- Cost and Quality Problems
- Improving Value
- Advocate Resources
- State News
The State of Rhode Island and Brown University announced a new initiative to study healthcare cost trends to improve how care is delivered throughout the state, according to the Peterson Center on Healthcare. Over the course of the year, this new initiative, the Rhode Island Healthcare Cost Trends Collaborative Project, will work with Rhode Island policymakers and staff. The team will analyze spending data from the state’s all-payer claims database to better understand and measure healthcare performance. Ultimately, with findings from this analysis, the project teams will work with multiple stakeholders to assess cost drivers, identify opportunities to improve outcomes and lower costs of care, and establish a target for future healthcare cost growth. The Peterson Center on Healthcare noted this project will give Rhode Islands the tools it needs to improve sustainability and quality for Rhode Islanders, while creating a model other states can duplicate.
The percentage of people in Virginia’s far southwest region—one hit hardest by the opioid crisis, poverty and unemployment—receiving treatment for opioid abuse rose from 67 percent in 2016 to 73 percent by April 2018. According to FierceHealthcare, the state launched the Addiction and Recovery Treatment Services (ARTS) Medicaid benefit last year, which will be accessible to more people now that Virginia is expanding Medicaid. State leaders found that counties with the highest rates of ‘deaths of despair,’ or ones from overdoses, suicides, or alcohol-related conditions, were among those with the highest number of people in poverty or with lowest high school graduation rates. For that reason, state Health and Human Resources representatives have re-characterized them as “deaths of disparity.” A Commonwealth Fund report found that these deaths increased by over 50 percent in the past decade. More understanding is needed to address disparities contributing to deaths, especially as Virginia rolls out Medicaid expansion.
The Centers for Medicare and Medicaid Services (CMS) approved Maryland's waiver to start a reinsurance pool for the Affordable Care Act exchange, according to Modern Healthcare. The state estimates that the program will cancel out the previously projected 30 percent average rate hike for individuals on the exchange for 2019. Officials estimate this waiver will lower premiums by about 30 percent and raise enrollment by about 6 percent. The executive director of the Maryland Health Benefit Exchange called the program, "The largest of it's kind in the country to bring rate relief... to residents who don't qualify for financial help with monthly premiums."
Oklahoma's Medicaid program is implementing a first-in-the-nation drug pricing policy where it only compensates drug companies the full price for their medications if they work as advertised, according to Business Insider. While the program is designed to hold pharmaceutical companies accountable for the efficacy and safety of their drugs, participation is voluntary—potentially mitigating the desired effect. But drug companies that do sign up will have their effective products included in a “preferred drug list,” which could result in a greater long-term profits.
New Jersey has received approval from CMS to implement a five-year reinsurance program that aims to lower individual health plan premiums by 15 percent. The program will operate from 2019 to 2023 and provide $218 million in reinsurance assistance to New Jersey’s individual health plans during the first year of operation. With lower premiums, the state predicts that enrollment in the individual market will rise by 2.7 percent in 2019, 2.6 percent in 2020, and 2.6 percent in 2021.
Vermont has dedicated $5 million in its fiscal 2019 budget to expand efforts to find and retain clinicians to help address the state's mental health crisis and opioid addiction epidemic, according to the Battleboro Reformer. The legislation outlined some potential solutions for combatting provider shortages, including new scholarships, stronger loan-repayment programs and "strategic bonuses" for professionals in Vermont's existing workforce. Funding for the initiative will be spread over four years "to ensure successful and sustainable implementation" of the new workforce programs.
Missouri’s primary care provider landscape has changed considerably over the past few years, with an increased number of physicians throughout the state—particularly in rural areas. However, shortages remain and are anticipated to continue into the future, which will require diligent efforts to maintain and increase the state’s supply. A recent report by Missouri Hospital Association discusses Missouri’s current and future primary care workforce needs and highlights successful strategies to improve recruitment and retention.
Statewide expansion of Medicaid managed care in May 2017 resulted in 240,000 Missourians being shifted from traditional Medicaid to coverage from one of three for-profit corporations. But despite the rapid growth of managed Medicaid delivery models in the U.S. and Missouri, limited evidence exists on the actual effectiveness of MCOs to deliver efficiencies and cost savings while improving health outcomes for enrollees. A new report by the Missouri Hospital Association evaluates recent trends in hospital utilization for the Medicaid managed care population compared to other Missouri Medicaid patients and describes observed differences regarding clinical, behavioral and sociodemographic risk factors. The study found that observed differences in hospital utilization for MO HealthNet beneficiaries can be explained by higher rates of clinical, behavioral and social complexity among fee-for service enrollees. Although Medicaid managed care patients have significantly lower clinical and behavioral risk factors, they have higher rates of emergency department utilization and inpatient readmissions, compared to the fee-for-service population.
A new Alaska law requires healthcare providers to publicly post the costs of common medical procedures and provide cost estimates to patients within 10 days of being asked, according to State of Reform. The law is meant to help patients make more informed decisions about the costs behind their care. The bill also includes provisions related to the licensure of and billing for marital and family therapists and establishes a measure related to ACES (adverse childhood experience syndrome), encouraging lawmakers to make policy decisions in a trauma-informed way.
The Los Angeles County Health Agency and community partners recently announced the release of a new plan that promotes health equity across the county, according to State of Reform. The five-year plan seeks to reduce and eliminate some of the county’s biggest gaps in health outcomes. Priorities include: reducing the gap in black infant mortality; eliminating congenital syphilis; reducing hazardous exposures to harmful toxins in low-income communities; improving health outcomes for residents with complex health needs; and ensuring health agency services are accessible and culturally and linguistically appropriate.