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Like many states, Alaska continues to face health care workforce shortages that are particularly challenging in the rural and frontier areas of the state. Through cross-agency collaboration, however, Alaska has made significant inroads to address its challenges of education and training initiatives, recruitment and promoting retention of healthcare workers. State successes include: implementing registered apprenticeships for healthcare occupations; providing Medicaid reimbursement for non-traditional healthcare workers; creating core competencies and training tools for direct support workers; conducting readiness assessments of state staff and behavioral health providers; and implementing a loan repayment program. A case study from the National Academy for State Health Policy highlights how Alaska has utilized this multi-sector, cross-agency collaboration to bolster healthcare workforce development.
Michigan has secured federal approval to negotiate Medicaid drug prices based on how well the medications work. This will give the state the authority to use additional rebate agreements for “outcomes-based” contracts with manufacturers, according to Modern Healthcare. This change comes after a congressional advisory panel on Medicaid found that drug spending increases have been higher for Medicaid than for other payers. Though it is too early to forecast savings, Oklahoma, which is using a similar amendment, has entered into alternative payment contracts for two drugs.
A handful of St. Louis area hospitals received a high rating for patient safety in a report from the medical watchdog nonprofit, the Leapfrog Group, according to St. Louis Public Radio. The St. Louis-area hospitals that received “A” ratings include Mercy hospitals in Festus and St. Louis, St. Anthony’s in Alton, St. Joseph’s in Breese and St. Elizabeth’s in O’Fallon, Illinois. No hospitals in St. Louis received an “F,” but two hospitals, St. Alexius and Christian Hospital Northeast, received “D” grades. According to Leapfrog, characteristics of patients in a hospital service area do not affect rankings.
The Archdiocese of St. Louis plans to open its first health clinic early next year in Washington County, in an effort to improve rural healthcare, reports the St. Louis Post Dispatch. The free clinic will offer primary care, chronic disease management, mental healthcare and social services — including housing and employment resources — for people without health insurance. Washington County is one of the poorest in the state, with a poverty rate of 22 percent. The county has the highest percentage of uninsured adults in the St. Louis region (at 17 percent) and ranks 109th out of 115 Missouri counties in health outcomes, including longevity and quality of life.
Delaware tied for last place, along with North Dakota and Washington, D.C., in Leapfrog’s bi-annual Hospital Safety Grade report, according to Delaware Online. In a dramatic decline since 2012, when the state was ranked 8th in the country, not one of the state’s six hospitals earned an A rating. Leapfrog’s ratings take into account hospital injuries and infections, medical errors, data from the CMS and American Hospital Association and responses from patient surveys,
Seven of 20 Kansas City area hospitals got A’s in the Leapfrog Group’s Fall 2018 report card on patient safety, while nine got B’s and four got C’s, according to KCUR. Kansas ranked 24th in the nation, with nearly a third of its hospitals receiving an A grade. Missouri ranked 34th, with about 23 percent of its hospitals receiving an A grade. Kansas moved up three notches from Leapfrog’s last survey in Spring 2018; Missouri dropped 21 notches. New Jersey, Oregon, Virginia, Massachusetts and Texas were the highest rated states. The lowest rated were Connecticut, Nebraska, Washington, D.C., Delaware and North Dakota.
The Health Care Cost Institute processed data from 1.78 billion commercial claims filed between 2012 and 2016 in 112 U.S. cities, including six California metropolitan areas, in its nationwide comparison of healthcare-services costs, reports State of Reform. The analysis showed that costs across San Jose, San Francisco, San Diego, Los Angeles, Oxnard and Riverside — as well as the rate of price increases — were not uniform between 2012 and 2016. San Jose was the second most expensive city in the national analysis, while Riverside was the 48th most expensive city. Researchers also found that outpatient costs in San Jose were 117 percent above the national average in 2016.
In 2014, Colorado Center on Law and Policy (CCLP) joined with consumer groups to address the high cost of specialty drugs in Colorado to open a dialogue with the state's Division of Insurance (DOI) and health insurers to address the unmanageable out-of-pocket costs, according to Health Affairs. Many plans charged coinsurance of up to 50 percent of the cost of drugs of the highest tier is discriminatory against people with disabilities and chronic conditions, in violation of the Affordable Care Act. Colorado's DOI enacted a regulation effective June 1, 2018, prohibiting plans from putting more than Most recently, Colorado’s DOI took decisive action by promulgating a regulation, effective June 1, 2018, prohibiting plans from putting more than half of drugs for a particular condition on the highest cost tier. Though it is difficult to assess whether enforcement of the rule will affect premiums, increases for 2019 individual plans are modest—an average of just 5.6 percent. Plan specifics for 2019 plans are now publicly available, and a review of formulary tiering for HIV drugs reveals some significant improvements from 2018. If carriers do not comply with the regulations of the ACA, the DOI should exercise its authority to assure that Coloradans have full access to the health care benefits and services they need.
Wyoming’s Volunteer Health Services Program, which shields providers or medical facilities willing to provide voluntary, free services to low-income residents from legal liability, has been approved by the legislature, according to the Casper Star Tribune. To participate in the new program, providers enter into a contract with the state that technically makes them state government employees or facilities, granting them sovereign immunity for the free care they provide. A patient wishing to participate must have an annual income that’s at or below 200 percent of federal poverty levels.
California implemented a pay-for-performance program in safety-net hospitals that incentivized measurement and improvement in key areas of ambulatory safety: referral completion, medication safety and test follow-up. A study in Health Affairs found that wide-scale measurement of ambulatory patient safety faces challenges, particularly for complex measures that require the integration of different types of data. Researches also documented wide variation in performance on a broad range of ambulatory patient safety measures. Health systems generally performed better in areas that require only a single contact with a patient and limited patient engagement or coordination with other providers. To prevent harm to patients in ambulatory care settings, the authors argue that hospital systems need research and policies that incentivize the adoption of robust data infrastructure as well as the development of measures in all areas of ambulatory patient safety.