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The New Hampshire Department of Health and Human Services produced this report to outline their plan to transform the current long term services and supports system with a 2013 State Innovation Model design grant. The plans include establishing a health home model, coordinating services and providing more control to individuals over the services they receive.
By focusing on patients that are in need of or at risk of needing long term services and supports, the State has the opportunity to tackle a high cost group, accounting for 64% of the state’s total Medicaid budget.
A New York Times article covered the huge markups included in hospital bills compared to the actual costs they incur, as seen in the Hospital Inpatient Cost Transparency Data. The data also shows the large discrepancy between providers on costs and charges. A second New York Times article highlighted important takeaways from the newly publicized data.
More than $350 million in annual costs are associated with potentially avoidable stays, according to the Hawaii Health Information Corporation. The five most common conditions to target to reduce potentially preventable hospitalizations include heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection and long-term diabetes complications.
South Carolina’s multi-stakeholder Birth Outcomes Initiative reduced early term, elective inductions by 50 percent, according to Catalyst for Payment Reform. The initiative improved health outcomes and saved $6 million in state and federal Medicaid spending in the first quarter of 2013.
To bolster the rate review process, the Arizona Department of Insurance should make information more transparent, demand more data-rich proposals justifying rate increases and request and advocate for authority to deny rate increases that are unjustified, according to a report by Arizona PIRG. The report recognized the department for its responsiveness to public inquiries and efforts to encourage stakeholder input for improvements.
A report from the Colorado Center on Law & Policy examines hospital charges and costs and found that Colorado hospitals charge (on average) four times more than what Medicare pays to treat a given diagnosis. The report also highlights the discrepancy between what hospitals charge and Medicare pays. Finally, the report demonstrates that the variation in charges between hospitals cannot be explained by the frequently-cited hospital cost drivers (e.g., regional labor costs, teaching status, and high volumes of low-income patients).
The largest such pharmaceutical recovery ever received by Louisiana was awarded as a result of two lawsuits over claims of off-label promotion to physicians, according to NOLA.com. Physicians prescribing off-label medications leave patients vulnerable to the potentially serious consequences of using non-approved, ineffective and unsafe treatments. A total of $229 million was split among eight states filing suits against the pharmaceutical company.
Founded with the goal of price transparency, the Surgery Center of Oklahoma is committed to charging fair prices, reports Think Progress. The center has been posting all of its prices online for the past several years and reportedly charges significantly less than other hospitals in the area.
Medicare data shows wide variation in prices for 100 common procedures among Wyoming Hospitals, according to the Caspar Star Tribune.
The Attorney General’s third report examining cost trends in Massachusetts identified consumers increasingly participating in tiered and limited networks, PPO and high-deductible plans, typically the cheapest options available to consumers. Growth in prices of medical services is the primary cost driver within the state and there continues to be a wide variation observed in prices. Providers are increasingly taking on insurance risk and aligning with other entities, potentially negatively impacting the market.