Research Roundup - March 2018

Florida

Florida Governor Signs Major Bill to Combat Opioid Epidemic

By Joe Reedy | ABC News | March 19, 2018

A new state opioid law is seen by many as a good first step in combating a crisis that has claimed at least 16 lives a day in the Sunshine State, according to a report from ABC News. The legislation includes tougher limits on most painkiller prescriptions, more money for treatment programs and requirements for physicians to check the state's prescription database. Opioid-related deaths across Florida have jumped 35 percent from 2015 to 2016, according to the Florida Department of Law Enforcement. Opioids were identified as either the cause of death or were present in the deceased person's body in 5,725 cases in 2016.

Rural Hospitals Wary of Florida’s Budget Proposal

By Andrew Quintana | Florida Trend | March 6, 2018

Rural hospitals are having trouble providing healthcare to their patients, and officials say the Florida Legislature’s budget plan isn’t likely to help, according to an article in Florida Trend. Last year, Florida’s Legislature cut $521 million from Medicaid funding—$11.4 million of which affected rural community hospitals. For example, because of state cutbacks, Doctors’ Memorial Hospital in rural Perry, Florida was paid approximately $2.5 million less than the cost to treat Medicaid patients between 2015 and 2017. It varies by hospital, but nearly half of rural patients rely on government plans like Medicare and Medicaid. Many rural hospitals also face the issue of providing care to uninsured patients who may not be able to afford their care. The Senate’s proposal offers $50 million in new funding for hospitals to balance last year’s cuts. However, the House’s budget plan would cut an additional $2.9 million in funding for rural hospitals.  

Maryland

Paying Hospitals to Keep People Out of Hospitals? It Works in Maryland.

By Jay Hancock | Kaiser Health News | March 18, 2018

Maryland's all-payer model is perhaps the most far-reaching attempt in the nation to control the medical costs driving up insurance premiums and government spending, reports Kaiser Health News. By essentially paying hospitals to lower avoidable admissions, global budgets incentivize hospitals to invest in community health improvement activities that keep patients healthy. The program has saved hundreds of millions of dollars for taxpayers, employers and others in just three years.

Massachusetts

Massachusetts Healthcare Spending Varies Widely

By Alex Kacik | Modern Healthcare | March 1, 2018

A new report by the Massachusetts Health Policy Commission highlights widespread variation in per patient spending among the state's 14 largest healthcare providers, according to Modern Healthcare. Providers affiliated with academic medical centers generally spent more than other types of organizations, with spending differences between the highest and lowest cost providers exceeding $1,500 per patient. The commission recommended bolstering competition, increasing transparency, improving incentives for payers and purchasers to seek out high-value care, and implementing alternative payment models to reduce variation.

Minnesota

Minnesota’s Accountable Communities for Health: Context and Core Components

By Carrie Au-Yeung and Christina Worrall | State Health Access Data Assistance Centers | March 2018

Minnesota’s Accountable Communities for Health, is a community-led model of delivering healthcare (both medical and non-medical) that targets patients with substantial health and social needs, according to a brief by SHADAC. The brief describes the development and implementation of the Accountable Communities in Minnesota, as well as the key components of implementing the model across the state.

Missouri

New Missouri Health Data Resource Unveiled

Missouri Foundation for Health and MHA Health Institute | March 21, 2018

The Missouri Foundation for Health and Missouri Hospital Association jointly announced the release of a new tool that allows community health improvement stakeholders and the public to identify health factors and outcomes at the local level. ExploreMOhealth.org enables users to access the state's county health dataset, in addition to ZIP code-level health data and analysis. This resource will help Missouri hospitals and public health professionals develop more targeted, data-driven approaches to deliver better value. The user-friendly format also allows private citizens to easily identify their county's top health concerns and pressing social issues.

Nebraska

Telehealth, RPM Help Visiting Nurses Fill Care Management Needs

By Eric Wicklund | mHealth Intelligence | March 13, 2018

Nebraska’s chapter of the Visiting Nurse Association (VNA) is launching a telehealth program to improve care management and coordination for its home-based patients, according to an article in mHealth Intelligence. The Omaha-based VNA is deploying 4G tablets with preloaded software and Bluetooth-connected devices to enable patients to gather and transmit vital signs to caregivers. The tablets also provide information and daily reminders on medications and other health-related tasks. With reimbursement for home telehealth programs limited, many of these services are either funded through grants or covered by the healthcare provider. Other programs are exploring alternative paths to sustainability.

New York

Podiatric Services Aid Chronic Care Management, Value-Based Care

By Jessica Kent | HealthITAnalytics | March 6, 2018

The integration of podiatric services could enhance chronic care management, improve health outcomes, reduce healthcare costs and ultimately benefit the shift toward value-based care, according to an article in HealthITAnalytics. A study was conducted on podiatric interventions and their effect on diabetes, obesity, back pain and fall prevention care. These conditions have a significant impact on New York residents: approximately two million New Yorkers have diabetes, 25 percent of whom develop foot ulcers. Researchers found that for diabetic patients with foot ulcers, podiatric services had the potential to reduce approximately 13,500 inpatient admissions annually and could save nearly $510 million in diabetes costs. In obese patients, podiatric treatment could reduce subsequent inpatient admissions by approximately 19 percent and save almost $1.1 billion in healthcare costs.

Oregon

Governor Signs Drug Price Transparency Bill

By Paris Achen | Portland Tribune | March 14, 2018

A new Oregon law requires pharmaceutical manufacturers to publicly disclose reasons for steep increases in drug prices, according to the Portland Tribune.  Specifically, when the price of a prescription drug increases by more than 10 percent, the manufacturer is required to report the reasons to the Oregon Department of Consumer and Business Services. The information reported must include the cost of production of the drug, advertising, marketing, research and profits from the drug, and whether there are generic alternatives available. Civil penalties of up to $10,000 per day for noncompliance are built into the law.

Oregon’s Emphasis on Equity Shows Signs of Early Success for Black and American Indian Medicaid Enrollees

By K. John McConnel, et al. | Health Affairs | March 2018

A new report published in Health Affairs valuated Oregon’s Coordinated Care Organizations’ (CCOs) progress towards the elimination of health disparities using claims-based measures of utilization, access and quality to assess baseline disparities and test for changes over time. The CCOs’ transformation and implementation of health equity policies was associated with reductions in disparities in primary care visits and white-black differences in access to care, but no change in emergency department use, with higher visit rates persisting among black and American Indian/Alaska Native enrollees, compared to whites.

South Dakota

Philips Telehealth ICU Program Saves $62M at Avera Health

By Cara Livernois | Clinical Innovation+Technology | Feb. 26, 2018

Avera Health, a rural health system in South Dakota, has achieved $62 million in healthcare savings by working with the Philips eICU program, according to an article in Clinical Innovation+Technology. The Avera eCare telehealth program showcased how decision-support technology could deliver high-quality care while minimizing gaps in ICU care. Patients in rural areas face increasing difficulties accessing personalized care in a timely manner. Using telehealth technology, Avera increased access by providing the bedside team with expert guidance and continuous monitoring to critically ill patients. Since implementing the Philips eICU program, Avera eCare has reduced length of ICU stay, mortality, cost of care and clinical burnout.

West Virginia

WV Medicaid Covers an Innovative and Less Costly Treatment Model for Opioid-Affected Infants

By Becky Nomile and Carrie Hanlon | NASHP | Feb. 27, 2018

In a new treatment option for infants suffering from neonatal abstinence syndrome (NAS), West Virginia has been granted a new financing approach for these infants, according to the National Academy for State Health Policy.  West Virginia has been hit particularly hard by the opioid epidemic, and the new treatment option offers treatment for infants suffering from less severe symptoms to be treated in a special care nursery referred to as NAS treatment centers. By introducing a bundle payment for NAS services outside the hospital setting, West Virginia is able to offer a lower cost option for treatment of these infants.

The Real Lesson from the West Virginia Strike

By Liz Mair | U.S. News & World Report | March 9, 2018

In the recent teachers strike in West Virginia, teachers were striking because of low pay increases, however they were also upset over rising healthcare costs that takes up any pay increases that are received, according to a story in U.S. News & World Report. While the teachers have agreed to return to work for a 5 percent pay increase, in the long run that may prove to be insufficient as healthcare costs rise faster than inflation. The story argues that the real lesson to be learned from West Virginia’s teacher strike is that it is time to get serious about bringing down healthcare costs.

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Recent Reports

National Health Expenditure Projections, 2017–26: Despite Uncertainty, Fundamentals Primarily Drive Spending Growth

By Gigi A. Cuckler, et al. | Health Affairs | March 2018

National health spending projections published in Health Affairs predict that health spending will grow an average of 5.5 percent annually over the next ten years. By 2026, health spending will represent 19.7 percent of the nation’s economy. Spending growth over the next decade is expected to be driven primarily by fundamental economic and demographic factors. These include trends in disposable personal income, increases in prices for medical goods and services and enrollment shifts from private health insurance to Medicare resulting from an increase in the number of babyboomers becoming eligible.

Addressing Social Determinants of Health through Medical-Legal Partnerships

By Marsha Regenstein, et al. | Health Affairs | March 2018

The medical-legal partnership is a collaborative intervention that embeds legal aid professionals in healthcare settings to address social problems that contribute to poor health outcomes and health disparities. More than three hundred healthcare organizations are home to medical-legal partnerships nationwide. This Health Affairs article identifies three models that healthcare organizations have adopted and the eight core elements of infrastructure they share. Financing and commitment from healthcare organizations are key considerations for sustaining and scaling up the medical-legal partnership as a health equity intervention.

Promoting Health Equity and Eliminating Disparities through Performance Measurement and Payment

By Andrew C. Anderson, et al. | Health Affairs | March 2018

The Institute of Medicine identified equity as a key domain of quality, but measures directly targeting reducing disparities are not well represented in quality improvement initiatives. An article in Health Affairs lays out a series of actions that stakeholders can take to meaningfully incorporate equity into efforts to deliver better healthcare value. They include: identifying and prioritizing reducing health disparities; implementing evidence-based interventions to reduce disparities; investing in the development and use of health equity performance measures; and incentivizing the reduction of health disparities and achievement of health equity. 

A Perspective on Prescription Drug Copayment Coupons

By Karen Van Nuys, et. al | The Essential SCAN | March 2018

A white paper by Karen Van Nuys and colleagues at USC examines copayment coupons and their impact by spending on the top 200 drugs in 2014. They find that 90 percent of all branded drugs had coupons available, and of these only 49 percent had a generic or close substitute available. An accompanying Health Affairs Blog by the authors argues that these findings are important for policy discussions, suggesting that policy interventions need to be “carefully tailored to varying scenarios.”

Transformation of the Healthcare Industry: Curb Your Enthusiasm?

By Lawton Robert Burns and Mark V. Pauly | The Milbank Quarterly | March 2018

There seem to be few provider risk payment models and new payment structures that have had an impact on healthcare costs and quality, according to research published in The Milbank Quarterly. Investigators argue that, because of the speed in which alternative payments models are shifting financial risk to providers, lowering costs and improving quality has been slow. Additionally, they argue that expectations on the impact of these types of payment models on the health system should be adjusted, as it will take time for these models to show any improvements. 

Competition and Premium Costs in Single-Insurer Marketplaces: A Study of Five Rural States

By Commonwealth Fund Staff | The Commonwealth Fund | March 2018

In a study of five rural states, the individual insurance markets were concentrated, with one insurance plan covering the majority of enrollees in 2010. More competition existed in 2015, but by 2017 these rural states were back to only one plan, according to a study by The Commonwealth Fund. The study indicates that 3 of the 5 study states experienced substantially higher premium increases than the national average. The authors suggest that policy options, such as cost-sharing reduction programs or risk corridors could help attract new or returning plans to these marketplaces increasing competition once again.

Healthcare Spending in the United States and Other High-Income Countries

By Irene Papanicolas, Liana Woskie and Ashish Jha | JAMA | March 2018

In 2016, the U.S. spent nearly twice as much on medical care and performed less well on several health outcomes compared to 10 other high-income countries, according to a recent study in JAMA. The study revealed that social spending and healthcare utilization in the U.S. did not differ substantially from other high-income nations, but that the prices of labor and goods seemed to be the main driver in the differences in spending. The authors suggest that efforts targeting utilization alone are not likely to reduce health care spending, and more effort should be focused on reducing prices and administrative costs.

Patients Overpay for Prescriptions 23% of the Time, Analysis Shows

By Sydney Lupkin | Kaiser Health News | March 2018 

Customers overpay for their prescriptions 23 percent of the time, according to a study from Karen Van Nuys and colleagues at USC. During a six-month period these overpayments totaled $135 million and reflect a practice known as a “clawback,” according to Kaiser Health News. A clawback is when the copay for a drug is higher than the full cost of the drug, and the pharmacy benefit managers are able to claw back the extra dollars from the pharmacy. This work suggests that clawbacks are more common than previously thought.

OHSU Researchers Find Some Costly, Recommended Cancer Treatments Lack Evidence

By Lynne Terry | The Lund Report | March 2018

Researchers at the Oregon Health & Science University suggest that recommendations of costly new cancer drugs, which include potentially harmful side effects, are often based on flimsy evidence, according to a news story in The Lund Report. The research studied recommendations and guidelines established by the National Comprehensive Cancer Network and found that oftentimes the Network (which sets guidelines for oncologists and determines federal healthcare coverage) recommended off-label uses for new cancer drugs. This is when a drug is used for an indication not approved by the Food and Drug Administration. While legal and often done, the problem—according to the authors—is that many of the off-label uses are not backed by solid evidence.

The Per Capita Cost of the Opioid Crisis

By Katelyn Newman | US News & World Report | March 20, 2018

The opioid epidemic has hit West Virginia, Washington D.C., and New Hampshire the hardest in terms of per capita costs, according to an article in US News. The opioid epidemic cost the country $504 billion in 2015 alone in mortality costs as well as health, productivity losses and criminal justice costs. The estimate is based on local wages, healthcare costs and criminal justice costs along with variation in opioid-related death and addiction rates, and average age-adjusted value of statistical lives lost. Of the lower 48 states and Washington D.C., West Virginia by far had the highest total per-capita burden at $4,378, followed by Washington, D.C. ($3,657); New Hampshire ($3,640); Ohio ($3,385) and Maryland ($3,337). 

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Commentary/News

A Bipartisan Blueprint for Improving Our Nation’s Health System Performance

By DJ Wilson | State of Reform | March 20, 2018

Governors from five states – Colorado, Ohio, Alaska, Pennsylvania and Nevada – unveiled a bipartisan blueprint to improve our nation's healthcare system, according to State of Reform. The report outlines four guiding principles: improving affordability, restoring stability to insurance markets, providing state flexibility for innovation and improving the regulatory environment.

What is the U.S. Health Spending Problem?

By David M. Cutler | Health Affairs | March 2018

The latest national health expenditure projections forecast modest but increasing growth in medical spending as a share of the economy over the next ten years. Rising medical spending inevitably leads to political concern. But economists agree that the overall share of the gross domestic product spent on medical care is not a problem if the services bought are worth more than their cost. In the U.S., wasteful medical spending and pervasive health and economic disparities imply that we are not getting value for the money we spend. This article in Health Affairs considers the question “How much healthcare spending is too much?”

Iowa Child's Death Begs for Medical Transparency

By David Chivers, et al. | Des Moines Register | March 20, 2018

A team of journalists working in a partnership between USA TODAY and Kaiser Health News discovered that at least 260 patients have died after basic outpatient procedures at surgery centers nationwide since 2013. Yet no one knows exactly how many people die each year in surgery centers because no national authority tracks these outcomes. Health facilities are not required to report them, even though researchers estimate that errors in hospitals and other healthcare facilities are now the third leading cause of death. This editorial in the Des Moines Register calls for a mandatory, comprehensive method to document and publish all medical mistakes to increase patient safety and, ultimately, save lives.

Too Late to Operate? Surgery Near End of Life is Common, Costly

By Liz Szabo | NPR | Feb. 28, 2018

Nearly one out of three Medicare patients has an operation within one year of their death, despite evidence that shows these patients are more likely to be harmed than benefitted, according to an NPR news story. Dr. Rita Redberg argues the practice is driven by financial incentives and a medical culture that is reluctant to talk about the appropriateness of surgical interventions. In a 2015 study, more than 12 percent of defibrillators were implanted in patients that were over 80 years old, costing roughly $60,000 per procedure. Solutions identified include developing easy-to-understand materials for patients to make information medical decisions with realistic expectations.

Major Inflation Would Devastate Healthcare Providers, Payers and, Ultimately, Patients

By Robert Pearl | Forbes | Feb. 27, 2018

Higher-than-expected inflation will cause many players in the U.S. economy to suffer, but no one more than the healthcare sector, according to this editorial in Forbes. The author argues healthcare is not a “normal” industry because federal and state governments control more than 50 percent of healthcare funding and have the power and authority to determine how much they will reimburse doctors and hospitals. Ultimately, according to the author, no one in healthcare does well in an inflationary world.

Financial Incentives and Vulnerable Populations – Will Alternative Payment Models Help or Hurt?

By Karen Joynt Maddox | NEJM | March 15, 2018

While there is broad agreement that fee-for service reimbursement does not do enough to encourage efficient, high-value care, it is unclear as to whether alternative payment models will benefit vulnerable populations or be an incentive for clinicians to avoid this population, according to a perspective in NEJM. The author argues vulnerable populations disproportionately incur high healthcare costs and have poor health outcomes. While alternative payment models may encourage physicians to coordinate care and include behavioral health integration, which could improve these health outcomes, the data has been mixed on whether this will truly happen.

Why the British Soda Tax Might Work Better Than Any of the Soda Taxes That Came Before

By Caitlin Dewey | The Washington Post | March 21, 2018

While the British soda tax has not yet started, some experts are already deeming it a success according to a news story in The Washington Post. The success is seemingly from the country’s largest soda makers revamping their recipes and reducing the percent of taxable sugar in their products. The reduction has been so significant that the British Treasury has cut its revenue forecast of the tax almost by half, to reflect the diminished number of soft drinks with a taxable amount of sugar. While other places, such as Mexico, South Africa and some U.S. cities (including Philadelphia and Berkeley), have implemented soda taxes with the goal of decreasing consumption and reducing healthcare costs, the UK designed its tax to encourage soda makers to cut the sugar in their products. 

Those Coupons People Use for Expensive Meds are Starting to Count for Less

By Dan Gorenstein | Marketplace | March 19, 2018

Pharmaceutical companies and insurers are fighting over drug coupons, and the fight is likely to affect the prices people pay for their prescriptions. Coupons, which are used to get steep discounts, typically come in the form of cards that consumers get in drug ads or from doctors. Coupons help drug companies sell more products, but according to an article in Marketplace, coupons also raise healthcare costs because they encourage people to buy more expensive drugs when cheaper generics are available. The federal government, which considers them kickbacks, already prohibits their use in Medicare and Medicaid. When a person uses a coupon card, the card’s value typically covers nearly all of the person’s share of the drug cost and the deductible. But under United’s new anti-coupon program, employers can now purchase a policy where their worker can still use the coupon, but the worker pays the deductible, potentially adding thousands in out-of-pocket costs.

HHS Secretary Assails ‘Pricing Schemes’ that Gouge Patients

By Robert Pear | New York Times | March 8, 2018

The secretary of the Department of Health and Human Services said that doctors and hospitals should tell patients how much their care would cost before patients receive treatment. If they do not do so voluntarily, the government may use its leverage to force them to disclose the information, according to an article in the New York Times. At a conference of health insurance executives, Secretary Azar said that such information would give patients more control over their healthcare. He described how drug manufacturers, health insurance companies and pharmacy benefit managers were profiting from “pricing schemes” that drove up costs to consumers and delayed access to copycat versions of expensive biotechnology drugs. He also denounced insurers for charging high co-payments to cancer patients who needed these lifesaving treatments.

UnitedHealth Tightens Reins on Emergency Department Reimbursement

By Shelby Livingston | Modern Healthcare | March 7, 2018

The nation's largest health insurer, UnitedHealth Group, is following rival Anthem's footsteps with a new payment policy aimed at reducing its emergency department claims costs. Under the policy, implemented nationwide on March 1, UnitedHealth is reviewing and adjusting facility claims for the most severe and costly ED visits for patients enrolled in the company's commercial and Medicare Advantage plans, according to an article in Modern Healthcare. Hospitals that submit facility claims for ED visits with Level 4 or Level 5 evaluation and management codes—codes used for patients with complex, resource-intensive conditions—could see their claims adjusted downward or denied, depending on a hospital's contract with the insurer, if UnitedHealth determines the claim didn't justify a high-level code. UnitedHealth's policy is different from Anthem's, which has been denying coverage for ED visits that it decides were not emergencies after the fact. However, both policies are aimed at lowering the insurers' spending on ED claims. Taken together, the two insurers' emergency department payment policies could represent a very real threat to providers' bottom lines. 

Friction in the Path to Use of Biosimilar Drugs

By Richard Frank | NEJM | March 1, 2018

According to an article in NEJM, there were only 7 biosimilar products on the U.S. market competing with originator brands, as compared with 14 that were on the European. FDA Commissioner Scott Gottlieb has expressed a desire to accelerate development of biosimilar competition. Currently, an estimated $3.2 billion (only 3%) of biologic spending is subject to competition from biosimilar products. Several factors probably account for the slow development of competition in this market. The complexity of many biologic products has previously been identified as one factor. Multiple surveys of physicians reveal that even those who routinely use biologic products do not have a clear understanding of biosimilar products.Physicians are therefore hesitant to prescribe biosimilars—especially given that regulations create the impression that a biosimilar may not be all that similar to its originator.

Wasting Away: How Health Systems are Advancing the Battle Against Low-Value Care

By Maria Castellucci | Modern Healthcare | March 12, 2018

In addressing the problem of low-value care, there are several factors that need to be considered, according to a news story in Modern Healthcare. Experts say students in medical school are taught to rule out all possibilities before landing on a diagnosis, and this mentality is reinforced by the reimbursement model that encourages the use of more services. Health systems can take steps to curb low-value services, but the approach used by the system to reduce low-value services needs to reflect the impact on patients and their outcomes.

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