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Milwaukee Journal Sentinel: Six of the largest health systems in Wisconsin created a partnership with the goal of improving healthcare quality and lowering costs. The six health systems are to share best practices for improving quality and eliminating waste. The new partnership hopes to contract with health insurers, and the statewide network could appeal to national and government employers. The six health systems now belong to the narrow networks of Anthem Blue Cross and Blue Shield in Wisconsin.
The three CareFirst carriers in Maryland received approval to increase premium rates by 9.8 percent (CareFirst BlueChoice, Inc.) or 16.2 percent (CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.), on average − substantial reductions from the 22.8 percent and 30.2 percent increases those companies requested for 2015, according to a news release from the Maryland Insurance Administration.
Forty-eight percent of primary care physicians that did their residency in North Dakota stay on to keep practicing in North Dakota, according to a report developed by the Center for Rural Health at the School of Medicine & Health Sciences at the University of North Dakota. Understanding who is coming to North Dakota to study and why they are staying can help attract other physicians to the state.
A California appeals court reversed a lower court’s 2012 decision to compel Blue Cross of California to pay Children’s Hospital of California the full chargemaster rates for services rendered outside of a contract, reports The Source on Healthcare Price & Competition. Judge Levy of the California Court of Appeals ruled in favor of Blue Cross’ claims that, under California regulations governing claims settlements, it only owed the Hospital the “reasonable,” or market, value of the services rendered. California hospitals must now expect to prove that what they bill for services is equal to the value of the services they provide. This case marks a win for fairness in hospital pricing at the legal level, and is likely to have great practical effects as well.
OSPIRG Foundation report analyzed the impact of health insurance rate review on 2015 premiums for Oregon individuals, families, and small businesses. The report revealed that one insurer made a major error in its initial filing, and some insurers overstated trends in medical costs. The report noted that the DOI review ensured that provider savings from reductions in uncompensated care (due to the expansion of health coverage under the ACA) were passed along to policyholders.
The Connecticut Health Policy Project released a report that examines how much Connecticut spends on health care. The report discusses Connecticut health spending and projected growth rates. The report also covers who pays the health care costs, where each health care dollar is spent, and what factors are driving health care costs, both nationally and in Connecticut.
This report complies with the Wyoming Senate’s requirement that Wyoming Department of Health study the use of managed models of care for some or all of the people enrolled in the Medicaid program with the goal of delivering care of the same or better quality as currently delivered, while also reducing costs. Most states have some type of Medicaid managed care; only Alaska and Wyoming do not. After comparing to similar states and soliciting extensive stakeholder feedback, HMA recommended that WDH pursue two coordinated care models.
Dr. Sanjeev Arora, a hepatologist at the University of New Mexico in Albuquerque, has developed Project ECHO, a solution for patients with hepatitis C that could help transform healthcare, according to The New York Times. A team of specialists used video conferencing to provide weekly training to primary care providers on managing patients with hepatitis C, removing the cost and travel barrier for New Mexicans living in remote areas. A Health Affairs study found that the primary care clinicians achieved better cure rates and their patients experienced fewer serious adverse events.
This Health Affairs blog post is a second in a series funded by the Robert Wood Johnson Foundation focusing on the development of Arkansas’ PCMH model. Additionally the post discusses the key aspects of the model, which include—payment structure, shared savings structure, quality metrics, payer involvement, provider participation, and legislative and regulatory alignment.
The Commonwealth Fund named Vermont as one of the top ranking states for improving healthcare access, quality, outcomes and lowering costs in the five years preceding implementation of the Affordable Care Act’s major coverage provisions, according to Vermont Biz.