- Cost and Quality Problems
- Improving Value
- Advocate Resources
- State News
Delaware tied for last place, along with North Dakota and Washington, D.C., in Leapfrog’s bi-annual Hospital Safety Grade report, according to Delaware Online. In a dramatic decline since 2012, when the state was ranked 8th in the country, not one of the state’s six hospitals earned an A rating. Leapfrog’s ratings take into account hospital injuries and infections, medical errors, data from the CMS and American Hospital Association and responses from patient surveys,
In 2014, Colorado Center on Law and Policy (CCLP) joined with consumer groups to address the high cost of specialty drugs in Colorado to open a dialogue with the state's Division of Insurance (DOI) and health insurers to address the unmanageable out-of-pocket costs, according to Health Affairs. Many plans charged coinsurance of up to 50 percent of the cost of drugs of the highest tier is discriminatory against people with disabilities and chronic conditions, in violation of the Affordable Care Act. Colorado's DOI enacted a regulation effective June 1, 2018, prohibiting plans from putting more than Most recently, Colorado’s DOI took decisive action by promulgating a regulation, effective June 1, 2018, prohibiting plans from putting more than half of drugs for a particular condition on the highest cost tier. Though it is difficult to assess whether enforcement of the rule will affect premiums, increases for 2019 individual plans are modest—an average of just 5.6 percent. Plan specifics for 2019 plans are now publicly available, and a review of formulary tiering for HIV drugs reveals some significant improvements from 2018. If carriers do not comply with the regulations of the ACA, the DOI should exercise its authority to assure that Coloradans have full access to the health care benefits and services they need.
In Ohio, the Office of Health Transformation, created in 2011, convenes all agencies that touch healthcare, including Health, Medicaid, Mental Health and Addiction Services, Jobs and Family Services, Veterans Affairs, Administrative Services, as well as representatives of the private insurance market -- to dedicate some time to reforms and long-term health improvement and to agree on which population health goals are most urgent, according to Governing. The Office helped develop an integrated eligibility system so Medicaid beneficiaries could see whether they also qualified for food assistance, child care, child welfare and cash assistance after the state expanded its Medicaid program. Additionally, to prevent providers from declining to see the patients with the biggest mental health needs, and to help those patients avoid having to hunt down doctors who would see them, the state identified the 5 percent of patients that were the costliest in behavioral health and matched them with a provider who could best serve them. As a result of these efforts and Medicaid expansion, Ohio has made large strides in transforming healthcare delivery in the state.
Blue Cross Blue Shield of Massachusetts, the state's largest health insurer, is trying a new strategy to tackle healthcare costs: putting hospitals on a budget, according to the Boston Globe. Blue Cross will be paying hospitals not per patient and procedure but for how well they control costs while trying to keep patients healthy, rewarding hospitals when they collaborate with physician groups to manage costs and improve outcomes. Hospitals are still rooted in a fee-for-service system and represent the biggest portion of healthcare costs (accounting for more than one third of the $61.1 billion in MA) so this shift in incentives in the hospital system is historic. Blue Cross is testing the model with South Shore Hospital in Weymouth, and if it goes well it will begin to offer the program to other Massachusetts hospitals by 2020.
Maryland implemented the Health Enterprise Zone Initiative in 2013 to improve access to healthcare and health outcomes in undeserved communities, by attempting to reduce healthcare costs and avoidable hospital admissions and readmission, according to a report in Health Affairs. In each community, the Health Enterprise Zone was a collaboration between the local health department or hospital and community based organizations, designed to attract primary care providers to undeserved communities and help support community efforts to improve health behaviors. This initiative was associated with a reduction of nearly 20,000 inpatient stays and an increase of around 40,000 emergency department visits between the study period of 2013-2016. The net cost savings of the reduction in inpatient stays greatly outweighed the initiative's costs to the states. This initiative could be modeled in other communities as a way to reduce healthcare costs.
CMS has approved a North Carolina Medicaid reform demonstration to move from traditional fee-for-service payments to a managed care delivery system. The reform model is an attempt to increase quality of service as well as create a more predictable budget, according to Health Affairs Blog. North Carolina will partner with health plans in an effort to target high-need Medicaid patients and better coordinate care. Among other innovations, the state will pilot an intervention in select regions that addresses social determinants of health including food security, housing instability, reliable transportation, toxic stress and interpersonal violence.
The Minnesota Attorney General Lori Swanson targeted drug manufacturers in a lawsuit for inflating the cost of insulin medication, according to the Star Tribune. Swanson is accusing others of being complicit in price-gauging sick patients with diabetes as well as the drug manufacturers. The lawsuit named three drug companies, Sanofi-Aventis, Novo Nordisk and Eli Lilly, that have tripled the list prices of their synthetic insulin medication since 2002. These medications are crucial to people with diabetes to manage their blood sugar and reduce their risk of disability, even death. Swanson is saying part of the price hike is due to the rebate structure implemented by pharmacy benefit managers (PBMs) who have ignored the impact of these rising costs have on patients. PBMs currently play a role in deciding which drugs are listed on insurance companies' preferred list. Because the PBM profits come through rebates, manufacturers have incentives to curry favor with them by raising prices and inflating rebates. Rising prices of insulin have raised concern over the past year with everyone from the President to Senator Amy Klobuchar appealing directly to insulin manufacturers, demanding legislation to compel the companies to lower their prices. Minnesota is the first state to bring a case against the insulin manufacturers.
Michigan has asked CMS for permission to enter into outcomes-based contracts with drug manufacturers under its Medicaid program in order to make drugs more accessible for beneficiaries, according to Inside Health Policy. Outcomes-based contracts stipulate that if patients using the medications do not meet specified benchmarks, manufacturers could be on the hook for paying additional rebates. Proponents are optimistic that outcomes-based contracts can give Medicaid beneficiaries access to higher-cost medications more quickly, and that risk would be transferred to manufacturers. However, a study published by the Commonwealth Fund found that outcomes-based contracts have a limited capacity to reduce costs because they only apply to a small subset of medications. If the request is approved, Michigan would be the second state allowed to enter into outcomes-based contracts, behind Oklahoma.
According to New Hampshire Public Radio, Governor Sununu announced $24 million dollars to help address the state’s nursing shortage. The one-time investment will help expand nursing programs at schools across the state including Plymouth State University and the University of New Hampshire. There are currently 1300 open positions to be filled in the state, and the hope is that increasing the number of trained nurses will help fill these and future openings in the state.
Tens of thousands of Connecticut residents lack access to adequate healthcare, despite the state’s tremendous wealth and strong embrace of the federal Affordable Care Act, according to The Connecticut Mirror. While Connecticut once had a generous social safety net that elevated its poorest residents above their counterparts in most other states, it has since been eroded by massive budget deficits, which could get worse in the near future. Advocates worry that changes on the horizon could mean greater barriers to healthcare for many Connecticut residents – low-income individuals and families, those who rely on safety-net clinics for care, middle-class earners whose income has been squeezed by healthcare costs, and those with insurance plans that increasingly require them to pay more for care.