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Virginia has submitted a 1115 waiver application that would add work requirements, premiums and emergency department co-pays to beneficiaries above the federal poverty level to their expanded Medicaid program, according to Modern Healthcare. Under the waiver proposal, eligible Medicaid enrollees would need 20 hours per month of work-related activities for the first three months that they're eligible for the program, which would gradually increase to 80 hours per month. The state also wants permission to impose a monthly premiums for beneficiaries above the federal poverty level, assessed on a sliding income scale.
A 90-day evaluation of a nursing triage line at D.C.’s 9-1-1 call center revealed that the program has yet to meet one of its intended goals: reducing ambulance trips for patients who don’t need them, according to The Washington Post. The program, known as “Right Care, Right Now,” aims to avoid unnecessary and costly trips to the ED by diagnosing callers who have non-life-threatening conditions and ordering quick, private transportation to clinics through a ride-share service. While the goal is to deploy ambulances, medics and fire crews more wisely, the evaluation showed that nearly half of all calls routed from a 9-1-1 dispatcher to triage nurses still resulted in a fire unit being sent out after the nurses heard a caller describe their medical need. Early evidence suggests that the nurses have become more comfortable with referring callers to clinics over time, although similar efforts in Philadelphia and Richmond have failed due to lack of return on investment.
Iowa saw almost three times higher Medicaid costs after moving to a new managed care program called HealthLink, according to Healthcare Dive. Dozens of states have moved their Medicaid program to managed care organizations (MCOs) in attempt to reduce costs. However, after the first full year of privatization Iowa saw per-member costs increase an average of 4.4 percent, almost triple the average increases of the past six years. A recent Iowa Department of Human Services report found that higher per Medicaid member costs are expected to rise in 2018 and 2019 because of prior period rate adjustments. However, despite these setbacks in Iowa, many states view MCOs in Medicaid positively; 38 states and DC have Medicaid contracts with MCOs with over 74 million Medicaid beneficiaries enrolled in an MCO plan in 2015.
Delaware ACO Aledade achieved $5.6 million dollars in Medicare savings in 2017, according to Delaware News Journal. Aledade credits the bulk of its improvements to its data portal which alerts primary care physicians to recent emergency department visits by their patients as well as needed patient tests and screenings. The ACO also provides on-call access to a doctor or nurse 24 hours a day, 7 days a week. As a result, emergency department visits have decreased by 9 percent among the ACO’s Medicare patients.
Billings Clinic is launching its first psychiatry residency program, dedicated to bringing trained psychiatric medical professionals to rural eastern Montana, according to the Lewiston Tribune. Montana has the highest suicide rate in the country, and is also one of three states that has no psychiatry residency program. Montana has seven psychiatrists for every 100,000 residents, and the desired number should be fourteen or more. Due to this shortage, quality mental healthcare has lagged behind the rest of the country. Access to good mental health services can result in fewer emergency department visits, shortened hospital stays, better interactions between patients and staff and other health benefits. This program will benefit rural communities and improve mental health across Montana.
Beginning Oct. 2, California doctors are required to consult the state’s prescription drug database—known informally as CURES—before prescribing opioids and other potentially addictive drugs, reports the Los Angeles Times. CURES enables physicians to view patients’ prescriptions, the doctors who prescribed them and the pharmacies that filled them to help spot signs of “doctor shopping” and identify potentially dangerous medication combinations. Theoretically, this will improve quality by enabling doctors to provide drug safety warnings, deny a patient’s request for prescriptions and even offer help when drug abuse is suspected. But some have expressed concerns over the tool’s design, which may not be user-friendly to providers. States such as New York, Kentucky and Tennessee have passed similar legislation.
California has been successful in controlling rising healthcare costs by promoting price competition through market-based, managed care policies, according to a study in Health Affairs. However, recent data revealed that the state has not been able sustain its initial success in controlling growth in hospital prices. This article explores two trends that researchers suggest are responsible for the erosion of the conditions needed to sustain price competition within the state: hospital consolidation and regulations to ensure timely access to emergency hospital services that increased hospitals’ bargaining power over health plans.
California’s drug transparency law, passed in October 2017, aims to promote transparency in pharmaceutical pricing, enhance understanding about pharmaceutical pricing trends and help manage pharmaceutical costs. While it might not significantly reduce drug prices, the law represents a meaningful step towards navigating the challenging political and legal environments preventing state action to rein in drug prices. This Health Affairs article examines the legal and regulatory aspects of the law, compares it to other state efforts to address rising drug prices and provides recommendations for maximizing impact by coupling transparency with other incentives.
Massachusetts made progress in controlling healthcare costs, according to a recent report. Total health spending increased 1.7 percent in 2017, the lowest the state has seen in the past five years, though healthcare costs remain a burden for many residents. A 2012 state law requires Massachusetts to contain the growth in medical spending to 3.6 percent a year, and the chairman of the state Health Policy Commission said this report shows Massachusetts is leading the country in lowering the rate of growth in medical spending. The president of the Massachusetts Association of Health Plans noted that “This is good news for employers and consumers, but today’s report also demonstrates that more work needs to be done to address health care cost drivers in our marketplace.”
A new study released by the Pennsylvania Health Care Cost Containment Council (PHC4) to look at heroin and pain medication overdose patients by age, ethnicity/race and socio-economic status found that pain medication overdose admission rates had the highest increases among Hispanic residents, followed by low income residents, according to the Philadelphia Business Journal. Male residents had a higher rate of hospitalization for heroin overdose last year at 24.1 per 100,000 residents, compared to 9.4 per 100,000 for females. In a comparison by county, Philadelphia had the state’s highest heroin overdose hospitalization rate at 54.7 per 100,000 residents. PHC4 is an independent state agency based in Harrisburg that collects, analyzes and reports information that can be used to improve the quality and restrain the cost of healthcare in Pennsylvania.