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Lowering overall cost of healthcare is a nonpartisan issue, according to the United States of Care research brief. This is an issue that all voters care about, and will be influence voting in November. United States of Care profiled the Minnesota healthcare landscape because they have a history of being a national leader in expanding coverage and access to healthcare, resulting in one of the highest rates of coverage in the nation. One imminent healthcare issue Minnesota is looking at is funding the Health Care Access Fund (HCAF). which is responsible for funding Medical Assistance Medicaid, MinnesotaCare and other public assistance programs. The provider tax that funds HCAF expires in 2020, so Minnesota legislators need to start thinking about ways to make up this $241 million line item. Other 2019 priorities for Minnesota include modernizing access for patient information, reducing costs of drugs, and the future of medical assistance. Some longer term goals include funding for mental health and substance abuse, access to care in rural areas and health equity. Successful solutions to these short and long term goals will require continued collaboration and creativity.
Arkansas, like many states, is targeting drug middlemen in attempt to reign in high pharmaceutical prices, according to the Washington Examiner. The state enacted a law earlier this year requiring licensure for pharmacy benefit managers (PBMs), which manage drug plans for employer- and union-sponsored health plans, to conduct business in the state. PBMs must provide a “fair and reasonable” compensation program for the reimbursement of pharmacist services in order to get a license. Four other states have passed similar laws requiring PBMs to obtain licenses: Florida, Louisiana, Maryland and Tennessee.
Rhode Island has implemented a statewide health information exchange to help coordinate care and improve population health management through real-time admission, discharge, and transfer alerts and prescription drug monitoring messaging, according to Health IT Analytics. Half of the state’s population is enrolled in the CurrentCare system, which is available to all healthcare providers in the state. The system has helped the state save money; hospital readmissions have decreased by 19 percent and repeat ED admissions have dropped by 16 percent, which has helped the state save $13.3 million, and has saved hours of manual work from providers’ daily schedules. This CurrentCare initiative has helped to improve the quality and continuity of care for patients in Rhode Island.
Virginia has submitted a 1115 waiver application that would add work requirements, premiums and emergency department co-pays to beneficiaries above the federal poverty level to their expanded Medicaid program, according to Modern Healthcare. Under the waiver proposal, eligible Medicaid enrollees would need 20 hours per month of work-related activities for the first three months that they're eligible for the program, which would gradually increase to 80 hours per month. The state also wants permission to impose a monthly premiums for beneficiaries above the federal poverty level, assessed on a sliding income scale.
Iowa saw almost three times higher Medicaid costs after moving to a new managed care program called HealthLink, according to Healthcare Dive. Dozens of states have moved their Medicaid program to managed care organizations (MCOs) in attempt to reduce costs. However, after the first full year of privatization Iowa saw per-member costs increase an average of 4.4 percent, almost triple the average increases of the past six years. A recent Iowa Department of Human Services report found that higher per Medicaid member costs are expected to rise in 2018 and 2019 because of prior period rate adjustments. However, despite these setbacks in Iowa, many states view MCOs in Medicaid positively; 38 states and DC have Medicaid contracts with MCOs with over 74 million Medicaid beneficiaries enrolled in an MCO plan in 2015.
Delaware ACO Aledade achieved $5.6 million dollars in Medicare savings in 2017, according to Delaware News Journal. Aledade credits the bulk of its improvements to its data portal which alerts primary care physicians to recent emergency department visits by their patients as well as needed patient tests and screenings. The ACO also provides on-call access to a doctor or nurse 24 hours a day, 7 days a week. As a result, emergency department visits have decreased by 9 percent among the ACO’s Medicare patients.
Billings Clinic is launching its first psychiatry residency program, dedicated to bringing trained psychiatric medical professionals to rural eastern Montana, according to the Lewiston Tribune. Montana has the highest suicide rate in the country, and is also one of three states that has no psychiatry residency program. Montana has seven psychiatrists for every 100,000 residents, and the desired number should be fourteen or more. Due to this shortage, quality mental healthcare has lagged behind the rest of the country. Access to good mental health services can result in fewer emergency department visits, shortened hospital stays, better interactions between patients and staff and other health benefits. This program will benefit rural communities and improve mental health across Montana.
California has been successful in controlling rising healthcare costs by promoting price competition through market-based, managed care policies, according to a study in Health Affairs. However, recent data revealed that the state has not been able sustain its initial success in controlling growth in hospital prices. This article explores two trends that researchers suggest are responsible for the erosion of the conditions needed to sustain price competition within the state: hospital consolidation and regulations to ensure timely access to emergency hospital services that increased hospitals’ bargaining power over health plans.
California’s drug transparency law, passed in October 2017, aims to promote transparency in pharmaceutical pricing, enhance understanding about pharmaceutical pricing trends and help manage pharmaceutical costs. While it might not significantly reduce drug prices, the law represents a meaningful step towards navigating the challenging political and legal environments preventing state action to rein in drug prices. This Health Affairs article examines the legal and regulatory aspects of the law, compares it to other state efforts to address rising drug prices and provides recommendations for maximizing impact by coupling transparency with other incentives.
Massachusetts made progress in controlling healthcare costs, according to a recent report. Total health spending increased 1.7 percent in 2017, the lowest the state has seen in the past five years, though healthcare costs remain a burden for many residents. A 2012 state law requires Massachusetts to contain the growth in medical spending to 3.6 percent a year, and the chairman of the state Health Policy Commission said this report shows Massachusetts is leading the country in lowering the rate of growth in medical spending. The president of the Massachusetts Association of Health Plans noted that “This is good news for employers and consumers, but today’s report also demonstrates that more work needs to be done to address health care cost drivers in our marketplace.”