State News Roundup - September 2020


Savings from Value-Based Primary Care in Arkansas
By Claire C. Brown, et al. | Milbank Memorial Fund | July 22, 2020

Overall healthcare spending decreased for patients participating in value-based primary care programs in Arkansas, according to a study from the Milbank Memorial Fund. The analysis found that for every dollar spent on care management fees, there was a two-dollar savings in beneficiary spending, with greater savings in later years of the programs—indicating that the return on investment increased over time. The program reduced inpatient stays and emergency department use, likely resulting in cost savings.

Arkansas' Medicaid Work Requirement's Impact on Coverage, Employment and Affordability of Care
By Benjamin D. Sommers, et al. | Health Affairs | Sept. 8, 2020

People who lost Medicaid coverage when Arkansas’ Medicaid program implemented work requirements experienced significant trouble affording care, according to a study in Health Affairs. Fifty percent of people had serious problems paying off medical debt, 56 percent delayed care because of cost and 64 percent delayed taking medications because of cost. These rates were significantly higher than among people who remained on Medicaid during the entire year. The study also found that most coverage losses were reversed after the work requirements were stopped, that the requirements did not increase employment rates and that awareness of the policy change remained poor—potentially hindering people from accessing Medicaid coverage even after the work requirements were no longer in effect.


San Francisco to Give $1,000 Monthly Stipend to Pregnant Black and Pacific Islander Women
By Katie Kindelan | ABC News | Sept. 15, 2020

Beginning in 2021, pregnant Black and Pacific Islander women in San Francisco will get a $1,000 monthly supplement during and up to six months after their pregnancy in a first-of-its-kind initiative meant to help improve health outcomes for both mom and baby, according to ABC News. The initiative aims to reduce disparities in premature births and maternal deaths among Black and Pacific Islander mothers (compared to white mothers), resulting from a lack of access to quality healthcare, income inequality issues and systemic racism. The supplements will be paid for through private donations and some public funding and will come without any restrictions on how the women spend the money.

California Could Be First State to Develop Its Own Generic Drugs
By Angela Hart and Samantha Young | Kaiser Health News | Sept. 11, 2020

California is poised to become the first state to develop its own line of generic drugs after the legislature overwhelmingly approved a measure directing the state’s top health agency to partner with drug companies to make or distribute a broad range of generic or biosimilar drugs that are cheaper than brand-name equivalents, reports Kaiser Health News. Though it could take years to successfully bring new generic products to the market, the move would put the state in direct competition with major generic and brand-name drug manufacturers that dominate the market, and potentially allow California to use its massive purchasing power to drive down drug prices.


Telehealth Visits in Colorado Were on the Rise Before COVID-19
By Michael Goldberg | State of Reform | Sept. 8, 2020

Prior to the COVID-19 pandemic, telehealth use was already increasing, reports State of Reform. Using the Colorado all-payer claims database, the Center for Improving Value in Health Care report shows telehealth utilization increased 33 percent among commercially insured patients, 91 percent for Medicaid beneficiaries and 13 percent for Medicare Advantage patients between January 2018 and February 2020. Telehealth utilization is especially high among females and young adults aged 18-22, as well as in some (but not all) rural counties.

Affordable Healthcare Eludes Millennials 
By Colorado Health Institute | Sept. 9, 2020

Young adults in Colorado, and millennials in particular, are more likely than Generation X or baby boomers to be facing financial challenges that directly affect their health, reports the Colorado Health Institute. Not only do millennials earn, on average, less than other working-age adults, but they are also the most likely among those three generations to report having problems paying medical bills.

The Impact of COVID-19 on Colorado's Native American Communities
By Bobbi Sheldon and Jennifer Campbell-Hicks | 9 News | Sept. 22, 2020

Native American communities across the country are experiencing five times the hospitalization rates and 40 percent more deaths than whites due to COVID-19, concerning state officials in Colorado, reports 9 News. The executive director of Denver Indian Health and Family Services, Adrianne Maddux, notes that factors such as food insecurity, lack of access to fresh water, healthcare and PPE make the communities even more vulnerable to the disease. The Colorado Department of Public Health and Environment is partnering with Denver Indian Health and Family Services to create a COVID-19 Native Responses team, that will be made up of community members trained in crisis counseling and will work to provide resources and mental health services to support the communities. The state will also provide free testing for Native Americans across Colorado and is working to develop culturally responsive public service announcements related to prevention.

Local Nonprofit Offers Rides and Homecare to Those in Mental Crisis
By Renae Skinner | KOAA News 5 | Sept. 22, 2020

Envida, a local nonprofit, offers a ride service to those experiencing a mental health crisis in El Paso and Teller Counties, as transportation can often be a barrier to care for some individuals, reports KOAA News 5. The service was rolled out as a test program last year, and Envida has seen their ridership quadruple since the COVID-19 pandemic hit. The drivers are trained in behavioral and mental health issues, and the program also provides home healthcare services to people with disabilities, older adults and those experiencing financial challenges.


Survey: Most Connecticut Residents Worry About Affording Healthcare if They Get COVID-19
By Michael Hamad | Hartford Courant | Sept. 1, 2020

At the height of the coronavirus pandemic, a majority of Connecticut residents worried they would not be able to cover their medical bills if a family member were to contract COVID-19, reports the Hartford Courant. Additionally, a survey of nearly 1,000 Connecticut adults revealed that most had experienced one or more healthcare affordability burdens—such as delaying or canceling medical appointments because of high costs, opting to go without insurance entirely or struggling to pay medical bills after receiving care—in the past year. Respondents strongly supported state and federal action on healthcare affordability problems; 92 percent said the government should expand health insurance options so that everyone can afford quality coverage. 


Federal Officials Approve Final Plan to Import Drugs from Canada 'for a Fraction of the Price'
By Phil Galewitz | Kaiser Health News | Sept. 25, 2020

The presidential administration announced a rule allowing the importation of some prescription drugs from Canada, clearing the way for Florida and other states to implement programs to bring medications across the border, according to Kaiser Health News. Florida’s law—approved in 2019—would set up two importation programs. The first would focus on getting drugs for state programs such as Medicaid, the Department of Corrections and county health departments. The second program would be geared to the broader state population. Prices are cheaper in Canada due to limitations on how much pharmaceutical companies can charge for medicines. State officials said they expect the program to save the state about $150 million annually. The rule, however, does not allow states to import all types of medications, including biologic drugs such as insulin. 


Hospitals in Georgia are Charging Insurers More Than Twice Medicare Rates
By Andy Miller | Georgia Health News | Sept. 18, 2020

RAND Corporation’s recent study shows that hospitals in Georgia charged private companies nearly three times the amount they were paid by the Medicare program for the exact same services, reports Georgia Health News. The gap between reimbursement from Medicare and private insurers has widened between 2016 and 2018. Lower reimbursements from Medicare and Medicaid has likely caused hospitals to “cost shift” and charge privately insured patients a higher rate for the same services.

Black Death Rate From COVID-19 in Georgia Far Higher Across All Ages
By Tom Corwin | Augusta Chronicle | Sept. 18, 2020

Black people in Georgia are dying from COVID-19 by as much as 3-4 times the rate for white people across all age groups, according to a new analysis in the Augusta Chronicle. The disproportionate impact of COVID-19 on Black people likely stems from systemic inequities in employment, education and access to healthcare, as well as the higher prevalence of chronic diseases among minorities. 


Idaho Recognized as Top Performing State for Critical Access Hospitals
By Idaho County Free Press | Sept. 2, 2020

The federal Health Resources & Services Administration (HRSA) has ranked Idaho the fourth best state in the nation for the quality and performance efforts of its critical access hospitals, reports Idaho County Free Press. HRSA’s measures are from its Medicare Beneficiary Quality Improvement Project, which includes more than 1,350 hospitals across 45 states. The program is intended to reduce hospital closures in rural areas, promote a process for improving rural healthcare and focus on community needs.


Grant Awarded to Fund Rural Healthcare Access Pilot Program
By Maureen Milliken | Mainbiz | Sept. 11, 2020

A $1.2 million grant from the U.S. Health Resources and Services Administration was awarded to fund a pilot program allowing paramedics to perform emergency care functions in order to improve healthcare access for rural citizens, reports Mainebiz. The grant will fund training for paramedics to perform urgent care skills under the direction of an emergency department via telemedicine, respond to acute 911 calls with local volunteer ambulance staff and pilot an emergency department physician consult program. The program works with community health centers in rural parts of the state to facilitate greater access to emergency services for Mainers who do not live near hospitals with emergency care services. 


MD Launches Program Aimed at Reducing COVID-19 in Hispanic Communities
By Hannah Gaskill | WTOP and Maryland Matters | Sept. 15, 2020

The Maryland Health Department has convened an inter-agency task force aimed at reducing the COVID-19 positivity rate in Hispanic communities, reports WTOP and Maryland Matters. The Hispanic Outreach Task Force will look to provide support to Baltimore City to connect underserved Hispanic communities to social services, prevention tactics, isolation housing, educational materials and contact tracing. The task force will also experiment with an intervention program that would provide financial assistance, medical care, isolation, food and other services for families who have tested positive.


Community-Level Factors Associated with Racial and Ethnic Disparities in COVID-19 Rates in Massachusetts
By Jose F. Figueroa, et al. | Health Affairs | Aug. 27, 2020

Across Massachusetts’ cities and towns, Latino and Black communities are experiencing higher rates of COVID-19 cases, and a recent study in Health Affairs identifies important factors that are independently associated with higher COVID-19 case rates in the state. The proportion of foreign-born, non-citizens was the strongest predictor of the burden of COVID-19 cases within a community, while household size and food service occupation were also strongly associated with the risk of developing COVID-19. Some factors, however, such as occupation in an essential service field, did not affect Black and Latino communities in a similar matter. The authors posit that other factors not examined in the study, such as structural inequities like disproportionately high incarceration rates, residence in areas with a higher concentration of multi-unit buildings and defacto neighborhood segregation, may contribute to the spread of COVID-19 in Black communities.

Massachusetts Announces $1.5 Million Grant Program to Support Opioid Treatment for Communities of Color
By Dialynn Dwyer | Boston Globe | Sept. 10, 2020

The Massachusetts Attorney General is launching a new grant program that aims to promote equity for treatment of opioid use disorder by supporting recovery programs in communities of color, reports the Boston Globe. The $1.5 million program is being funded by the recent settlement the state reached with an Andover mail-order pharmacy whose alleged actions fueled the opioid crisis in the state. The program will fund recovery and behavioral health services that are, “committed to standards that serve Black, Indigenous and People of Color (BIPOC) communities,” in the state, with organizations based in the communities they serve getting priority. The program seeks to remove barriers to treatment that have systematically and disproportionately harmed such communities.


Michigan's Surprise Billing Legislation Attracts National Attention
By Mark Sanchez | MiBiz | Sept. 13, 2020

A legislative effort to curtail surprise medical billing in Michigan has gained attention from national healthcare organizations shifting their focus to states amid stalled federal efforts, according to MiBiz. The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. In emergency situations, the out-of-network provider would have to accept payment that’s the median amount within the region that a health insurer pays an in-network provider or accept 150 percent of what Medicare pays for a medical service, whichever is greater. If enacted, the legislation would require the Michigan Department of Finance and Insurance Services to conduct an annual survey on surprise billing that includes the number of out-of-network billing complaints and the adequacy of insurers’ care networks in Michigan.


Building a Statewide Subscription Model for Medical-Legal Partnership Services with Help from a Primary Care Association
By National Center for Medical-Legal Partnership & Montana Primary Care Association | Sept. 8, 2020

Primary care associations and Health Center Controlled Networks are uniquely situated to serve as a bridge between individual health centers and prospective legal partners, as well as help plan for the financing, operation and sustainability of medical-legal partnership activities, according to a case study by the National Center for Medical-Legal Partnership and the Montana Primary Care Association. The case study focuses on how the Montana Primary Care Association helped develop a statewide subscription model for medical-legal partner services, which integrate lawyers as part of the health center team to support addressing social determinants of health for patients. This new model allows health centers to “subscribe” to MLP services, creating a sustainable mechanism for supporting ongoing civil legal aid access for patients. Previously, geographic clusters of health centers would collectively contract and share a dedicated legal intake specialist and a lawyer from Montana Legal Services Association (MLSA) but ran into issues stemming from Montana’s limited resources and rural landscape. The success of the pilot is attributed to a few factors: partners defined shared values early on; legal services were integrated into the health center’s existing workflows; screening and data tracking were streamlined; and medical-legal partnership outcomes were tied to health center priorities in order to advance sustainability.

New Jersey

NJ Doctors Track Insurance Denials in Hopes of Helping Patients
By Jen Ursillo | New Jersey 101.5 | Sept. 14, 2020

The Medical Society of New Jersey has launched a new insurance denial registry for physicians’ offices to help track denials of healthcare services to New Jersey consumers, reports New Jersey 101.5. Until now, there hasn’t been a systematic way of tracing which companies, which procedures and what types of drugs are routinely denied. Understanding the reasons for insurance denials will help physicians get patients the care they need. A spokesperson for the Medical Society of New Jersey explained that such denials disrupt patient care and office workflow, and they expect many physicians' offices to contribute data.

Lower Costs, Better Outcomes in NJ Shared Accountability Arrangement
By New Jersey Business Magazine | Sept. 21, 2020

Horizon Blue Cross Blue Shield of New Jersey and Atlantic Health System have seen early success in their payer-provider shared accountability program in which they tie payments for services directly to outcomes in achieving quality and cost goals, reports New Jersey Business Magazine. The program represents a step away from traditional “fee for service” models and have has resulted in more than a 9 percent reduction in unnecessary hospitalizations and a 5 percent reduction in the total cost of care for patients and members in its first program year. The program used prior cost trends to jointly set a total cost of care target for certain members, and the reimbursement is adjusted annually based on performance as compared to cost targets, quality of care and patient outcomes.

New York

New York City Expands Healthcare Program for Uninsured to All 5 Boroughs
By Matt Troutman | Patch | Sept. 2, 2020

Uninsured New York City residents in all five boroughs can now enroll in a city program that gives them access to a physician and other health services, reports Patch. The program, NYC Care, expanded into Manhattan and Queens four months ahead of schedule. Regardless of immigration status or ability to pay, residents can enroll in the program and receive a card that helps them connect with guaranteed low or no-cost services. New Yorkers who are eligible for health insurance will be directed to the city’s public choice health plan, MetroPlus. About 30,000 New Yorkers have enrolled in the program since its launch last year and have used it for 85,000 provider visits and to fill 30,000 prescriptions. 

North Carolina

NC's Rural Provider Shortage Persists Despite Decades of Efforts
By Liora Engel-Smith | North Carolina Health News | Sept. 8, 2020

Despite decades of federal and state efforts to bolster the healthcare workforce in some of North Carolina’s most remote areas, many rural counties in the state still face provider shortages, reports North Carolina Health News. Among the strategies to combat provider shortages is loan repayment, whereby state and federal programs forgive a portion of school loans of health professionals in exchange for service in areas of high need, but assessing the success of this strategy is difficult. Theoretically, the state’s rural areas should have gained more than 250 new providers in the last year, but the actual number is far lower. Cities also have pockets of high need and providers can choose placement there. All in all, advocates for rural health believe there needs to be a more coordinated plan for increasing rural healthcare access.  


The Disproportionate Impact of COVID-19 on Ohio Communities of Color
By Health Policy Institute of Ohio | Sept. 11, 2020

Black Ohioans make up about 13 percent of the state’s population but accounted for larger percentages of COVID-19 cases (22.8%), hospitalizations (30.6%) and deaths (18.7%), while white Ohioans make up about 82 percent of the state’s population, but accounted for smaller percentages of COVID-19 cases (53.1%), hospitalizations (56.9%) and deaths (77.5%), according to a new report from Health Policy Institute of Ohio


Community-Derived Recommendations for Healthcare Systems and Medical Students to Support People Who are Houseless in Portland, Oregon
By Caroline King, et al. | SIREN at UCSF | Sept. 2, 2020

A study to understand perceptions of how medical students and institutions can meet the needs of the self-identified houseless community found that people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level, according to the Social Interventions Research & Evaluation Network at the University of California, San Francisco. Authors concluded that medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems and institutions should change their approaches to healthcare delivery and advocacy.

Oregon Health System Transformation: CCO Metrics 2019 Final Report
By Oregon Health Authority | September 2020

The Oregon Health Authority released the 2019 CCO Metrics Report, which shares the results of Oregon’s pay-for-performance quality incentive program for its coordinated care organizations (CCOs). This report shows CCO performance across three categories of measures: CCO incentive metrics, state quality metrics and CMS core metrics. For example, in 2019, nine of 15 CCOs improved on the use of emergency departments among members with mental illness. However, asthma as a cause of hospital stay increased almost 12 percent at the statewide level in 2019. 


Pennsylvania Leads New Round of State Laws to Tackle Drug Costs
By Trish Riley | NASHP | Sept. 14, 2020

Proposed legislation in Pennsylvania would allow the state to set payment rates for high-cost prescription drugs equivalent to prices in Canada, where prescription drugs can cost as much as 80 percent less than in the U.S., reports NASHP. This model would reduce prices for 250 high-cost drugs identified by the state, hold drug manufacturers more accountable and result in significant savings for both patients and states. If a drug manufacturer refuses to comply or withdraws their drugs from the market, they will have to pay significant penalties to the state.

Black Patients are Twice as Likely as Whites to Die of Treatable Health Conditions
By  Sarah Gantz | Philadelphia Inquirer | Sept. 11, 2020

Black patients in Pennsylvania are more than twice as likely to die prematurely of treatable health conditions compared to white patients, reports the Philadelphia Inquirer. Black patients had a mortality of 162.1 deaths per 100,000 people due to treatable health conditions, compared to 74.2 deaths per 100,000 people among white patients and 70.8 deaths per 100,000 among Hispanic patients. 

South Carolina

Orangeburg County School District Helping Expand Telehealth Services
By Dionne Gleaton | Times and Democrat | Sept. 14, 2020

The Orangeburg County School District has developed a mobile application that can link its students and their families with telehealth services, reports the Times and Democrat. The district partnered with Palmetto Care Connections, a nonprofit telehealth network and two practices to create the SMART (Students’ Medical Access to Resources in Telehealth) Virtual Health Collaborative. Under the initiative, the app now appears on all district-issued devices and leads to a webpage of telehealth providers. Students and families can also begin accessing telehealth services through the district's website.


Vermont to Reboot All-Payer Model in Response to Warning from Feds
By Anne Galloway | VTDigger | Sept. 18, 2020

The Centers for Medicare and Medicaid Services issued a warning after Vermont failed to meet performance targets for the state’s all-payer model, reports the VTDigger. The experiment—which combines money from Medicare, Medicaid and commercial insurance to fund healthcare services on a per-patient basis, rather than a fee for services rendered—aims to incentivize preventive care and to lower the growth of healthcare spending, neither of which has been realized in the three years since the program began. OneCare Vermont, a for-profit hospital and provider group that manages the all-payer system, has also failed to meet enrollment targets. If the state is unable to provide a satisfactory response within 90 days, the federal government will draw up a corrective action plan. Vermont’s Agency of Human Services has asked state healthcare leaders to develop a “complete plan for rebooting the all-payer model” within 45 days.


$8.4 Million in Funding Announced for Virginia Rural Communities
By CBS 19 News | Sept. 28, 2020

Virginia decisionmakers announced more than $8.4 million in community development block grants for 14 projects to help rural communities in Virginia, according to CBS 19 News. The funding can be used to help with COVID-19 response and recovery activities including, but not limited to: acquisition costs for telework or telemedicine services; business assistance for job training or re-tooling business services to reopen and adapt in a new environment; and construction or rehab of structures for shelters. For example, Wise County is using the funding to partner with Lunchbox276 to expand food programing options for approximately 500 children and families. 


Report on Improving Healthcare in Washington State
By Washington Health Alliance | September 2020

The Washington Health Alliance released its second Community Checkup report in 2020 on the quality of healthcare in Washington state. In addition to other features, the report includes a new Quality Composite Score that combines up to 29 Community Checkup measures to make it easier to compare the quality of healthcare being delivered across the state and by different provider groups. While the composite score provides a more streamlined and nuanced understanding of care quality on primary care measures endorsed by Alliance members, it does not provide an understanding of other important factors, such as cost, patient experience, and care disparities. As the work of the Alliance continues, the Quality Composite Score may evolve to incorporate and measure these important aspects of healthcare. 

Tailored Approaches for Medicaid Physical-Behavioral Health Integration
By Center for Health Care Strategies | Sept. 22, 2020

In 2020, Washington State finished a phased, regional process to transition from three fragmented Medicaid systems for physical health, mental health and substance use disorder services into one integrated system to improve care coordination and health outcomes for individuals with physical and behavioral health needs. A webinar hosted by the Center for Health Care Strategies explored Washington’s transition to physical-behavioral health integration, with a focus on how this approach was tailored to the strengths of different regions. Speakers shared lessons for stakeholders interested in integrating care, presented emerging data on resulting outcomes and addressed the evolving role of public regional behavioral health systems.


Eight States Pass Legislation to Place Caps on Insulin Price; Five More Await Ruling
By Karena Yan | diaTribe Foundation | September 2020

Maine, New Mexico, New York, Utah, Washington and West Virginia have joined Colorado and Illinois in becoming the first states to legislate on insulin affordability, capping insulin copayments at or under $100 per month, reports the diaTribe Foundation. In addition to price caps, Colorado, Illinois and New Mexico’s legislation requires the states to produce a report on insulin pricing practices and provides public policy recommendations to increase affordability. As of September 2020, Connecticut, Florida, Kentucky, Tennessee and Virginia have advanced legislation regarding insulin copay caps and are awaiting a final verdict.

Risk Adjustment Based on Social Factors: State Approaches to Filling Data Gaps
By State Health Access Data Assistance Center | August 2020

Researchers with State Health Access Data Assistance Center examined the use of administrative and claims data, survey data and the hybrid use of both survey data and administrative and claims data in Massachusetts and Minnesota to identify patients’ social risk factors when risk-adjusting payments or quality measure performance. After investigating these three different approaches across the two states, researchers determined that a key challenge to incorporating social risk factors into risk-adjustment methodologies is filling data gaps, since data on social determinants of health such as food insecurity, transportation access and housing hasn’t been systematically collected. A benefit of using administrative and claims data is that states may already have data on Medicaid beneficiaries that could identify social risks, or the Medicaid agencies may fill gaps through data sharing with other state agencies. Medicaid agencies may also be able to take advantage of publicly available survey data on social risk factors, which may be used as a geographically based proxy since the data aren’t specific to individual beneficiaries’ circumstances. Finally, state Medicaid agencies may consider new data collection efforts to fill gaps on social risk factors, as Massachusetts did when they began using Z-codes for homelessness in their risk adjustment methodology. As such, they gave healthcare providers an incentive to use these codes that already existed but were not commonly used.

2020 Scorecard on State Health System Performance
By Radley, David C., Sara R. Collins and Jesse C. Baumgartner | Commonwealth Fund | Sept. 11, 2020

Across states, patients are facing eroding insurance coverage, rising healthcare costs, more preventable deaths and widening racial and ethnic disparities, with the pandemic threatening to exacerbate these trends, according to the Commonwealth Fund’s 2020 Scorecard on State Health System Performance. The scorecard assesses all 50 states and the District of Columbia on healthcare measures covering access, quality, service use and costs of care, health outcomes and income-based health care disparities. Hawaii, Massachusetts, Minnesota, Iowa, and Connecticut ranked at the top of the scorecard and West Virginia, Missouri, Nevada, Oklahoma and Mississippi ranked at the bottom.


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