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In 2010 Rhode Island adopted affordability standards that imposed price controls, specifically inflation caps and diagnosis-based payments, on contracts between commercial insurers and hospitals and clinics, according to researchers from Stanford and Harvard. These standards also required commercial insurers to increase their own spending on primary care coordination services, to help ensure patient's caregivers work together efficiently. The results, published in Health Affairs, shows that fee-for-service spending in the Rhode Island group compared to out-of-state health care enrollees decreased after the policy was implemented. And, primary care coordination spending increased per enrollee, which is good, because these services are designed to prevent more costly medical needs in the future like emergency room visits. The Rhode Island Office of Health Insurance Commissioner noted in this same time frame they did not see a decline in health care quality, possibly because of the investment in care coordination.
The Kaiser Family Foundation and California Health Care Foundation released the results of a new poll assessing the healthcare priorities of California residents, reports State of Reform. Making healthcare more affordable ranked as a top issue for Californians, with 45 percent ranking it as “extremely important” and 35 percent ranking it “very important.” Increasing access to mental health treatment topped the list of specific healthcare priorities. These concerns are likely related to the fact that, in all six geographic areas surveyed, residents said that their communities did not have enough mental health providers. Communities of color reported mental health provider shortages at higher rates than other communities.
Californians rank making healthcare more affordable among their top overall priorities for the state’s new governor and legislature, with 45 percent citing it as “extremely important,” according to a new Kaiser Family Foundation/California Health Care Foundation poll examining state health policy issues. Other top priorities are ensuring that people with mental health problems can get treatment, making sure all Californians have access to health coverage. Mental health access ranks in the top two health priorities for Democrats, Republicans and independents alike. Half of all Californians say their community does not have enough mental health providers to serve local needs.
Blue Cross and Blue Shield of North Carolina (BCBSNC) and five of the largest health systems in the state announced moving larger sections of their business towards value-based care, reports North Carolina Health News. BCBSNC has put contracts in place to move half their payments to these health systems to value-based by 2020. This move is aligned with other value-based initiatives happening in the state’s Medicaid program as well as successful ACOs programs that care for Medicare patients.
Air ambulance companies in Missouri use the practice of balance billing to stick patients with bills for tens of thousands of dollars, reports Missouri Business Alert. The findings come from a new report from the Missouri Department of Insurance, Financial Institutions and Professional Registration (DIFP). The DIFP estimates that air ambulance providers charged a total of $25.7 million for their services in Missouri in 2017. Of that amount, patients could have been balance-billed up to $12.4 million, which comes out to $20,000 per passenger. The report also cites “vigorous collection efforts,” including wage garnishments and liens, by some air ambulance companies.
Urgent care centers and walk in clinics that treat a range of medical issues are proliferating, especially in affluent suburbs of Massachusetts, according to the Boston Globe. A state commission counted 150 urgent care centers last year, up from 18 in 2010, reshaping the healthcare landscape in Massachusetts, promising to treat non-life-threatening medical conditions without appointments at a fraction of the cost of ERs. But companies are not rushing to open urgent care centers in the lower-income neighborhoods in Boston. Only a small fraction of their revenue comes from patients on Medicaid, which insures more than one quarter of the state's residents. 30 to 40 percent of centers refuse to treat Medicaid patients, saying the program's requirements are onerous and does not pay enough to cover their costs. The state generally will not pay for residents on Medicaid to visit an urgent care center unless the patient has a referral from a primary care doctor, a burdensome requirement which can prevent the urgent care companies from treating large numbers of low-income patients. MinuteClinics began operating in Massachusetts more than a decade ago, and are regulated by the state, while urgent care centers are still new enough to Massachusetts that the state has no official definition for them, nor specific rules for how they operate.
Starting January 2019 four employers in the Twin Cities are offering a new "SmartCare" program, a new employee health plan with a limited network of doctors and hospitals, according to the Star Tribune. This limited clinic choice is another example of how health insurers are offering lower premiums, with consumers agreeing to have their care coordinated by a small subset of doctors and hospitals, and pay more out of pocket to visit other healthcare providers. Narrow network health plans have been around for decades, but they are making new appearances in the Minnesota insurance market recently, particularly in the market where individuals under 65 buy their own coverage. The first SmartCare clinic has seen a 10 to 20 percent reduction in total cost.
Gov. Jay Inslee and Democratic lawmakers will introduce legislation that would provide a public healthcare option in Washington through the state’s Health Benefit Exchange, announced the Governor’s Office. The proposal addresses the challenges of health insurance availability as well as affordability—specifically, the proposal will improve affordability through standardized plan designs that are easier to understand and have lower out-of-pocket costs for consumers. “With volatility and uncertainty at the federal level, the goal of this proposal is to provide a sensible alternative that is affordable and accessible in every county,” said the bill’s sponsor, Rep. Eileen Cody.
California’s Governor announced several actions he would take related to healthcare, according to State of Reform. Governor Newsom signed an executive order placing all Medi-Cal prescription drug pricing negotiations under the Department of Health Care Services, rather than a “fragmented” array of purchasers. The Governor also wrote a letter to Congress and the White House asking lawmakers to “amend federal law” so that states can get waivers that allow for state-based innovation – “including creating paths to single-payer” – and provided a preview of healthcare-related items in his budget.
A University of Delaware study, commissioned by the Delaware Department of Health and Social Services, found a 6 percent decline in primary care doctors actively providing patient care from 2013 to 2018, according to WHYY. In addition to a declining number of practicing physicians, the state’s physician workforce is also aging, with only 60 percent of Kent County physicians say that they still plan to be practicing in five years. Delaware’s Primary Care Collaborative is expected to release a report with long-term solutions to increase access to primary care in the state.