- Cost and Quality Problems
- Improving Value
- Advocate Resources
- State News
California has enacted a law that will require HMOs seeking to merge plan offerings to get permission from the state's Department of Managed Health Care, reports Modern Healthcare. The new law also gives the department the ability to veto mergers that negatively impact competition. Plans seeking to merge must outline any potential impact to access, network adequacy, handling of consumer complaints and claims processing. It also requires insurers to host public hearings. Supporters claim that the bill’s passage provides an important consumer protection, as three insurers control nearly 90 percent of the state’s HMO market.
Manufacturers, distributors and retailers in Philadelphia are passing the full amount of the city’s newly implemented sugar-sweetened beverage tax on to consumers, according to Mathematica Policy Research. Although the data revealed some variation across stores, the tax of 1.5 cents per ounce typically raised retail prices by roughly 1.5 cents per ounce. As a result of the tax, sweetened drinks are more expensive and less available in stores. These findings come at a time when a growing number of communities are considering beverage taxes as a solution to rising rates of obesity and diet-related chronic diseases, such as Type 2 Diabetes.
Hospital acquisition of physician practices–particularly in markets with limited hospital competition–was associated with higher prices for outpatient visits and higher insurance premiums on California’s individual marketplace from 2010-2016, according to a Commonwealth Fund study published in Health Affairs. Prices for outpatient visits were 5-10 percent higher in areas with high hospital-physician employment, while premiums for individual coverage rose the most in areas with both high consolidation among hospitals and a high percentage of hospital-owned physician practices. While integration and consolidation among providers and health plans has the potential to improve care coordination and quality, these findings indicate a need for careful scrutiny of healthcare mergers and acquisitions.
After premiums in Charlottesville rose more than 300 percent in 2018 and became the most expensive in the country, advocates successfully challenged Optima and state regulators about how premiums were set, according to The Washington Post. Thanks to their efforts, the city’s rates are coming back down ahead of open enrollment for 2019 and Anthem has decided to reenter the Virginia market. The group of consumer advocates also helped pass legislation to allow solo entrepreneurs to purchase health insurance on the small-group market.
Be There San Diego—a multi-stakeholder population health collaborative consisting of partners at the federal, state and local levels—was established in 2011 to reduce cardiovascular events through the uptake of best practices and patient and medical community activation. Before its inception, rates of hospitalization for heart attacks were about the same in San Diego County compared to the rest of the state. Since then, hospitalizations for acute myocardial infarction (AMI) have decreased by 22 percent in San Diego County versus 8 percent in the rest of the state, according to a study published in Health Affairs. Researchers estimate that 3,826 AMI hospitalizations were avoided and $86 million was saved in San Diego. The results suggest that a science-based health collaborative can improve community health outcomes while lowering costs.
A survey of California nurse practitioners (NPs) examining employment and practice barriers revealed that NPs are well prepared to help fill care gaps arising from shortages of primary care physicians in California, but barriers to practice remain, according to a report published in Health Affairs. Challenges include a higher concentration of NPs and NP education programs in areas with high physician-to-population ratios; a racially homogenous workforce that does not reflect populations living in communities with the greatest need; and restrictions limiting NPs’ “scope of practice.” The authors recommend expanding education programs in underserved areas, increasing the diversity of the nurse practitioner workforce and empowering nurse practitioners to practice at the “top” of their licenses to meet both current and future primary care needs.
California initiated the Global Payment Program (GPP)—a pilot program included in the state's current Section 1115 demonstration waiver—in 2015 to support public healthcare system efforts to deliver more cost-effective and higher-value care to the state's uninsured. A midpoint evaluation of the GPP conducted by RAND revealed that the program has helped county-based public healthcare systems (PHCSs) build and strengthen primary care, data collection and integration and care coordination over time. Positive trends were observed regarding the use of non-behavioral health services: use of outpatient non-emergent services have generally increased, while use of ED and inpatient services have generally decreased. However, undesirable trends were observed for behavioral health services: outpatient mental health and substance abuse treatment services generally decreased, while mental health ED and crisis stabilization services and mental health inpatient service use generally increased.
This op-ed highlights the connection between stable housing and behavioral health, particularly for Idahoans undergoing or finishing treatment. Given the shortage of affordable housing units in the state, these individuals are at high-risk of relapse—increasing the likelihood of costly emergency department visits, hospital admissions and incarceration. Supportive services provided by programs like Housing First can successfully break the cycle of recovery and crisis.
The State of Rhode Island and Brown University announced a new initiative to study healthcare cost trends to improve how care is delivered throughout the state, according to the Peterson Center on Healthcare. Over the course of the year, this new initiative, the Rhode Island Healthcare Cost Trends Collaborative Project, will work with Rhode Island policymakers and staff. The team will analyze spending data from the state’s all-payer claims database to better understand and measure healthcare performance. Ultimately, with findings from this analysis, the project teams will work with multiple stakeholders to assess cost drivers, identify opportunities to improve outcomes and lower costs of care, and establish a target for future healthcare cost growth. The Peterson Center on Healthcare noted this project will give Rhode Islands the tools it needs to improve sustainability and quality for Rhode Islanders, while creating a model other states can duplicate.
The percentage of people in Virginia’s far southwest region—one hit hardest by the opioid crisis, poverty and unemployment—receiving treatment for opioid abuse rose from 67 percent in 2016 to 73 percent by April 2018. According to FierceHealthcare, the state launched the Addiction and Recovery Treatment Services (ARTS) Medicaid benefit last year, which will be accessible to more people now that Virginia is expanding Medicaid. State leaders found that counties with the highest rates of ‘deaths of despair,’ or ones from overdoses, suicides, or alcohol-related conditions, were among those with the highest number of people in poverty or with lowest high school graduation rates. For that reason, state Health and Human Resources representatives have re-characterized them as “deaths of disparity.” A Commonwealth Fund report found that these deaths increased by over 50 percent in the past decade. More understanding is needed to address disparities contributing to deaths, especially as Virginia rolls out Medicaid expansion.