Research Roundup - February 2020


Report: More than a Quarter of Alabama's Rural Hospitals at High Risk of Closure
By Amy Yurkanin | Advance Local | Feb. 11, 2020


The highest numbers of vulnerable rural hospitals are in the South and Midwest, reports Advance Local. Researchers from the healthcare analytics firm Chartis Group issued a report that found that 12 of Alabama’s 45 rural hospitals are considered “most vulnerable” to closure based on several factors, including revenue, system affiliation and the lack of Medicaid expansion. Seven rural hospitals have closed in Alabama since 2010, and the overall percentage of rural hospitals nationally operating in the red has increased from 39 to 47 percent in the last five years, with Alabama being one of the most affected states for closures.


Californians Want Action on Healthcare Costs and Access to Mental Health Treatment 
By DJ Wilson | State of Reform | Feb. 19, 2020


The California Health Care Foundation released its second annual California Health Policy Survey, identifying mental health, the provider workforce, and lowering prescription drug prices as top priority issues for Californians, reports State of Reform. Healthcare affordability continues to be a primary concern, with more people reporting that they are worried about unexpected medical bills, out-of-pocket costs for health services and prescription drug costs compared to last year. There is also an increase in the number of people who skipped or postponed care due to cost.


Colorado Health Costs Will Drop Under Public Option Proposal, Say Experts 
By Monte Whaley | State of Reform | Feb. 13, 2020


Colorado hospitals can operate effectively with commercial insurance rates that are at a drastically smaller percentage of the Medicare reimbursement rate  than what many are bringing in now under the state’s current healthcare system, according to State of Reform. The Colorado Department of Health Care Policy and Financing released an analysis showing that Colorado hospitals, on average, can cover their costs if reimbursed at 143 percent of Medicare rates. The conclusion is based on 2018 payment to cost ratio for Medicare payments and how much was needed to raise Medicare rates to ensure hospitals were paid their costs for seeing patients. The study also concluded that hospital across the nation, on average, cover the cost of providing care to patients at 115 percent. A RAND Corp. study found that Colorado hospitals charge privately insured patients for inpatient and outpatient, combined, on average, 269 percent of the Medicare rate, while inpatient services were billed at, on average, 221 percent of the Medicare price, indicating that commercial rates may be higher than they need to be.


Florida's Strategy for Tackling Its Top 5 Health Concerns

By Cindy Krischer Goodman | Sun Sentinel | Feb. 24, 2020


The Florida Agency for Health Care, armed with 31 percent of Florida’s total state budget, is exploring new strategies to address resident and other stakeholder concerns. For one, the state wants to focus on shifting spending upstream (towards early intervention and prevention instead of the ED) due to worry about inconsistent health outcomes. Though the state has already launched a health price finder, the agency is looking do reduce utilization of low value services, according to the Sun Sentinel. Other strategies target issues related to nursing home care, mental health, provider competition. These priorities were developed through provider and health expert convenings throughout the state.


Legislation to Curb Surprise Big Hospital Bills Passes Georgia Senate

By Beau Evans | Marietta Daily Journal | Feb. 24, 2020


Legislation aimed at ending surprise bills for emergency hospital visits in Georgia under certain insurance plans passed unanimously out of the Georgia Senate. According to Marietta Daily Journal, Senate Bill 359 would prohibit hospitals from handing patients unexpectedly large bills for emergency procedures done by specialists who are outside that hospital’s coverage network. 


To Fight Health Disparities, Native Hawaiians Return to Their Agriculture, Wellness Roots

By Eleni Gill | Milwaukee Journal Sentinel | Feb. 13, 2020


National surveys consistently rank Hawaii as one of the healthiest states in the nation, but commonly used metrics fail to recognize the stark inequities between Native Hawaiians and other groups, reports the Milwaukee Journal Sentinel. As the high cost of nutritious food has contributed to higher rates of preventable diseases, community leaders are emphasizing cultural traditions like indigenous farming practices and hula dancing as a means of improving health.


Survey: 81% of Illinois Residents Worry About Future Cost of Health Care

By Kristen Thometz | WTTW | Feb. 24, 2020

Survey: 81% of Illinois Residents Worry About Future Cost of Health Care
By Kristen Thometz | WTTW | Feb. 24, 2020

According to a new Altarum survey, 81 percent of residents say they are “worried” or “very worried” about being able to afford some aspect of health care in the future, such as prescription drug costs and health insurance. According to WTTW, Illinois residents have continuously reported concern about rising healthcare costs, and how they will pay for it in the future.  

New Survey Finds Majority of Illinoisans Have Difficulty with Healthcare Costs

By Health News Illinois | Feb. 25, 2020


A majority of Illinoisans have had difficulty affording healthcare and prescription drugs in the past year, according to a new study by Consumer Healthcare Experience State Survey. According to a recent Health News Illinois article, Rep. Will Guzzardi unveiled a proposal that would create a new state board that would review data on drug prices and set new payment limits for state-regulated plans. This CHES Survey was commissioned by Protect Our Care Illinois and Altarum’s Healthcare Value Hub. 


County in Rural Kansas is Jailing People Over Unpaid Medical Debt

By CBS News | Feb. 9, 2020


Kansas families struggling to pay exorbitant healthcare costs are falling prey to predatory collection practices by law firms representing local providers, according to CBS News. In rural Coffeyville, residents with unpaid medical bills must appear in court every three months for a "debtors exam." Failure to appear may result in jail time and bail money is commonly used to pay debt collectors and healthcare providers, rather than being returned to defendants when they appear in court.


Report Tracks Highest-Cost and Most-Used Prescription Drugs in Massachusetts

By Anne-Gerard Flynn | MassLive | Feb. 13, 2020


Just 10 treatment categories of drugs, including anti-asthmatic, cardiovascular and antiviral, accounted for over 70 percent of Massachusetts pharmacy claims from 2015 to 2017, according to MassLive. These statistics are available in the latest report on prescription drug use and spending from the Center for Health Information and Analysis (CHIA), an independent state agency that monitors the performance of Massachusetts’ healthcare system. The report found that anti-inflammatory tumor necrosis factor inhibiting agents, like Humira and Enbrel, which are used to treat difficult-to-manage diseases like rheumatoid arthritis, accounted for the largest portion of spending.

New Mexico

New Mexico Healthcare Access Bill Wins Final Approval

By Carol A. Clark | Los Alamos Daily Post | Feb. 19, 2020


Legislation increasing access to, and the affordability of, health insurance for New Mexico families passed both the state House and Senate, passed the Senate floor with a vote of 28-14 and the House concurred, reports the Los Alamos Daily Post. The bill codifies Affordable Care Act (ACA) requirements for state-based health insurance exchanges and authorizes BeWellNM to continue moving toward becoming a fully state-based exchange. 

North Carolina

North Carolina Medicaid Finds Savings in Care Management Strategy

By Diana Manos | Health Data Management | Feb. 7, 2020


North Carolina’s Medicaid system has found a way to save as much as $6,000 annually per patient with the help of a unique care management program, reports Health Data Management. The management program – provided by the Community Care of North Carolina (CCNC), a public-private partnership of healthcare providers and payers – focuses on providing medical homes, community support and data analysis to meet the needs of Medicaid beneficiaries in the state. CCNC’s report notes that the organization uses administrative data to create an “impactability score” for Medicaid members that focuses on Medicaid utilization patterns that go beyond medical care to include social determinants of health and other variables.


High-Powered Committee Sets 3.4 Percent Cost Growth Cap for Healthcare Spending in Oregon

By Lynne Terry | The Lund Report | Feb. 12, 2020


The Oregon Sustainable Health Care Cost Growth Target Committee, assigned to set a statewide cap on the rise in healthcare spending, has agreed to a growth cap of 3.4 percent per year, according to the Lund Report. Committee members still have to decide how to measure quality and equity, ensure that the program is transparent and that the industry is held accountable. State advocates also asked the committee to prioritize affordability for consumers.


PA Submits Waiver Application to Develop State Health Reinsurance Program to Lower Costs

By GANT News | Feb. 13, 2020


Pennsylvania state legislators have submitted a 1332 State Innovation Waiver application to the Center for Medicare and Medicaid Services (CMS) to create a state reinsurance program, according to GANT News. By reimbursing carriers for a portion of their higher-cost claims and spreading that risk across the broader marketplace, a reinsurance program could lower the premiums for individual health insurance plans. Lower premiums would be especially beneficial for Pennsylvanians who are not eligible for financial assistance. 


Will Voters Revolt Over Healthcare Prices? Texans Have Plenty of Reason to Push for Change

By Mitchell Schnurman | Dallas News | Feb. 9, 2020


In a recent scorecard, Texas ranked low on affordability, in part because it’s “among the most expensive states, with private payer prices well above the national median,” Altarum found. Almost half of Texans had problems with out-of-pocket expenses and one-third had trouble paying medical bills, the report said. Another report also found that Texas ranked dead last on access and affordability, according to Dallas News. The state legislature, and specifically its committee appointed to study healthcare costs, has an opportunity to identify state-based strategies that would address residents’ affordability and access struggles. 


Is UVM Health Network Consolidation Raising Healthcare Prices?

By Katie Jickling | VT Digger | Jan. 20, 2020


UVM Health Network’s system-wide consolidation has resulted in longer wait times for patients seeking diagnosis and treatment and could increase healthcare costs for Vermonters down the line, according to the VT Digger. When hospitals control more of the medical care market they have more leverage in negotiations with insurance companies, which can ultimately lead to higher prices per procedure. These higher prices trickle down to patients in the form of higher deductibles, copays, and premiums. Barriers to access have caused some Vermont residents to seek care across state lines.  


Hospital Use Declines After Implementation of Virginia Medicaid's Addiction and Recovery Treatment Services

By Andrew J. Barnes et al. | Health Affairs | February 2020


After a Virginia Medicaid program responding to the opioid crisis by expanding treatment coverage and reforming delivery systems was implemented, the likelihood of having an emergency department visit in a quarter declined by 9.4 percentage points, according to Health Affairs. Virginia combined a Section 1115 waiver with a comprehensive reform to its Medicaid substance use disorder (SUD) treatment services to implement the Addiction Recovery and Treatment Services (ARTS) program focused on increasing access to evidence-based addiction treatment services for Medicaid beneficiaries.


Wisconsin's Caregiver Workforce Shortage Getting Worse, Report Says

By David Wahlberg | Wisconsin State Journal | Feb. 19, 2020


One in four direct caregiver positions at Wisconsin’s nursing homes and assisted-living facilities are vacant, up from one in five two years ago, reports the Wisconsin State Journal. As many as 20,655 jobs are open at long-term care facilities, compared to 16,500 in 2018, according to a survey by provider associations. Citing these alarming statistics, report authors called for expanding a state program aimed at increasing the number of nurse aides and reducing required training for certified nursing assistants from 120 hours to 75 hours. 
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Recent Reports

Evidence-Based Community Health Worker Program Addressed Unmet Social Needs and Generates Positive Return on Investment

By Shreya Kangovi et al. | Health Affairs | February 2020


An analysis of a standardized community health worker intervention that addresses socioeconomic and behavioral barriers to health in low-income populations found that every dollar invested would return $2.47 to the Medicaid program within a year, according to Health Affairs. These findings are important because the growing interest in community health worker programs is fueled, in part, by expected cost savings. However, most programs have not been subjected to rigorous economic analysis. This favorable return-on-investment analysis convinced a regional Medicaid payer to expand its investments from the delivery of patient care to the delivery of social support—which was previously not reimbursed.

Nonprofit Hospitals with Healthiest Finances Offer Little Charity Care

By Reuters | The New York Times | Feb. 17, 2020


Among nonprofit hospitals, those with the highest net incomes tend to devote the smallest proportion of their earnings to providing free care to uninsured and low-income patients, reports The New York Times. Overall in 2017, nonprofit hospitals nationwide generated $47.9 billion in net income, provided $9.7 billion in charity care to uninsured patients and spent another $4.5 billion in charity care for people with insurance who couldn't afford their bills. For every $100 of net income, the top earning hospitals devoted just $11.50 to charity care for the uninsured and $5.10 to free care for other low-income individuals. 
By contrast, the lowest-earning hospitals - most of which had net losses - dedicated $72.30 of every $100 of net income to charity care for the uninsured and another $40.90 to free care for other low-income patients. 

One in Five Surgery Patients Hit with Surprise Medical Bill, JAMA Study Finds

By Hailey Mensik | Healthcare Dive | Feb. 11, 2020


One in five commercially insured adults undergoing an elective surgery with primary surgeons who were in-network received a surprise medical bill in the past two years, according to research published in JAMA, reports Healthcare Dive. For the JAMA study, researchers analyzed 347,356 patients who had undergone one of seven common elective operations between 2012 and 2017. Anesthesiologist and surgical assistants, such as physician's assistants and registered nurses, were associated with the most out-of-network charges. Bills from out-of-network surgical assistants averaged $3,633, compared to $1,219 from anesthesiologists.

Employer Health Plan Spending Jumped 4.4 Percent in 2018

By Harris Meyer | Modern Healthcare | Feb. 13, 2020


Per capita health spending for the 160 million Americans in employer-sponsored health plans grew by 4.4 percent in 2018, the third consecutive year of increases above 4 percent, while utilization only rose 1.8 percent, according to the latest annual spending report by the Health Care Cost Institute. Prescription drug prices jumped 3.6 percent in 2018, up from 1.4 percent in 2017, while prices for outpatient visits rose by 3.8 percent, reports Modern Healthcare. Patient out-of-pocket spending rose from $874 in 2017 to $907 in 2018, an increase of 3.8 percent—alarming because the average American has not seen that large of an increase in take-home pay. Most of the spending increase was due to increases in prices—people are paying more for the exact same set of services.

Introducing the Low Value Care Visualizer - A Tool to Help States Simplify Analytics for Action

By Beth Beaudin-Seiler | Altarum | Jan. 30, 2020


Altarum has released the Low Value Care Visualizer, an open-source, web-based dashboard that provides users with a template to upload their cleaned claims data, then outputs clear visualizations across 44 potential low-value care services. This tool is intended to understand the prevalence of low-value care in order to curb waste in the healthcare system.

Study: Medicare Could Save Billions on Insulin

By Jeff Minerd | MedPage Today | Feb. 3, 2020


Medicare could save billions per year on insulin and other drugs if it were allowed to negotiate prices and implement a cost-saving formulary as the Department of Veterans Affairs (VA) does, according to research published in JAMA. An earlier study also found that annual net Medicare Part D spending on the top 50 oral drugs ranged from $26.3 billion in 2011 to $32.5 billion in 2016. In 2016, if Medicare had obtained VA prices, the cost of the drugs would have been $18 billion, a savings of $14.4 billion or 44 percent, according to MedPage Today.

Improving the Prognosis of Healthcare in the U.S. 

By Alison Galvani et al. | The Lancet | February 2020


A new study found that a single-payer, universal healthcare system is likely to lead to a 13 percent savings in national healthcare expenditure, or about $450 billion annually. Currently, although per capita healthcare expenditure is higher in the U.S. than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Furthermore, researchers estimate that ensuring healthcare access for all Americans would save more than 68,000 lives and 1.73 million life-years every year compared with the status quo.

Twenty-Two Studies Agree: 'Medicare for All' Saves Money

By Diane Archer | The Hill | Feb. 24, 2020


Twenty-two studies on the projected cost impact for single-payer health insurance showed long-term cost savings, according to an analysis published in PLOS Medicine. These studies were conducted by organizations from across the ideological spectrum. The reasoning is that Medicare for All is less costly than our current system largely because it reduces administrative costs, according to The Hill.

Middle-Aged Adults Worried About Health Insurance Costs Now, Uncertain for Future

By Kara Gavin | University of Michigan Health Lab | Feb. 7, 2020


More than a quarter of people in their 50s and early 60s lack confidence that they’ll be able to afford health insurance in the next year, and the number goes up to nearly half when they look ahead to retirement. Two-thirds are concerned about how potential changes in health insurance policies at the national level could affect them, according to a study published in JAMA. Moreover, more than 18 percent had avoided seeking care, or had not filled a prescription, because of cost in the past year, the University of Michigan’s Health Lab reports.  

Co-Payment Policies and Breast and Cervical Cancer Screening in Medicaid

By Lindsay M. Sabik, et al. | The American Journal of Managed Care | Feb. 14, 2020


Medicaid enrollees with co-payments for preventive services before the ACA was implemented were less likely to receive both screening mammograms and Pap tests than enrollees in states not requiring cost sharing for preventive services, according to a study in the American Journal of Managed Care. The study included data from 43 states from 2003, 2008 and 2010, and looked at nonelderly, nondisabled, nonpregnant women in the recommended age range for each screening (mammograms and Pap tests). Researchers determined that for both mammograms and Pap tests, women were less likely to receive screening when their state required co-payments for these services. For both types of screening, the group that had copayments for some visits but had them waived for preventive care that the highest rates of screenings. These findings suggest that Medicaid policies should take into account the impact of copayments on utilization for high-value services.   


Impact of Complex Care Management on Spending and Utilization for High-Need, High-Cost Medicaid Patients

By Brian W. Powers et al. | The American Journal of Managed Care | Feb. 10, 2020


Complex care management programs have emerged as a promising model to better care for high-need, high-cost patients. A randomized quality improvement study published in the American Journal of Managed Care evaluated the impact of a complex care management program on spending and utilization for high-cost, high-need Medicaid patients and found that patients in complex care management had lower total medical expenditures, fewer inpatient bed days, fewer inpatient admissions and fewer specialist visits, though there was no significant impact on care center or emergency department visits. The study looked at 253 patients at CareMore Health in Memphis, Tennessee, who were randomized into complex care management or usual care.


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Expand Predeductible Coverage Without Increasing Premiums or Deductibles

By Mark Fendrick | The American Journal of Managed Care | Feb. 13, 2020


One goal of high-deductible plans is to encourage consumers to be engaged in their healthcare purchases, according to a piece in the American Journal of Managed Care. However, the current form in which deductibles are applies, there is no distinction between essential services and low-value care. Before meeting the deductible, consumers must pay full price for all their care, regardless of actual value. There are some policies to advance predeductible coverage, including new benefit design approaches, like preventive drug lists and the Internal Revenue Service’s formal guidance (IRS-2019-45) that expanded the flexibility of high-deductible health plans linked to HSAs to cover essential services for chronic diseases. Another alternative includes plan sponsors pursuing a range of nuanced cost-reduction strategies to create room for extra spending on high-value services without shifting costs to the consumer.


After a New Version of a Decades-Old Drug Gets Orphan Status, the Price Suddenly Skyrockets

By Alia Paavola | Becker's Hospital Review | Feb. 12, 2020


After Belcher Pharmaceuticals won an orphan designation to sell its version of an injectable medicine called dehydrated alcohol for use with a specific heart procedure, the cost for a pack of 10 vials is expected to jump from about $1,300 to nearly $10,000, according to Becker’s Hospital Review. The drug, which has been available for years, is used to treat chronic pain or prevent infection in patients who need nutrients intravenously.

How Independent Assessment of Drug Value Can Help States

By Steven D. Pearson and Sarah K. Emond | California Health Care Foundation | Feb, 4, 2020


State policymakers are exploring a variety of strategies to rein in drug prices: transparency efforts, bulk purchasing, forbidding pay for delay, anti-price gouging and outcomes-based contracts. A drug value assessment report, or a systematic review of a drug’s comparative clinical effectiveness versus other drug treatment options, combined with an analysis of the drug’s long-term cost-effectiveness versus those other options, could complement other tools by providing a fair benchmark with which to evaluate drug prices set by manufacturers and measure the success of strategies designed to place downward pressure on prices, according to a CHCF blog


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