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Women leave the correctional system a lot heavier than when they arrived, reports the Washington Post. In an effort to stem weight gains and improve chronic health conditions like heart disease and diabetes that disproportionately affect people who are incarcerated, the Warden of the Maryland Correctional Institution for Women worked with a dietitian to retool meals for women by cutting around 1,000 calories a day (previously a 3,200 calorie menu). The warden expects this initiative will show savings on healthcare costs, including medications, which is the biggest line item in the budget. And, women in the facility already report greater satisfaction with the healthier meals, changing their actions by eating in the dining hall rather than eating unhealthy food from the commissary. This has improved morale in prison, which could translate to heightened safety. Significant challenges remain including a lack of funding: an increase is unlikely even if there are the potentials for saving money down the road.
Specialty care accounts for a significant and growing portion of year-over-year Medicaid cost increases. Some referrals to specialists may be avoided and managed more efficiently by using electronic consultations. A study in Health Affairs found that linking primary care providers with specialists in dermatology, endocrinology, gastroenterology and orthopedics in Connecticut using an electronic platform reduced the need for face-to-face visits, saving an average of $82 per patient per month. Researchers concluded that expanding the use of electronic consultations for Medicaid patients and reimbursing the service could result in substantial savings while improving access to and timeliness of specialty care and strengthening primary care.
Healthcare spending at Minnesota clinics slowed sharply last year as physicians discouraged wasteful services and encouraged patients to choose lower-cost sources for prescription drugs, labs and imaging, according to the Minnesota Star Tribune. Per patient costs varied widely based on where patients received their primary care, ranging to a two and a half times difference in price, according to the total cost of care report. For example, specialty clinics, like the Mayo Clinic as well as rural providers tended to have higher prices. The report suggests that doctors managed costs by steering patients to low cost clinics instead of hospitals for outpatient services which declined spending on those outpatient hospital services by 1 percent in 2017 following a 7.3 percent increase in 2016. Business leaders said this comparison information is vital as health care costs increases and the payment burden falls more heavily on patients. Minnesota is currently the only state where detailed price information is published.
The governor of Iowa projected his Medicaid privatization program would save the state $232 million, but a report by the state auditor found that only around $126 million was saved, according to the Lexington Herald. The report also found that officials and lawmakers failed to file state-required quarterly financial reports. Iowa, like 39 other states, adopted a privatized, managed care system as a way to address Medicaid cost growth. But opponents questioned whether privatization actually producing any savings and pointed out that some insurance companies were sustaining losses.
The Virginia Department of Medical Assistance Services has asked the governor to include $19.1 million in his budget proposal to boost Medicaid reimbursements for primary care doctors in order to prevent a physician shortage, according to the Richmond-Times Dispatch. With Medicaid expansion set to begin on January 1, state legislators are concerned about the widening gap between reimbursement rates to doctors in Medicaid and those in Medicare and inconsistent access to care under the Medicaid program. For the current fiscal year, Medicaid reimbursement was 71 percent of the rates paid by Medicare. The state expects to enroll 360,000 people under expanded Medicaid eligibility.
Connecticut’s U.S. congressional delegation is at odds with the governor over the failure to apply for an expansion of the HUSKY program that would give low-income residents access to new telemedicine services, especially for psychiatric care and substance abuse treatment, reports The CT Mirror. Five Democrats representing Connecticut in the U.S. House of Representatives are pressing the Malloy administration to apply for the waiver, which would allow the state’s doctors and hospitals to receive Medicaid reimbursements for their services when they treat HUSKY patients through telemedicine. The Malloy administration says the process for obtaining permission to add these services is lengthy, may not achieve the desired results and is not currently a priority. Connecticut is the only state in the nation that has not requested a waiver from the Department of Health and Human Services to incorporate telemedicine into its Medicaid program.
In 2010, South Carolina launched the Safe Surgery South Carolina program to promote the implementation of the World Health Organization Surgical Safety Checklist. The checklist is a patient safety tool to improve safety in all care settings for patients undergoing surgical procedures. The hospitals that have reported full implementation of the checklist had significantly higher rates of physician and CEO engagement as well as high-touch activities, such as in-person meetings, than comparison hospitals, according to Health Affairs.
Like many states, Alaska continues to face health care workforce shortages that are particularly challenging in the rural and frontier areas of the state. Through cross-agency collaboration, however, Alaska has made significant inroads to address its challenges of education and training initiatives, recruitment and promoting retention of healthcare workers. State successes include: implementing registered apprenticeships for healthcare occupations; providing Medicaid reimbursement for non-traditional healthcare workers; creating core competencies and training tools for direct support workers; conducting readiness assessments of state staff and behavioral health providers; and implementing a loan repayment program. A case study from the National Academy for State Health Policy highlights how Alaska has utilized this multi-sector, cross-agency collaboration to bolster healthcare workforce development.
Michigan has secured federal approval to negotiate Medicaid drug prices based on how well the medications work. This will give the state the authority to use additional rebate agreements for “outcomes-based” contracts with manufacturers, according to Modern Healthcare. This change comes after a congressional advisory panel on Medicaid found that drug spending increases have been higher for Medicaid than for other payers. Though it is too early to forecast savings, Oklahoma, which is using a similar amendment, has entered into alternative payment contracts for two drugs.
A handful of St. Louis area hospitals received a high rating for patient safety in a report from the medical watchdog nonprofit, the Leapfrog Group, according to St. Louis Public Radio. The St. Louis-area hospitals that received “A” ratings include Mercy hospitals in Festus and St. Louis, St. Anthony’s in Alton, St. Joseph’s in Breese and St. Elizabeth’s in O’Fallon, Illinois. No hospitals in St. Louis received an “F,” but two hospitals, St. Alexius and Christian Hospital Northeast, received “D” grades. According to Leapfrog, characteristics of patients in a hospital service area do not affect rankings.