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Urgent care centers and walk in clinics that treat a range of medical issues are proliferating, especially in affluent suburbs of Massachusetts, according to the Boston Globe. A state commission counted 150 urgent care centers last year, up from 18 in 2010, reshaping the healthcare landscape in Massachusetts, promising to treat non-life-threatening medical conditions without appointments at a fraction of the cost of ERs. But companies are not rushing to open urgent care centers in the lower-income neighborhoods in Boston. Only a small fraction of their revenue comes from patients on Medicaid, which insures more than one quarter of the state's residents. 30 to 40 percent of centers refuse to treat Medicaid patients, saying the program's requirements are onerous and does not pay enough to cover their costs. The state generally will not pay for residents on Medicaid to visit an urgent care center unless the patient has a referral from a primary care doctor, a burdensome requirement which can prevent the urgent care companies from treating large numbers of low-income patients. MinuteClinics began operating in Massachusetts more than a decade ago, and are regulated by the state, while urgent care centers are still new enough to Massachusetts that the state has no official definition for them, nor specific rules for how they operate.
Starting January 2019 four employers in the Twin Cities are offering a new "SmartCare" program, a new employee health plan with a limited network of doctors and hospitals, according to the Star Tribune. This limited clinic choice is another example of how health insurers are offering lower premiums, with consumers agreeing to have their care coordinated by a small subset of doctors and hospitals, and pay more out of pocket to visit other healthcare providers. Narrow network health plans have been around for decades, but they are making new appearances in the Minnesota insurance market recently, particularly in the market where individuals under 65 buy their own coverage. The first SmartCare clinic has seen a 10 to 20 percent reduction in total cost.
Aledade and Blue Cross Blue Shield of North Carolina are co-leading a new initiative to support physician-led accountable care organizations (ACOs). The aim is for physicians and other care providers to work collaboratively as a team to improve quality of care, improve management of chronic conditions and ultimately reduce costs. Participating physicians will have the opportunity to earn increased reimbursement rates and share in any health care cost savings achieved, according to Blue Cross Blue Shield.
The Delaware Economic and Financial Advisory Council (DEFAC) set the state’s target healthcare spending growth at 3.8 percent for 2019. This is the first year of the healthcare spending benchmark, established in response to Delaware’s historical ranking in the top 10 states in per-capita spending. Over the next 3 years the benchmark is expected to decline to 3 percent to match the state’s estimate of overall state spending increases, according to the Office of the Governor.
Attorney General Lori Swanson, who is leaving office next year, is reminding lawmakers that legislation blocking nonprofit health plans from becoming for-profit companies will expire next year, and requires follow-on legislation, according to the Star Tribune. For decades, Minnesota required HMOs to be nonprofit, but Republicans pushed for opening the market to investor-owned companies. Swanson highlighted this issue in a letter to Governor-elect Tim Walz, noting the importance to protect Minnesota taxpayers from having billions of dollars in nonprofit health plan assets converted to for-profit use, without providing sufficient compensation to the public.
A new analysis from the Urban Institute revealed that Texas has both the largest number and highest percentage of uninsured residents under age 65 in the country. Additionally, patients often struggle to pay their bills, according to Kaiser Health News. Part of the problem may be “entrepreneurial healthcare practices” like freestanding emergency rooms, doctor-owned hospitals and balance billing. At last count, 214 freestanding ERs, which are generally highly profitable, have popped up across the state, in addition to hundreds of urgent care clinics and surgery centers. Employers are also continuing to eliminate subsides for employee premiums and shifting to high-deductible health plans. Without policy changes, Texas’ working poor and uninsured will find it difficult to access quality care.
Forty-one of Oklahoma's 77 counties are designated “maternity deserts,” meaning they lack a hospital performing deliveries or an obstetrics provider, reports NewsOK. Most of the counties are rural, and women who live there are more likely to live in poverty than the statewide average. The decline in hospitals performing deliveries is partially due to the economics of running a maternity unit – for example, they must be staffed around the clock, which isn't feasible in areas that don't have a large enough population. Ideas to expand maternity care in rural areas include: offering incentives for doctors to work in rural areas; training doctors who grew up in rural areas and are more likely to return to practice; and expanding Medicaid to increase the number of women receiving coverage for prenatal care.
CMS recently approved Hawaii’s 1115 waiver amendment request to use Medicaid funds to help those experiencing chronic homelessness and mental health issues find housing, according to State of Reform. Services that will be covered by Medicaid include assistance with housing searches, job skills training, moving and education/training on tenant responsibilities. Officials hope to see reductions in healthcare costs for eligible individuals by addressing a prominent social determinant of health. Hawaii is one of the few states approved to use CMS funds for these kinds of supportive housing services.
The religious right in Indiana has long been a powerful political force. But now a progressive interfaith movement, called Faith In Indiana, is trying to challenge that foothold, according to WBUR News. The group, consisting of a broad political spectrum of Muslims, Jews and Christians, has organized in minority communities on issues like immigration, universal health care, criminal justice reform, and early childhood education. Indiana's branch of Faith In Action launched statewide this year. It targeted five races in the general election, with the ambitious goal of ending the Republican supermajority in the statehouse.
The Free Clinics, serving Henderson and Polk counties, has seen success in caring for the areas most complex patients through its “Bridges to Health” program. The Bridges program works as drop-in sessions where patients can discuss social and emotional issues as well as medical concerns with an integrated care team, according to Robert Wood Johnson Foundation. In the first nine months of the project, the clinic reduced per-patient ER use by 72% and approximately 80% of the participants saw underlying health conditions improve. Bridges also made improvements in social determinants of health, such as housing and employment, for patients, which has helped build robust community support for the program. The Bridges to Health Program received the Robert Wood Johnson Foundation Award for Health Equity in 2017.