Research Roundup - May 2018


Alabama HIE Joins SHIEC to Improve Rural Health Data Access

By Kate Monica | EHR Intelligence | May 1, 2018

The Strategic Health Information Exchange Collaborative announced a joint effort with Alabama One Health Record to improve health data access and patient care delivery for patients in rural, underserved areas, according to an article in EHR Intelligence. The health information exchange provides health data exchange services to patients and providers across Alabama and works to promote patient participation in clinical decision making to improve health outcomes statewide. 


‘Time’s Up’: Covered California Takes Aim at Hospital C-Section Rates

By April Dembosky | Kaiser Health News | May 24, 2018

Covered California, the state’s health insurance marketplace under the Affordable Care Act, will begin holding hospitals accountable for their quality of care by potentially excluding them from the “in-network” designation of health plans sold in the marketplace if they fail to meet targets for safety and quality, reports Kaiser Health News. Beginning in 2019, hospitals will be evaluated based on their abilities to perform fewer unnecessary cesarean sections, prescribe fewer opioids and cut back on the use of imaging to diagnose and treat back pain. Research has shown these procedures and prescriptions are problem areas in many hospitals, as they have been overused to the point of causing patient harm.


How Colorado’s Innovation Model is Connecting Primary and Behavioral Healthcare

By Pamela Tabar | Healthcare Informatics | May 4, 2018

Colorado has a deep need for increased access to behavioral health services, particularly in rural areas. According to Healthcare Informatics, for much of the rural areas of Colorado, mental health clinics aren’t usually connected to primary care physician offices, and mental health specialists tend to have minimal interaction with hospitals until an inpatient encounter, which often occurs long after the best opportunity for productive intervention. A $65 million grant from the Center for Medicare and Medicaid Innovation (CMMI) will enable Colorado to be one of the few states in the country to connect primary care and behavioral healthcare together in one system through telehealth technology. The four-year Colorado State Innovation Model (SIM) project began with a single idea: harness technology to connect primary care practices with mental health services at every patient encounter. In Colorado, using telehealth technology to bridge service gaps will bring needed services to any location in the state.


Drug-Price Transparency Bill Passes CT Legislature with No Dissent

By Mackenzie Rigg | CT Mirror | May 9, 2018

A new Connecticut law requires drug companies, health insurers and pharmacy benefit managers to disclose a wide range of drug pricing information to the state, reports CT Mirror. Key provisions that go into effect on Jan. 1, 2020, include: requiring drug companies to justify potentially unwarranted drug price increases; requiring insurers to identify the 25 drugs with the highest cost to the plan, the 25 with the greatest year-over-year price increases and the 25 most frequently prescribed, as well as the portion of premium growth that is attributable to prescription drugs; and requiring PBMs to report how much they collect in rebates and the share that they keep. Insurers will also be required to report whether they use the rebates to offset premiums or pass the money down to residents at the pharmacy counter. The bill does not include a proposed requirement that the majority of rebates from drug companies be passed down to consumers when they buy drugs at pharmacies. 


Lack of Medicaid Expansion Hurts Florida in National Health Care Rankings

By Michael Moline | Florida Politics | May 3, 2018

Florida ranked 48th overall among the 50 states and District of Columbia on The Commonwealth Fund’s 2018 Scorecard on State Health System Performance, according to an article in Florida Politics. Among categories, the state ranked 49th for access and affordability; prevention and treatment; avoidable hospital use and cost; and providing equal access to healthcare. The state made improvements in the number of uninsured adults and children, but could have made more progress had it expanded Medicaid. There was also improvement in the number of adults who went without care because of cost, access to mental health services and treatment of breast cancer. However, many areas saw no improvement, such as 30-day post hospital mortality, and number of people who smoke, are obese, lost six or more teeth or reported only fair or poor health.

Florida VA Center Finds New Uses for Telehealth in Treating PTSD

By Eric Wicklund | mHealthIntelligence | May 9, 2018

Telehealth has proven its value in providing much-needed mental health services to Armed Forces members and veterans dealing with PTSD. Now a Florida VA center is tweaking that platform to give veterans access to a unique form of therapy, according to an article in mHealthIntelligence. The Gainesville-based Malcom Randall VA Medical Center is seeing positive results with its Telehealth Creative Arts Therapy program, in which veterans suffering from PTSD connect via virtual visits with therapists offering treatment through music, movement and visual arts. The program is one of several telehealth services launched by the VA and Department of Defense to connect service members and veterans with healthcare outside of the often-crowded walls of the nearest VA hospital. Such programs also serve to improve access and health outcomes for veterans who can’t easily get to the nearest hospital or clinic or don’t want to go there.


Illinois Granted Medicaid Flexibility for Mental Health and Substance Abuse Pilots

By Syd Stone | The Daily Northwestern | May 9, 2018

Illinois received federal approval for a state Medicaid waiver that will allow service providers to offer more care for individuals suffering from mental health and substance abuse disorders, according to an article in The Daily Northwestern. The Centers for Medicare and Medicaid Services approved the state’s application for a waiver, clearing the way for the state to use $2 billion of federally allocated Medicaid funds to invest in 10 new pilot projects that aim to improve patient experiences, including ones around mental health, violence, public safety and opioid abuse.


CMS Renews Maryland's All-Payer System

By Virgil Dickson | Modern Healthcare | May 15, 2018

The Centers for Medicare and Medicaid Services (CMS) approved Maryland’s requests to continue and expand its unique all-payer model, according to Modern Healthcare. Under the model, the state is exempt from typical Medicare regulations and has the unique ability to set its own rates for hospitals. Starting Jan. 1. 2019, doctors' offices and nursing homes can voluntarily participate in the program as well. Through this model, Maryland officials aim to coordinate care better across hospital and non-hospital settings, including mental health and long-term care services. 

New Jersey

New Jersey Becomes Second State to Adopt Individual Mandate

By Katie Jennings | Politico | May 30, 2018

On May 30, New Jersey became the second state in the nation, after Massachusetts in 2006, to adopt a state-level individual health insurance mandate, according to Politico. The new legislation, the New Jersey Health Insurance Market Preservation Act, will go into effect on Jan. 1, 2019. Revenue collected from New Jersey’s individual mandate penalty will help fund a state-based reinsurance program established under separate legislation also signed into law on May 30. 

New York

Building Healthy Communities: One Funder’s Place-Based Approach to Help Neighborhoods Transform Themselves

By NYS Health Foundation | April 2018

Improving access to healthy foods and access to safe places for physical activity is the focus of the Building Healthy Communities initiative from the NYS Health Foundation. This report examines the strategies to develop the initiative, set goals and assess the progress and impact in six targeted neighborhoods. Lessons learned and next steps for additional neighborhood transformation is also included in the report. 


Texas Ruling on $11,000 ER Bill May Have Long-Lasting Effects, Experts Say

By Sabriya Rice | Dallas News | May 3, 2018

The healthcare industry is closely watching a recent decision by the Texas Supreme Court that some say could have broader implications on how hospitals and health insurers negotiate reimbursement rates, according to an article in Dallas News. The court sided with an uninsured woman who was billed $11,037 after an emergency department visit. The justices said that in order to prove her bill was “reasonable” compared with what an insured patient would be billed, the medical center would need to the court with details about the discounted rates it had with health insurers--data that’s generally claimed to be proprietary and confidential.

West Virginia

Report Finds Opioid Crisis Costs West Virginia $8.7 Billion

By Kara Leigh Lofton | WV Public Broadcasting | May 3, 2018

Senator Joe Manchin’s office released a report today that found in 2016, the economic cost of the opioid epidemic in West Virginia was more than $8.7 billion, according to an article in WV Public Broadcasting. The brief from Manchin’s office relied heavily on the CEA report to draw conclusions about the financial impact on West Virginia. The council looked at the cost of opioid-related fatalities, healthcare spending, addiction treatment, criminal justice and lost productivity, concluding that fatalities resulting from overdose were the single most costly effect of the opioid epidemic. 

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Recent Reports

American’s Confidence in Their Ability to Pay for Healthcare is Falling

By Sara Collins, et al. | The Commonwealth Fund | May 2018

Consumer confidence in being able to afford needed healthcare is declining, according to a study from The Commonwealth Fund. The Commonwealth Fund Affordable Care Act Tracking Survey indicates that 62 percent of adults were very or somewhat confident they could afford all of the healthcare they would need if they were to become seriously ill, down from 70 percent in 2015, with significant declines in multiple demographic categories. These findings suggest that policymakers will need to take notice of these concerns as more and more Americans feel less confident in their ability to pay for their healthcare.

2018 Scorecard on State Health System Performance

By David Radley, et al. | The Commonwealth Fund | May 2018

Many states are not getting good value for their healthcare dollars, according to a report by The Commonwealth Fund on the performance of state health systems. The report provides state-by-state comparisons on more than 40 measures related to access to care, quality of care, health outcomes and health disparities. Overall, the findings indicate states have large health disparities, and are not making progress in key measures reflecting life expectancy. However, states did make improvements in some areas that were targeted for progress, such as a reduction in the use of tobacco. The report concludes that all states can improve their healthcare performance, even those that topped the scorecard.

The Business Case for Racial Equity: A Strategy for Growth

By Ani Turner | Altarum | April 2018

Eight trillion more in the U.S. economy. That is what could be gained by 2050 if the U.S. could eliminate racial disparities in education, healthcare, incarceration and employment, according to an Altarum report. The report estimates the boost in workforce and consumer spending to be 0.5 percent per year which would increase our country’s competitiveness for decades. The report offers a path forward to take the steps necessary to advance racial equity.

The Impact of Prescription Drug Manufacturer Rebates on Health Plans and Consumers

By Charles Roehrig | Altarum | April 2018

An estimated $89 billion in prescription drug rebates were paid to health insurers in 2016, representing on average a 21% reduction off of list prices, according to an Altarum study. The study found that rebates have benefitted both payers and consumers, with little evidence that rebates cause manufacturers to raise list prices above what they would be in the absence of a rebate. While PBMS gain financially from the rebate system, this study did not find an excessive amount of profits coming from the rebate system.

The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured

By Zack Cooper, et al. | Health Care Pricing Project | May 2018

For privately insured consumers, half of health spending variation is due to price variation across regions and the other half is due to the quantity, according to a recent study by the Health Care Pricing Project. The authors examined insurance claims data to study variation in health spending, the structure of insurer-hospital contracts, and hospital price variation across the United States. Their findings indicate prices vary substantially across regions and hospitals, as well as within regions and even within hospitals. Market structure and monopoly hospitals have a significant impact on pricing. 

Meal Delivery Programs Reduce the Use of Costly Healthcare in Dual Eligible Medicare and Medicaid Beneficiaries

By Seth A. Berkowitz, et al. | Health Affairs | April 2018

Delivering food to nutritionally vulnerable patients is important for maintaining these patients’  health, according to a study published in Health Affairs. Specifically, the study found that low-income seniors or disabled younger people who received home-delivered meals — particularly those tailored to recipients’ medical needs — had fewer ED visits and lower medical spending than a similar group of people who did not receive meal deliveries. These findings suggest that meal delivery programs could reduce the use of costly healthcare and decrease spending for vulnerable patients. 

Understanding Trends in Medicare Spending, 2007-2014

By Laura Keohane, et al. | Health Services Research | March 2018

Declines in spending levels in the Medicare population with chronic conditions may suggest changes in patterns of care, according to a study in Health Services Research. The study analyzed spending growth in Medicare beneficiaries from 2007 to 2014, including the role of demographic characteristics, chronic conditions and Medicare coverage attributes. Authors suggest a change in patterns of care use by health care professionals, may be moderating spending growth. 

Visit the Hub website for background on drug spending, addressing social and medical needs, measuring healthcare affordabilitystrategies to address frequent ED utilizers, state roles in healthcare value and more!


Telemedicine Opening Doors to Specialty Care for Inmates

By Michelle Andrews | Kaiser Health News | May 2018

Prisons are often located in rural areas far from medical centers that have experts in cancer, heart and other disease treatments. Even if the visit just involves a trip to a hospital across town, the inmate must be transported under guard, often in shackles. The whole process is expensive for the correctional facility and time consuming for the patient. Given the challenges, it’s no wonder many correctional facilities have embraced telemedicine. According to an article in Kaiser Health News, prisons use video conferencing to enable inmates to see medical specialists and psychiatrists without leaving the facility. A survey on prison healthcare in 2011 found that 30 states out of 45 that responded said they used telemedicine for at least one type of specialty or diagnostic service. The participating states reported that telemedicine was most commonly used for psychiatry (62.2%) and cardiology (26.6%), according to the research, which was published in 2016.

While the Administration Mulls How to Curb Prescription Costs, State Legislatures Take the Lead

By Trish Riley | NASHP | April 2018

More than 160 bills that address drug costs were introduced in 42 states in the past year, despite short legislative sessions in most of them, according to an article from NASHP.  As many legislatures wind down, it is clear that the issue of drug costs has saliency in red, blue, and purple states and legislators appear positioned for a long-term engagement, recognizing that challenging the pharmaceutical industry and making major changes can take time. The most common approach advanced in state legislatures this year addressed pharmacy benefit managers (PBM), with transparency of drug pricing being an important first step. Eighty-eight PBM bills were introduced and to date nine have been enacted.

Medical Mystery: Something Happened to U.S. Health Spending After 1980

By Austin Frakt | New York Times |May 14, 2018

In 1980 the U.S. was in the realm of other countries in per-capita health spending, but then something happened, according to a commentary by Austin Frakt. The same was true of life expectancy: In the 1980’s the U.S. was in the middle of the pack for life expectancy at birth. By the mid-2000’s the U.S. was at the bottom of the pack. Prices, the lack of competition, additional costs associated with insurers, all arguably contribute to the spending increases, but none of which can easily explain the complicated cause of substantial increase in health spending. At the same time, the reduction in life expectancy is as nearly as difficult to explain, with some arguing a lack of universal coverage for the most vulnerable populations is part of the problem.

A Novel Strategy for Increasing Access to Hep C Treatment for Medicaid Beneficiaries

By Neeraj Sood, et al. | Brookings | May 2018

Twenty thousand Americans die each year from Hepatitis C. However, medicines are now available to cure Hep C and allow us to eliminate the disease. In a policy brief from Brookings, the authors outline the high cost of curing Hep C and examine a novel approach spelled out in an Annals of Internal Medicine article that recommends states negotiate rebates directly with Hep C drug companies on behalf its Medicaid beneficiaries. 

To Lower Drug Costs at Home, Trump Wants Higher Prices Abroad

By Robert Pear | New York Times | May 9, 2018

President Trump’s strategy to lower prescription drug prices may not be so popular in other countries. The strategy is to bring down costs at home by forcing higher prices in foreign countries that use their national health systems to make drugs more affordable, according to an article in the New York Times. The White House Council of Economic Advisors said in a February report that profit margins on brand-name drugs in the U.S. were four times as high as those in the more regulated markets of Europe and Japan. The Council said the U.S. needs to address the root of the problem: foreign, developed nations, that can afford to pay for novel drugs, free-ride by setting drug prices at unfairly low levels, leaving American patients to pay for the innovation that foreign patients enjoy. People who work in the industry said it was unlikely that consumers would see a meaningful reduction in drug prices before the end of the year. 

Industry Orgs Express Concerns with Healthcare Price Transparency

By Jacqueline Belliveau | RevCycle Intelligence | May 3, 2018

Industry groups are cautioning a bipartisan group of U.S. Senators on the challenges and limitations of healthcare price transparency from the provider organization perspective after the policymakers called for more information on the topic earlier this year, according to an article in RevCycle Intelligence. Hospitals groups said it is challenging for provider organizations to provide set prices to consumers because actual costs of care are based on several factors. They also mentioned how instead of making provider-level prices accessible to consumers, the healthcare price transparency initiative should focus on sharing out-of-pocket costs. Patients undergoing the same procedure could end up paying different amounts based on their health plan. Therefore, they argue that out-of-pocket cost information is more valuable to consumers.

It’s the Monopolies, Stupid!

By David Blumenthal | The Commonwealth Fund | May 24, 2018

Drug companies benefit from government-sanctioned monopolies through patents, market exclusivity and other means, argues David Blumenthal in this commentary piece. Blumenthal notes that because of the patent process, new drugs have on average 12-13 years of exclusivity in the market, in which manufacturers can charge any price they choose. Additionally, manufacturers have become increasingly good at extending the patent life of drugs without substantially changing the clinical significance. He argues that as long as these monopolies continue to exist, there will be no competitive force or free market solution to the soaring drug prices.

Most Physicians Say Addressing Social Determinants of Health Isn’t Their Job

By Maria Castellucci | Modern Healthcare | May 9, 2018

Most physicians don't think it's their responsibility to address patients' social determinants of health, according to an article in Modern Healthcare. Nearly half of doctors reported that their patients would benefit from food assistance, affordable housing and transportation to appointments. Yet well over 50 percent of doctors didn't think they or insurers have a role in providing that help. Physician resistance to address social determinants comes as providers are increasingly responsible for patients' well-being with the transition to value-based payment models. Research indicates a person's health status is tied to their social environment, so providers are currently rethinking—and debating—the services they should offer patients and the community. In the survey, 45 percent of doctors said it would greatly or moderately help their patients if they had assistance obtaining affordable housing, but 91 percent said it wasn't their responsibility. Forty-eight percent of doctors said food assistance would help their patients, although 84 percent said they weren't obligated to provide that service. And 66 percent of respondents said patients would benefit from help arranging transportation to healthcare visits, yet 69 percent didn't think it was their responsibility.  

Why Your Health Insurer Doesn’t Care About Your Big Bills

By Marshall Allen | ProPublica | May 2018

By examining the games, deals and incentives in the health insurance world, NPR and ProPublica are taking a hard look at the role of insurance companies in higher costs, delays in care and denials of treatment. This article delves into the various reasons why health insurers often may not worry about the cost of healthcare to the patient, including the fact that a lack of transparency makes it very difficult for anyone to uncover the true costs of procedures and negotiated rates.


Visit the Hub website for background on drug spending, addressing social and medical needs, consolidation and market power, price transparency and cost drivers.