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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.
An analysis from the Catalyst for Payment Reform, the Virginia Center for Health Innovation and the Virginia Association for Health Plans found that 67 percent of healthcare payments to Virginia physicians and hospitals by commercial insurers in 2016 were tied to value. The report was based on an examination of data from commercial and Medicaid managed care plans insuring 4.6 million Virginians. Other key findings include: 80 percent of value-oriented commercial insurer payments were in hospital contracts, 41 percent of value-based Medicaid managed care payments were in primary care, and the most commonly used value-based payment model was Shared Savings.
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.
A study by the Health Care Cost Institute at the request of the New Jersey Health Care Quality Institute found that fewer people are being admitted to New Jersey hospitals in recent years, with improvements in medical care and a growth in less-costly outpatient options. However, according to NJSpotlight, with the price of inpatient care escalating by nearly 40 percent over four years, spending on this category continues to climb.
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.