A recent analysis of Montana’s 47 nonprofit hospitals’ community benefit spending—required in exchange for their tax-exempt status—found that the millions of dollars spent on community needs had no impact on residents’ health, reports NASHP. Montana’s Legislative Audit Division completed a report that calculated that the state’s nonprofit hospitals received more than $146 million in tax exemptions in 2016 and self-reported more than $257 million in community benefit spending—4 percent of which went to community health improvement, while 87 percent directly funded hospital services, raising concerns about efficiency. This finding is consistent with national research showing that only a small percentage of community benefit spending goes to community-based activities aimed at upstream drivers of health. The Division recommended the state enact laws defining reporting expectations for hospital community benefit spending and its impact on community health to ensure community benefit spending reflects state and community health goals.
Adam Woodrum was biking with his wife and kids when his 9-year old son Robert crashed his bike. Robert received anesthesia and stiches in the emergency department. In this edition of Kaiser Health News’ Bill of the Month, it is revealed that the insurance company denied the medical claim and the Woodrums were charged the entire bill of $18,933.44. This is an example of subrogation, where health insurers try to save money when an accident is involved by passing the buck to other insurers (such as auto or homeowners). Eventually, the insurance company reconsidered the claim after Adam completed an accident questionnaire stating that there was no liable third party responsible for the bike crash.
Cancer and rheumatoid arthritis brand-name drugs continue to be the most expensive for Oregon residents, according to new data from the Oregon Division of Financial Regulation. For the second year in a row, the brand-name drug Humira, commonly used to treat rheumatoid arthritis, was the costliest prescription drug reported by Oregon’s health insurance companies, as well as the most prescribed specialty drug. Glatiramer, used to treat multiple sclerosis, was the most expensive generic drug reported, costing insurance companies approximately $2,800 per prescription. To determine what insurers paid on average for each prescription and to identify the most expensive prescriptions, the program team examined claims data for drugs prescribed to 10 or more enrollees and compared the total dollars spent by insurers to the corresponding prescription counts for each drug.
In 2016, nearly 70 percent of Alabama’s pregnancy-related deaths were preventable, according to a report from the state's Department of Public Health and Maternal Mortality Review Committee. The committee recommended that Alabama improve maternal health by: expanding Medicaid coverage; increasing resources and services for women with mental health and substance use disorders; improving Medicaid reimbursement for providers; and encouraging broader education of mothers and families on maternal death risk factors. In this opinion piece in the Montgomery Advertiser, the author notes that Black women in the state die at three to four times the rate of white women from pregnancy-related complications, showing the importance of eliminating racial disparities in access to quality and affordable healthcare.
Intermountain Healthcare, United Way of Salt Lake and several other healthcare stakeholders in Utah have collaborated to create scalable programs to address social determinants of health throughout Utah, reports Healthcare Finance News. The organizations will collaborate to improve the health and wellbeing of communities, improve coordination across health systems and reduce healthcare costs by addressing the upstream economic, education and social factors that impact people's health. This program builds on Intermountain Healthcare’s work to address social determinants of health in St. George and Ogden to create a state-wide network that addresses upstream factors of health.
Many Massachusetts physician groups are struggling to leverage telehealth as they continue to deal with lagging patient volumes, reports Modern Healthcare. Overall, there were more struggling small physician practices in Massachusetts than successful ones as of September and October, according to data released by the Massachusetts Health Policy Commission, as many providers found it difficult to use or clinically inadequate. Anecdotally, some providers are considering early retirement or joining larger practices.
Colorado has become one of the first states in the U.S. to allow pharmacists to prescribe HIV prevention drugs, as part of a public health effort to curb rising infection rates, reports the Colorado Sun. Pharmacies can now offer the daily preventive pill or an emergency version that can be taken within 72 hours of an exposure to the virus. While rural communities may have just two or three primary care doctors, they typically have about a dozen pharmacies, making this law a true expansion of access to the medication. This new HIV protocol also allows pharmacists to collect reimbursement from insurance companies for providing consultation to patients.
More than 40 percent of surveyed Coloradans with diabetes said that high insulin costs forced them to ration their own use of the lifesaving drug at least once a year, reports the Colorado Sun. According to a new report from the state’s Attorney General, insulin costs for Colorado patients rose 262 percent in the past 10 years, which could be the result of a lack of competition among drug makers and distributors. These ‘lockstep’ price increases that have drawn lawsuits over alleged collusion. The report was ordered as part of a 2019 bill that caps copays for insulin at $100 a month and zeroes in on the fact that the insulin market is dominated by just three manufacturers and three pharmacy benefit managers. The report recommends steps that the state or federal government can make quickly to ease consumer burdens.
Massachusetts’ Attorney General hosted a discussion summarizing a new report with recommendations on racial justice and equity in healthcare, reports CapeCod.com. The report highlights longstanding disparities, as well as the disproportionate effect that COVID-19 has had on Black, Hispanic and Latinx communities. The report calls for action in five domains: data to identify and address health disparities; equitable distribution of healthcare resources; telehealth as a tool for expanding equitable access to care; healthcare workforce diversity; and social determinants of health and root causes of health inequities.
Telehealth has grown rapidly in Illinois this year, in part thanks to an executive order by the state’s governor requiring insurance companies regulated by the state to cover telehealth appointments like in-person office visits, reports WBEZ. The state also expanded telehealth coverage for Medicaid and Medicare patients, and the federal government has loosened restrictions as well. However, if the pandemic ends (along with it, the governor’s order) with no legislative action, Illinois would revert to prior rules and healthcare providers would not be reimbursed for the same services at the same rates. Though experts are still unsure about the long-term impact on costs, telehealth has helped increase access without increasing patient costs for rural residents. Similarly, there is concern about lack of internet access among Black, Latinx and senior patients, which may cause them to miss out on telehealth access.