The Colorado Department of Health Care Policy & Financing evaluated the impact of telemedicine policy changes during COVID-19, reported State Network. The report found that the percent of telemedicine visits increased from 0.2% of services before the pandemic to 20.3% during the height of the pandemic. The top diagnoses among adult telemedicine users were opioid dependence, generalized anxiety, major depression, hypertension, diabetes and back pain. Urban providers delivered a higher proportion of services via telemedicine compared to rural providers, which may be due to lower broadband access in rural areas. Federal qualified health centers were the highest adopters of telemedicine; at the height of the pandemic, telemedicine visits were 61.3% of all visits.
A new analysis found large variations in commercial health insurance payments compared to Medicare payments across Colorado hospitals, reports the Center for Improving Value in Health Care. Colorado hospitals received commercial payments for inpatient and outpatient services that were anywhere from 108% to 508% of Medicare rates for the same services at the same hospitals. In particular, outpatient services in Colorado are among the most expensive in the state and a driver of rising healthcare costs.
Access Health CT, Connecticut’s official health insurance marketplace, published a report summarizing findings from a data-grounded exercise designed to identify the needs and opportunities of Connecticut communities and develop recommendations to address health disparities in the state. Recommendations include reducing the cost of care and improving insurance coverage; implementing bias and cultural competency training to help providers become better attuned to implicit biases and develop skills to address them; supporting the work of Community Health Workers or Care Coordinators as “super navigators;” and centralizing data to make information more accessible/enhance reporting to better support whole person health.
The District of Columbia was ranked the best state for children’s healthcare in a study from WalletHub. The study assessed states on 35 indicators of cost, quality and access to children’s healthcare. D.C. ranked number one in children’s oral health, number two in children’s health and access to healthcare and number seven in children’s nutrition, physical activity and obesity.
Delaware’s Department of Health and Social Services (DHSS) released its first healthcare Benchmark Trend Report, detailing total healthcare spending for 2019 and comparing it to baseline data collected for 2018, according to a DHSS press release. The report follows Executive Order 25, signed by the governor in late 2018, which established a state healthcare spending benchmark, a rate-of-growth benchmark and several healthcare quality measures. The first spending benchmark went into effect on Jan. 1, 2019 and was set at 3.8%, with the target expected to decrease gradually to 3% over the following three years.
The Georgia General Assembly unanimously passed a bill that would automatically enroll children who receive food stamps into Georgia’s Medicaid program, according to Northwest Georgia News. An estimated 60,000 Medicaid-eligible children will gain healthcare coverage through an automatic enrollment process that eliminates bureaucratic paperwork. Once the bill is signed by the governor, it will need approval from the federal government.
A study from WalletHub ranked states across many key health metrics, including children’s health and access to healthcare—where Hawaii earned the top rank, reports State of Reform. Hawaii earned second place overall for children’s healthcare, only just behind the District of Columbia. The state also earned a high score for lowest percentage of uninsured children, children with unaffordable medical bills and percentage of overweight children. However, Hawaii had the second to last ranking for children’s oral health.
A report from Hawaii State Department of Health reveals many COVID-19 inequities, particularly among Pacific Islanders, Native Hawaiians and Filipinos, reports State of Reform. Pacific Islanders accounted for a quarter of Hawaii’s COVID-19 cases, despite making up four percent of the state’s population, and had the highest age-adjusted mortality rate in the country. The report also shows that while Native Hawaiians and Pacific Islanders make up a quarter of the state’s population, they have received 13 percent of the state’s vaccinations. The report includes several recommendations, including collaborating with community organizations and stakeholders and increasing the representation of historically marginalized communities in government leadership positions and workgroups.
The Centers for Medicaid & Medicaid Services approved Illinois’ 1115 waiver allowing for the extension of full Medicaid benefits from 60 days to 12 months postpartum, reports the Illinois Office of the Governor. Illinois is the first state to extend full Medicaid benefits to this extent. It is hoped that this extension will strengthen continuity of care to improve health outcomes for mothers in Illinois and reduce the rate of maternal morbidity and mortality, particularly reducing the significant health disparities for Black women. Women with incomes up to 208% of the federal poverty level will have continuous Medicaid eligibility through 12 months postpartum.
A federally commissioned study found that Indiana’s Medicaid expansion program had mixed results in improving health and access to care, reported Kaiser Health News. Indiana’s Medicare expansion program, called the Healthy Indiana Plan, requires eligible beneficiaries to make monthly contributions to a health savings account that is then used to pay for covered healthcare services. A federally funded study found that although the program increased healthcare coverage, it did not improve healthcare access, affordability or health status compared to both states that did and did not expand Medicaid.
Maine’s governor announced that it would be establishing an Office of Population Health Equity within the Maine Center for Disease Control and Prevention, reports Maine Public Radio. The mission of the office is to identify and address health disparities for certain populations. State health officials noted that there were plans to establish the Office before the pandemic and that the health disparities caused by the public health emergency highlighted the need for it. A health equity office had existed within the Maine CDC for years under different names, including the Office of Minority Health, but was dissolved in 2015.
Maryland’s unique healthcare financing model may have helped providers financially weather the pandemic storm, report experts at a panel held by State of Reform. Maryland’s global budget system for hospitals provided stability and allowed providers to focus on responding to the pandemic, but the payment services system struggled, experts acknowledge. However, the flexibility the financing system in Maryland allowed healthcare systems to focus on social determinants of health and could be implemented elsewhere.
Newly passed legislation in Maryland, the Maryland Health Equity Resource Act, will reduce inequality in health, reports Maryland Matters. The bill will fund grants in neighborhoods that have suffered from health disparities and poor health outcomes, offering communities in those neighborhoods funding opportunities for programs to reduce health disparities, improve outcomes, boost access to primary care, prevent illness or reduce hospital use. The neighborhoods eligible for the grants will likely mirror those that qualified for Maryland’s previous Health Enterprise Zone program in 2016.
While health insurance is intended to protect families from high healthcare costs, gaps in that protection remain for Massachusetts residents who are insured all year, reports the Center for Health Information and Analysis. Results from the Massachusetts Health Insurance Survey reveal that in 2019, one in seven residents (15%) who were insured all year had problems paying or were unable to pay their or their families’ medical bills over the previous 12 months. Though the type of problem medical bills ran the full gamut of services (like medical tests, procedures or prescription drugs), nearly half of residents reported problems with bills for dental care, which is not typically covered by insurance plans.
An old Massachusetts policy called “automatic retention” stopped residents from losing their health coverage, reports Tradeoffs. The results of an NBER working paper show that this unique feature protected 14% of adults per year from losing health insurance coverage due to payment lapses. Because in CommCare (Massachusetts’ pre-ACA health insurance exchange) there was always one plan option with zero premium available to people making 100-150% of the federal poverty limit, if someone missed a payment for another plan, they were switched automatically to the premium-free plan. Researchers found that the adults who benefited from this policy were often younger and healthier, keeping the market risk pool balanced.
The Minnesota governor’s office announced the publication of vaccination data by race and ethnicity, made possible through a partnership between the state and the Minnesota Electronic Health Record Consortium, reports KSTP. The data will inform additional targeted strategies to ensure equitable distribution of vaccine to Minnesotans disproportionately impacted by COVID-19 as a result of systemic inequities. There is hope that the ongoing partnership will also provide the infrastructure needed for future public health crises.
Before the COVID-19 pandemic hit, Minnesota medical providers were improving on care metrics for low-income Minnesotans, reports the Mankato Free Press. These findings stem from MN Community Measurement’s latest report, which compared treatment quality for patients on public Minnesota Health Care Programs to patients with other types of insurance. Overall, care gaps for patients with public health insurance plans narrowed in 2019, with a greater percentage of patients with these plans receiving diabetes care, breast cancer screenings and colorectal screenings than in the previous year. All other health measures in the report showed similarly narrowed gaps where comparisons were possible. However, researchers posit that post-pandemic findings could look drastically different, with postponement of care and increases in telehealth potentially playing large roles.
‘Let Voters Decide’: Mississippi Medicaid Expansion Ballot Initiative Filed
A nonprofit incorporated by the president of the Mississippi Hospital Association and others has filed preliminary paperwork to start a ballot Initiative that would put Medicaid expansion in the state constitution, according to Mississippi Today. Mississippi is one of just 12 states that has refused to expand Medicaid, leaving hundreds of thousands of citizens without the ability to afford healthcare coverage and rejecting at least $1 billion per year in federal funds. The planning stages of the ballot initiative signals a broad coalition may be on board with the effort.
Montana’s state employee health plan has experienced significant savings in the two years since the transition to reference-based pricing, reports NASHP. The independent analysis of the program reveals no evidence that utilization artificially increased as a result of the new payment model, which would occur if hospitals needlessly push more services onto patients to offset lower reimbursement rates. Furthermore, the report notes that there have been no hospital closures in Montana. Prior to implementing reference-based pricing, Montana’s third-party administrator negotiated hospital reimbursement rates as a discount off of a hospital’s chargemaster rates. Before the transition, Montana paid a range of 191 to 322 percent of Medicare rates for inpatient services and 239 to 611 percent of Medicare rates for hospital outpatient services. After the reference-pricing went into effect, Montana pays 220 to 225 percent for inpatient services and 230 to 250 percent for outpatient services.
A new Montana law aimed at reducing healthcare costs will allow healthcare providers to contract directly with patients for certain basic care, such as annual checkups, office visits, vaccines, bloodwork and stitches, reports the Flathead Beacon. Currently, eight clinics in Montana are working as direct primary care providers as allowed under a 2017 memo issued by the then-Insurance Commissioner. The new law allows dentists, chiropractors and other health providers to offer similar direct care contracts to patients. Supporters of the law argue that direct care coverage can be used in combination with lower-cost catastrophic health coverage or a healthcare sharing ministry to reduce costs.
Insurers and policymakers have created healthcare price transparency websites to facilitate price shopping and reduce spending, but a study in Health Affairs reveals that they may not work as planned. Researchers analyzed the use of New Hampshire’s public price transparency website and learned that the large online advertising did increase visits to the website. However, this increase in visits did not translate to an increased use of lower-price providers. Researchers posit that the limited success of such transparency tools in reducing spending is driven by structural factors limiting consumers’ ability to use healthcare price information as opposed to a lack of awareness of these tools.
The New Jersey governor announced members to the state’s Healthcare Affordability Advisory Group. The committee, established by executive order, is comprised of members across hospitals, providers, employers, consumer advocates and policy leaders. The Group’s objective is to advise the Healthcare Affordability Interagency Workgroup on the development and implementation of healthcare cost growth benchmarks. The benchmarks provide an opportunity for increased oversight and accountability.
New Mexico’s governor signed the Patients’ Debt Collection Protection Act into law, reported KRWG. This law will protect patients from medical debt by requiring hospitals and other healthcare facilities to screen uninsured patients for public insurance and other financial assistance programs. In addition, the law also protects patients whose household income is at or below 200% of the federal poverty level from being sent to debt collectors or sued by healthcare facilities for unpaid medical bills.
New Mexico’s governor signed a bill creating the Health Care Affordability Fund and eliminating cost sharing for behavioral services covered by health insurance plans, announced the Office of the Governor. The Health Care Affordability Fund will be used to invest in initiatives to make health insurance and healthcare services more affordable for working families, such as lowering premiums and out-of-pocket costs for individuals who purchase health insurance from the state marketplace and uninsured residents who do not qualify for federal assistance. The Urban Institute estimates that investing in these initiatives could provide up to 23,000 uninsured New Mexicans with affordable healthcare coverage.
Omitting social determinants of health (SDOH) data from CMS’ Hospital Readmissions Reduction Program misallocated penalties attributable to SDOH to hospitals with the largest share of high-risk patients, according to a Health Affairs study. Researchers used 2012-2016 data from New York City to project the program’s penalties by augmenting CMS’ readmission model for heart attack, heart failure and pneumonia with SDOH scores created to measure geographic levels and individual-level social risk. They found that including these scores affects projected penalties for hospitals treating the highest proportion of patients with high SDOH scores. If CMS continues to omit this relevant patient and geographic data from this readmission model, penalties due to SDOH and social risk factors are misallocated to hospitals serving the largest share of these populations.
The United Hospital Fund published a report identifying the most effective ways to present meaningful and user-friendly pricing information to New York consumers, following a 2020 directive to create a consumer-friendly website, NYHealthcareCompare. Some recommendations include: using the “allowed amount,” as it best reflects the actual underlying price of healthcare services, using commercial claims data for the first iteration of the transparency website, and displaying pricing information for public insurance programs.
Ohio ranks 47th in the nation in health value as compared to other states and D.C., according the Health Value Dashboard from the Health Policy Institute of Ohio. The Dashboard found that the majority of Ohio’s healthcare spending is on downstream factors of health to treat health problems, particularly due to a lack of investment in children, equity and prevention. The equity profiles highlight many health disparities experienced by Ohioans, including that Black, Hispanic and Ohioans with disabilities are more likely to be unable to see a doctor due to cost than white Ohioans or Ohioans without disabilities. The Dashboard recommends nine policies to improve health value in Ohio, including: strengthening the public health workforce; training on racism and discrimination; and increasing eligibility for a childcare subsidy.
The Oregon Health Authority (OHA), along with the Oregon Health Leadership Council, announced that 40 organizations have signed a compact to adopt “value-based payments” which reward healthcare quality rather than healthcare quantity, according to OHA. The agreement targets moving to 70 percent of payments following advanced value-based payment methods over five years and supports the work of the cost growth target program, which is beginning implementation this year. In Oregon’s healthcare transformation efforts, value-based payments are one of a few key tools to achieve meaningful cost containment while prioritizing quality care.
Health insurers in Oregon that waived all deductibles, copayments and other costs for insured patients who fell ill with COVID-19 and needed hospital care, doctor visits, medications or other treatment are no longer waiving fees for COVID treatment, according to The Lund Report. In a study released in November, researchers found about 88 percent of people covered by insurance plans — those bought by individuals and some group plans offered by employers — had policies that waived such payments at some point during the pandemic. Waivers resulted in significant savings for COVID patients who fell seriously ill and wound up in the hospital.
Although hospitals must publicly release their prices in response to a new federal requirement, this information is often difficult for consumers to navigate, reported AboutHealthTransparency.org. To help Philadelphia residents navigate price comparison information, the Philadelphia Inquirer compiled a database with prices for more than 70 common services for 29 hospitals and 43 insurance companies. This revealed wide cost variations for medical services that can be scheduled in advance. For example, the price of a hip or knee replacement in the Philadelphia area ranged from $12,234 to $60,666.
The Tennessee Health Care Campaign’s Rural Equity Report shows three-fourths of the state’s 25 remaining essential access rural hospitals are at high risk of closure in the next few years, reports The Rogersville Review. The report includes a toolkit for rural communities with vulnerable hospitals that offers solutions to rural health inequities, including: prioritizing infrastructure improvements in roads, broadband and emergency call centers; state oversight of hospital ownership transfers; increased financial investment in rural health; and increasing coverage for Tennesseans in rural areas. The report also includes interviews with stakeholders that share their experiences and perceptions of rural hospital closures.
A group of Tennessee Medicaid recipients has filed a lawsuit seeking to halt a plan that would make contentious changes to the state's program designed to provide medical coverage to low-income earners in the state, according to Modern Healthcare. The Tennessee Justice Center — who is representing the recipients — claims the federal government exceeded its authority in approving the proposal. Block grant supporters argue that the current system gives states little incentive to control expenses because no state pays more than half the total cost. However, opponents and health advocates have expressed concern that spending caps might cause states to purge their rolls or reduce services.
Virginia’s governor has signed the Commonwealth Health Reinsurance Program into law, according to State of Reform. The program requires the State Corporation Commission to establish a reinsurance program with the goal of expanding access to healthcare and lowering premiums, especially for those who are not eligible for federal subsidies. The law will help offset premiums that currently average $650 a month.
Utah’s governor signed the Mental Health Access Amendments into law, which now require remote mental health visits to be reimbursed at the same rate as in-person visits, reports State of Reform. This law makes permanent some of the temporary telehealth measures enacted during the coronavirus pandemic. Utah now joins the ranks of only a few states who have permanently enacted payment parity for mental health visits.
The Washington Health Alliance released its 15th Community Checkup report that comprehensively reviews medical claims data to measure progress toward improving health outcomes for Washington residents. The report summarizes information from 1,869 clinics, 322 medical groups, 105 hospitals, 15 health plans, 39 counties and all nine Accountable Communities of Health on more than 100 performance measures in order to: (1) compare Washington’s performance with national benchmarks; (2) rank providers’ performance on primary care delivery; (3) monitor opioid prescribing and healthcare spending trends; and (4) spur action by health plans, healthcare professionals, and purchasers like employers and union trusts.
Programs that incorporate family members who provide care can help support person-centered care for Medicaid enrollees and also help states address the demand for long-term services and supports. After a nationwide scan of Medicaid waivers and state plan options for older adults and adults with physical disabilities, the National Academy for State Health Policy (NASHP) identified three states — Connecticut, Florida, and Virginia — that have long-standing consumer-directed care programs and illustrate the various policy strategies available to states to help Medicaid enrollees (and their family caregivers) who are older adults or have physical disabilities live in their communities. The authors highlighted lessons learned, including: consumer direction provides an important opportunity to support health equity and culturally competent care; paying family caregivers can be a cost-neutral Medicaid rebalancing strategy; and outreach to Medicaid enrollees is critical. However, states may want to consider enhancing data collection to better identify family caregivers who are reimbursed through consumer-directed programs.