State News

California | September 4, 2018 | Report

One in Five Fewer Heart Attacks: Impact, Savings, and Sustainability in San Diego County Collaborative

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.


California | September 4, 2018 | Report

California Nurse Practitioners Are Positioned to Fill the Primary Care Gap, But They Face Barriers to Practice

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 | September 3, 2018 | Report

Evaluation of California’s Global Payment Program

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.


Idaho | August 28, 2018 | News Story

Affordable Homes are Key to Mental Health Solutions

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.


Rhode Island | August 23, 2018 | News Story

Effort Will Leverage State’s Healthcare Cost Data to Improve Quality and Accountability

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.


Virginia | August 22, 2018 | News Story

How Virginia is Seeking to Reframe the Discussion Around ‘Deaths of Despair’

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. 


Maryland | August 22, 2018 | News Story

CMS Approves Maryland Reinsurance Waiver for Obamacare Markets

The Centers for Medicare and Medicaid Services (CMS) approved Maryland's waiver to start a reinsurance pool for the Affordable Care Act exchange, according to Modern Healthcare. The state estimates that the program will cancel out the previously projected 30 percent average rate hike for individuals on the exchange for 2019. Officials estimate this waiver will lower premiums by about 30 percent and raise enrollment by about 6 percent. The executive director of the Maryland Health Benefit Exchange called the program, "The largest of it's kind in the country to bring rate relief... to residents who don't qualify for financial help with monthly premiums."


Louisiana | August 22, 2018 | News Story

Louisiana Uninsured Rate Cut in Half Due to Medicaid Expansion

Louisiana's Medicaid expansion cut the state's uninsured rate among adults by half in two years, plummeting from more than 22 percent to just over 11 percent. According to FierceHealthcare, the lowest rate can be found in the Houma-Thibodaux region, where only 8.5 percent of adults lack coverage. This data was uncovered by the most recent Louisiana Health Insurance Survey, which is sponsored by the Department of Health and conducted by Louisiana State University. Medicaid expansion made geographic discrepancies in coverage across the state “much more muted in 2017,” the report notes, adding that the statewide uninsured rate “may drop further in future years as residents become more informed of Medicaid options and eligibility.” 


Vermont | August 21, 2018 | News Story

Vermont Pilot Program Seeks to Lessen Hospital Stays for Medicare Patients

Medicare rules dictate that patients must stay at a hospital for at least three consecutive days before the program will cover treatment at a skilled nursing facility. However, OneCare Vermont, a statewide network of insurers and medical facilities, granted Brattleboro Memorial Hospital and three local facilities a waiver that reduces that requirement to one day, reports the Sentinel Source. The waiver is expected to decrease unnecessary hospital stays, cut costs and potentially improve quality by protecting patients from hospital-borne infections.


Vermont | August 21, 2018 | News Story

Vermont Pilot Program Seeks to Lessen Hospital Stays for Medicare Patients

Medicare rules dictate that patients must stay at a hospital for at least three consecutive days before the program will cover treatment at a skilled nursing facility. However, OneCare Vermont, a statewide network of insurers and medical facilities, granted Brattleboro Memorial Hospital and three local facilities a waiver that reduces that requirement to one day, reports the Sentinel Source. The waiver is expected to decrease unnecessary hospital stays, cut costs and potentially improve quality by protecting patients from hospital-borne infections.