Research Roundup - February 2017


Battle Heats Up on Surprise Billing in Georgia Hospitals

By Ariel Hart | Atlanta Journal-Constitution | Feb. 6, 2017

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.


Central Illinois Faces “Crisis” Over Medicaid Network

By Virgil Dickson | Modern Healthcare | Feb. 18, 2017

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.

Illinois Gov. Calls for Revamp of Medicaid Program in Hopes of Saving Money, Improving Care

By Lisa Schencker | Chicago Tribune | Feb. 27, 2017

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.


Poll:  Kentucky Households Cite Cost as Barrier to Medical Care

The Lane Report | Feb. 22, 2017

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 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.  


New Task Force Created to Help Address Problems with Healthcare Costs for Local Government

By Jacob Owens | MI News | Feb. 6, 2017

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.


Saint Luke’s Partners With UnitedHealthcare to Cut Costs

By Elise Reuter | Kansas City Business Journal | Feb. 8, 2017

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.


Surprise Medical Bills Hit Huge Numbers of Texans

By Charlotte Huffman | WFAA | Feb. 22, 2017

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.

For more state news, please visit

Recent Reports

The 500 Cities Project

By Oktawia Wojcik | Robert Wood Johnson Foundation | Feb. 23, 2017

The CDC and CDC Foundation are starting to provide city and neighborhood level data for 500 of the largest U.S. cities, making it possible to identify emerging health problems and effective interventions, according to the Robert Wood Johnson Foundation. The 500 Cities Project website illustrates city level information on the risk behaviors associated with illness and early death, as well as the health conditions and diseases that are the most common, costly and preventable. Ideally, this information could be used to better target the limited resources that exist to address the social determinants of health.   

Trends in U.S. Health Coverage and Affordability

The Commonwealth Fund | February 2017

Fewer Americans are uninsured and fewer are reporting skipping care due to cost, according to the Biennial Health Insurance Survey by The Commonwealth Fund. Their interactive web tool allows users to explore the data by race, income, age and quality of insurance.

Since ACA, Market Works Better for Consumers Buying Health Plans on Their Own

The Commonwealth Fund | Feb. 1, 2017

The proportion of consumers shopping for individual coverage who reported they could not find an affordable plan dropped from 60 percent in 2010 to 34 percent in 2016, according to a Commonwealth Fund survey. Among those with health problems, the rate fell from 70 percent to 42 percent. The survey also shows that people with low incomes are finding it easier to get affordable insurance on the individual market.

Challenges and Opportunities in Caring for High-Need, High-Cost Medicare Patients

Bipartisan Policy Center | Feb. 9, 2017

Recent research indicates that integration of non-clinical supports and services with medical services can have an impact on improving quality, optimizing efficiency, and reducing utilization of healthcare services, according to a report from the Bipartisan Policy Center. The report points to five principal policy issues could present limitations on the ability of Medicare Advantage plans, Accountable Care Organizations, and Comprehensive Primary Care Plus Model participants to furnish non-Medicare-covered health-related support interventions to Medicare-only individuals. It also provides potential policy options. BPC will issue final recommendations in April of 2017.

Early Performance of Medicaid Accountable Care Organizations

By John McConnell, et al. | JAMA Internal Medicine | Feb. 13, 2017

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.  

Changes in Postacute Care in the Medicare Shared Savings Program

By Michael McWilliams | JAMA Internal Medicine | Feb. 13, 2017

Participation in the Medicare Shared Savings Program by Accountable Care Organizations was associated with a 9 percent reduction in spending on post-acute care, as reported in a new study in JAMA Internal Medicine. Cost reductions were achieved largely due to decreases in skilled nursing facility use and average length of stay.  

America’s Biggest Worry is Healthcare

Monmouth University Polling Institute | Feb. 7, 2017

Healthcare costs are threatening the financial security of Americans, with one quarter of respondents reporting it is the biggest concern facing their families, according to a poll conducted by Monmouth University, as reported in The Wichita Eagle. Concerns over healthcare affordability trumped worries over job security, household bills, national security and immigration. A separate Deloitte study found that the importance of affordable care and coverage to a consumer comes second only to the experience they expect from their providers. Other significant, but less important factors include the convenience of getting care and the availability of digital tools.  

Medicaid and Home Visiting: Best Practices From States

By Rachel Herzfeldt-Kamprath, et al. | Center for American Progress | Jan. 25, 2017

When young children deal with poverty and other toxic stressors, it leads to lifelong health disparities across socioeconomic groups, according to the Center for American Progress. For this reason, interventions that help families provide a nurturing, healthy environment -- including pioneering programs highlighted in the report  -- are critical to reducing the hospitalization rate among participating mothers and children. The report points to reforms that would help states slow the growth of healthcare costs, improve the quality of their healthcare systems and protect their residents.

How Has Obamacare Impacted State Healthcare Marketplaces?

By Michael Morrisey et al | Brookings Institution | Feb. 9, 2017

A recent Brookings report summarizes interviews with key marketplace stakeholders on why health insurance carriers chose to enter or exit markets, how provider networks were built, and how state regulatory decisions affected the landscape. Researchers focused on California, Florida, Michigan, North Carolina and Texas. California was highlighted as being “most successful,” due largely to Covered California’s ability to negotiate premiums with insurers, its consistent benefit offerings, a large and stable number of insurers (11) offering plans, and a large network of navigators.

Debunking the Argument that the Bundled Payment for Care Improvement Program Contributed to Higher Procedure Volumes

By Andrew Wilson, Francois de Brantes and Patrick Conway | Altarum Institute | Feb. 8, 2017

No evidence suggests that participation in the Bundled Payment for Care Improvement (BPCI) program increased the volume of procedures -- contrary to the claims of an editorial in JAMA -- according to Altarum. The adjusted average annual volumes increased among participants and nonparticipants after the start of BPCI. The increasing volume can be explained by trends in regional demographic and market characteristics - such as a growth in the Medicare beneficiary population and the number of hospitals in a hospital referral region.

Survey Shows Providers are not Prepared to Take on Risk-Based Contracts

By Dave Barkholz | Modern Healthcare | Feb. 6, 2017

Providers are predicting less revenue from risk-based contracts within the next two years, according to this article in Modern Healthcare. Doctors and insurers are finding it harder and more expensive to implement the software and population health management process necessary to successfully accept value-based care. However, population health management efforts seem to be largely embraced by the provider community. For example, 74 percent of survey respondents indicated that their organizations are operating a designated division, department or institute for population health programs.

Regulation of Narrow Provider Networks: State Protections Take on Added Significance

By Justin Giovannelli and Ashley Williams | The Commonwealth Fund | Feb. 2, 2017

While narrow networks are increasingly adopted by insurers, concerns remain about consumers access to reliable information on the quality of these networks and the ability to provide timely access to care, according to The Commonwealth Fund. Despite the establishment of a federal baseline, states will likely be given wide latitude to address network issues.

Nudging Promotes Shopping for Health Plans but Not Switching

By Keith Marzilli Ericson, et al. | Health Affairs | February 2017

Typically, consumers who got coverage through ACA marketplaces are automatically re-enrolled in their old plans, which potentially exposes them to unexpected increases in premiums and cost sharing. As reported in Health Affairs, this study tested the effect of letters and emails to “nudge” consumers to check for other available plans during open enrollment. Although consumers were more likely to shop if they received these reminders (a 23% increase), consumers were not more likely to switch plans.The impact was particularly strong in unsubsidized and young enrollees.

Mexico Shows Promising Results After Implementation of Sugar Sweetened Beverage Tax

By Arantxa Cochero, et al. | Health Affairs | February 2017

After Mexico implemented a sugar-sweetened beverage tax on Jan. 1, 2014, purchases of taxed beverages fell 5.5 percent in 2014 and by 9.7 percent in 2015, according to Health Affairs. The results are promising for other countries looking to reduce the consumption of sugar-sweetened beverages.  


High-Risk Pools Deja Vu: Lessons from States, Questions for Policymakers

By Trish Riley and Anita Cardwell | National Academy for State Health Policy | Jan. 31, 2017

As part of congressional negotiations to repeal the ACA, one of the possible elements of an ACA replacement proposal is high risk pools, which are designed to mitigate the impact of high-need, high-cost enrollees on the nongroup market. But the history of high risk pools is marked by underfunding, limited choice of plans, benefit restrictions and high costs, according to this NASHP article. The article explores lessons learned from high-risk pools in different states to inform the current debate, particularly related to adequate funding.

Seniors Aren’t Learning to Choose Better Prescription Insurance Plans

By Jason Abaluck | Yale Insights | Feb. 21, 2017

Seniors’ behavior while choosing Medicare Part D plans demonstrates how the power of the market does not successfully keep costs down, according to Yale Insights. Seniors often don’t select insurance plans that offer the best value. Researchers found that in 2006, beneficiaries could have saved an average of 19-33 percent of their Medicare Part D expenses if they had selected a plan that best matched their medical circumstances. Only 11 percent of patients selected the best plan in 2006; this number fell to 2 percent in 2009.

Project ECHO: The Evidence is Catching Up with the Enthusiasm

By Sanjeev Arora | Health Affairs Blog | Jan. 13, 2017

While Project ECHO quickly gained a lot of attention and enthusiasm, the evidence is just now providing insight into the improved access and reduced costs associated with the program, according to this Health Affairs blog post. A forthcoming paper found participation in Project ECHO reduced hospital admissions and emergency room visits for the most complex Medicaid patients. More research is needed, and some is in the works. Upcoming research is exploring the impact of Project ECHO on patients with diabetes, autism and opioid addiction.

It’s Hard to Be a Small-Time Family Doctor These Days, New Data Shows

By Max Ehrenfreund | Washington Post Wonkblog | Jan. 9, 2017

Provider reimbursement depends largely on the market power of the insurers and the provider, according to the Wonkblog. A study featured in Health Affairs highlights how small insurers have been less successful in negotiating reimbursement rates. So, while driving down reimbursement rates may be a compelling reason to appreciate large insurance companies, insurance giants operating without competition can simply pocket additional profits rather than reducing prices for patients.

Insurance Market Stability: The High-Deductible Problem

By Barbara Markham Smith | AcademyHealth| Feb. 28, 2017

Republicans and Democrats must stabilize the insurance market in order to improve the marketplaces to make coverage better, attract healthier people and to lower costs, according to this AcademyHealth blog post. An easy fix--one that doesn’t require legislation or appropriations--is to address “the deductible problem.”  For most Americans, deductibles alone are higher than the penalty for not having health insurance. This drives younger and healthier people away, making risk pools worse and contributing to higher premiums. To improve risk pools and stabilize the market, standardized lower deductibles should be a mandatory element of individual market insurance benefits.