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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.
Defense attorneys for Sutter Health — Northern California’s largest health system which stands accused of abusing its market power and charging higher prices — have subpoenaed 50 other California hospitals to hand over pricing information the hospitals consider proprietary, such as the terms of their contracts with insurers, reports the San Francisco Chronicle. Sutter says it needs the information to show that its pricing and contracting practices are no different than that of other hospitals. But some rival hospitals argue that handing over confidential information to their competitor could allow Sutter to use it to its advantage later — for example, by undercutting the rates that other hospitals charge insurance companies for certain services.
A survey conducted Altarum’s Healthcare Value Hub for the Universal Health Care Foundation of Connecticut revealed that residents across the political spectrum want state laws that require healthcare pricing transparency and make it easier to navigate the complex system, reports Hartfordbusiness.com. The survey found that half of survey respondents had experienced healthcare affordability burdens in the previous 12 months. Of that group, four in five said they had delayed or skipped a doctor visit, medical procedure or test, cut pills in half or skipped doses, or had trouble accessing mental healthcare due to cost. Though lower-income households had the highest reported affordability burdens, 42 percent of households making more than the state's median income reported experiencing cost burdens. Respondents supported a number of steps to remedy affordability problems, such as showing patients a "fair cost" for specific procedures, requiring medical providers and insurers to give up-front cost estimates and giving the state Attorney General the authority to prevent price gouging on prescription drugs.
Humana will pay Texas a $700,000 fine for failing to maintain an adequate number of in-network anesthesiologists at its contracted hospitals in four counties, according to Modern Healthcare. After patients receiving out-of-network bills for anesthesiology services contacted the insurer about balance bills, Humana has agreed to hold enrollees responsible only for the in-network charges and not for the balance bills. Texas has lagged in addressing the surprise billing issue after becoming one of the first states to establish a mediation system for resolving these billing disputes in 2009, which has only been accessed by 3,824 people since its inception. More than 300 Texas hospitals did not have a single emergency physician who was in-network with at least one of three major carriers, Humana, Blue Cross Blue Shield and UnitedHealth Group. Lawmakers have proposed legislation that would require insurers and providers to resolve out-of-network bills while shielding consumers.
According to a report by Virginia Health Information (VHI), healthcare costs vary dramatically depending on where consumers live, highlighting the need for local cost of care information. For example, a colonoscopy in 2016 averaged as little as $1,075 in Southwest Virginia physician offices and as much as $2,940 in Central Virginia hospitals, according to Augusta Free Press. In a 2017 national report card published by Altarum, Virginia was just one of six states earning a passing grade in pricing transparency.
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.