.
A New York Times article covered the huge markups included in hospital bills compared to the actual costs they incur, as seen in the Hospital Inpatient Cost Transparency Data. The data also shows the large discrepancy between providers on costs and charges. A second New York Times article highlighted important takeaways from the newly publicized data.
More than $350 million in annual costs are associated with potentially avoidable stays, according to the Hawaii Health Information Corporation. The five most common conditions to target to reduce potentially preventable hospitalizations include heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection and long-term diabetes complications.
South Carolina’s multi-stakeholder Birth Outcomes Initiative reduced early term, elective inductions by 50 percent, according to Catalyst for Payment Reform. The initiative improved health outcomes and saved $6 million in state and federal Medicaid spending in the first quarter of 2013.
To bolster the rate review process, the Arizona Department of Insurance should make information more transparent, demand more data-rich proposals justifying rate increases and request and advocate for authority to deny rate increases that are unjustified, according to a report by Arizona PIRG. The report recognized the department for its responsiveness to public inquiries and efforts to encourage stakeholder input for improvements.
A report from the Colorado Center on Law & Policy examines hospital charges and costs and found that Colorado hospitals charge (on average) four times more than what Medicare pays to treat a given diagnosis. The report also highlights the discrepancy between what hospitals charge and Medicare pays. Finally, the report demonstrates that the variation in charges between hospitals cannot be explained by the frequently-cited hospital cost drivers (e.g., regional labor costs, teaching status, and high volumes of low-income patients).
The largest such pharmaceutical recovery ever received by Louisiana was awarded as a result of two lawsuits over claims of off-label promotion to physicians, according to NOLA.com. Physicians prescribing off-label medications leave patients vulnerable to the potentially serious consequences of using non-approved, ineffective and unsafe treatments. A total of $229 million was split among eight states filing suits against the pharmaceutical company.
The Attorney General’s third report examining cost trends in Massachusetts identified consumers increasingly participating in tiered and limited networks, PPO and high-deductible plans, typically the cheapest options available to consumers. Growth in prices of medical services is the primary cost driver within the state and there continues to be a wide variation observed in prices. Providers are increasingly taking on insurance risk and aligning with other entities, potentially negatively impacting the market.
An APCD may be important for curbing the unsustainable rates of growth of healthcare spending, according to a report to the State of Alaska Health Care Commission. Data collected by the APCD would be critical for measuring performance and improvement efforts in the coming years.
Colorado voted the second happiest state in the U.S., after Hawaii. Read more >
This report evaluates the early implementation of Connecticut's Health Enhancement Program, a new value-based insurance design plan for state workers created in partnership between the governor's office, a coalition of unions representing state employees.
This New Hampshire Insurance Department’s report outlines the steps necessary to alter the current All-Payer Claims Database to be incorporated into a more robust rate review process.
Pharmaceutical reimbursement in Alaska is on par with other states, according to a report by Milliman. Workers’ Compensation payment rates were the least similar to the state average, averaging 17 percent higher than Washington, Oregon, Idaho, Wyoming and North Dakota. Commercial dispensing fees were also similar.
This report by the New Hampshire Center for Public Policy found that, consistent with other areas in the country, hospital services are growing quickly and continue to make up the largest share of the state’s spending. This growth is primarily due to an increase in unit price. Cost-shifting has also increased over time leaving private payers to increasingly assume costs not paid by Medicare and Medicaid.
In an effort to inform state-level discussion of healthcare savings opportunities in Missouri, the Missouri Foundation for Health funded a report that estimates the impact of six scenarios that could help contain escalating costs in Missouri while improving quality. The scenarios include: implementing mandatory managed care for dual eligibles, adopting bundled payment methods, enabling a robust insurance exchange, promoting shared decision making and palliative care, care coordination and disease management; and broadening the scope of practice of primary care practitioners.
The state’s Medicaid Redesign Team announced $14 million was saved in the 2011-12 fiscal year. The savings came without reducing benefits, while implementing a global spending cap and expanding coverage to include 140,000 additional low-income people.
According to a report by the New Hampshire Insurance Department, hospital charges include relatively large markups. Uncovered costs and emergency services are major cost pressures for hospitals. Twenty percent of costs, or $900 million, were uncovered in 2010 alone. According to the report, in order to decrease the cost of non-emergency services, payers must be willing to increase reimbursement of emergency services.
NC Health News reports Community Care of North Carolina, the state Medicaid program that assigns patients to a “medical home,” has saved the state close to a billion dollars over a four year period, according to analysts who examined four years of state Medicaid cost data. The study found the use of medical homes not only reduced cost but also increased healthcare quality, especially among the high cost and high need patients.
In the Healthy Indiana Plan Demonstration Section 1115 Annual Report, an evaluation of the predecessor program found that the program attracted many consumers with chronic disease as they had no other insurance option. While many were able to make their contributions to the POWER accounts, 14 percent of former HIP members reported that cost-sharing was their reason for leaving the program.
The state’s Medicaid Redesign Team completed a Multi -Year Action Plan with several recommendations to improve health outcomes and curb the cost trend that include expanding access to supportive housing, expanding provider scope of practice, targeting trouble areas, such as Brooklyn, and implementing a system of performance measurement.
Alaska’s reimbursement rates exceed that in comparison states for physician services, according to a report by Milliman. Alaska’s relative reimbursement is 160 percent of that of Washington, Oregon, Idaho, Wyoming and North Dakota, across all payers and all specialties analyzed.
Cost shifting between commercial and public payers, high operational costs for healthcare providers and high physician reimbursement rates all drive healthcare spending in Alaska, according to a report by Milliman. Two previous commissioned reports identified that Alaska’s reimbursement exceeds that in the comparison states for both physician and hospital services likely due, at least in part, to the large negotiating leverage providers have in the small market of Alaska. Hospitals criticized the report for a variety of reasons, including the comparison between tax paying for-profit hospitals in Alaska to nonprofit hospitals in the comparison states.
Alaska’s commercial payment levels are approximately 213 percent of Medicare payment levels, on par with Washington, Oregon, Idaho, Wyoming and North Dakota, according to a report by Milliman. This is the first of three reports commissioned by the state in an attempt to understand where opportunities exist to quell the unsustainable cost of care.
Healthcare spending has increased 40 percent between 2005 and 2010 and anticipated to reach more than $14 billion by 2020, according to the University of Alaska Anchorage. This comprehensive review describes how spending is divided among payers, healthcare costs, age of recipients and service.
The Attorney General’s second annual report examining cost drivers in the Massachusetts healthcare market with specific focus on the cost containment resulting from the inclusion of global payments. The study found continue wide price variation between providers not explained by differences in quality of care, globally paid providers do not consistently lower total medical expenses, total medical spending is higher for people with higher incomes, tiered network products have increased consumer engagement in value-based purchasing decisions, PPO products produce significant barriers to providing coordinated care and providers designed around primary care and global payments may encourage coordinated care; however, global payments pose significant challenges.
This WBUR article reflects on the Attorney General’s new findings that global payment reform may not result in lower total medical expenses, as expected. In reality, the reform has led to increased health costs, increasing payments to two provider groups by more than 26 percent between 2008 and 2009. Wide price disparities continue to exist within the Massachusetts healthcare market and are based on providers’ reputation rather than quality differences. Despite the increases observed, insurers believe cost savings may be observed in the long run.
A Michigan regional collaborative improvement program, which was paid for by a large private insurer, yielded improvements for a range of clinical conditions and reduced costs in several important areas, according to Health Affairs. For example, general and vascular surgery patients in the Michigan Surgical Quality Collaborative experienced a 2.6 percent drop in surgical morbidity rates. That translates to approximately 2,500 fewer Michigan patients with surgical complications each year. The results suggest that hospitals in regional collaboratives can improve upon healthcare quality metrics more quickly than hospitals abstaining from participation.
The Tennessee Department of Commerce and Insurance, Division of Health Planning plans on launching their APCD in 2010, according to the Commonwealth Fund. The goal is to use the data to improve healthcare access, affordability, and coverage; inform healthcare policy; determine the capacity and distribution of existing health care resources; evaluate the effectiveness of intervention programs to improve patient outcomes; compare costs across treatment setting and providers; and provide the public with information on healthcare quality.
The Attorney General’s first annual report examining cost trends and cost drivers in the Massachusetts healthcare market with the goal to identify, understand and explain why costs are escalating faster than general inflation. The report found price increases is the chief cost driver in Massachusetts over the last few years and that prices vary significantly within the same geographic area, unrelated to quality of care, the health of the population,the kind of facility care is received or delivery costs. These price variations were found to correlate with provider market power. The report calls for increasing transparency and standardization, improving market function, engaging consumers with decision-making tools and prompt action prohibiting insurer-provider contracts perpetuating market disparities.
The Aloha state has some of the lowest healthcare costs in the United States, according to The New York Times. Since 1974, all Hawaiian employers have been required to provide insurance to employees working 20 or more hours per week. Residents also have some of the least expensive insurance premiums in the country. While the exact reason has yet to be discovered, some suggest Hawaii’s successes in efficiencies, such as adopting an electronic medical record system, have been key to keeping costs down.
Atul Gawande, a physician who visited McAllen, Texas, discovered a broken healthcare system as described in The New Yorker. Overutilization, rather than population health and quality, seemed to explain the vast amount of spending, making the city one of the most expensive healthcare markets in the country.
The Long-Term Care Community Choices Act has been signed by the Governor, providing $1.2 billion to traditional nursing homes and community-based services providers in Tennessee’s managed care Medicaid program, according to the National Governors Association. The law provides consumers more choices for residential care providers and allows Medicaid funds to serve more people in cost-effective home and community settings.