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NC Health News reports Community Care of North Carolina, the state Medicaid program that assigns patients to a “medical home,” has saved the state close to a billion dollars over a four year period, according to analysts who examined four years of state Medicaid cost data. The study found the use of medical homes not only reduced cost but also increased healthcare quality, especially among the high cost and high need patients.
In the Healthy Indiana Plan Demonstration Section 1115 Annual Report, an evaluation of the predecessor program found that the program attracted many consumers with chronic disease as they had no other insurance option. While many were able to make their contributions to the POWER accounts, 14 percent of former HIP members reported that cost-sharing was their reason for leaving the program.
The state’s Medicaid Redesign Team completed a Multi -Year Action Plan with several recommendations to improve health outcomes and curb the cost trend that include expanding access to supportive housing, expanding provider scope of practice, targeting trouble areas, such as Brooklyn, and implementing a system of performance measurement.
Alaska’s reimbursement rates exceed that in comparison states for physician services, according to a report by Milliman. Alaska’s relative reimbursement is 160 percent of that of Washington, Oregon, Idaho, Wyoming and North Dakota, across all payers and all specialties analyzed.
Cost shifting between commercial and public payers, high operational costs for healthcare providers and high physician reimbursement rates all drive healthcare spending in Alaska, according to a report by Milliman. Two previous commissioned reports identified that Alaska’s reimbursement exceeds that in the comparison states for both physician and hospital services likely due, at least in part, to the large negotiating leverage providers have in the small market of Alaska. Hospitals criticized the report for a variety of reasons, including the comparison between tax paying for-profit hospitals in Alaska to nonprofit hospitals in the comparison states.
Alaska’s commercial payment levels are approximately 213 percent of Medicare payment levels, on par with Washington, Oregon, Idaho, Wyoming and North Dakota, according to a report by Milliman. This is the first of three reports commissioned by the state in an attempt to understand where opportunities exist to quell the unsustainable cost of care.
Healthcare spending has increased 40 percent between 2005 and 2010 and anticipated to reach more than $14 billion by 2020, according to the University of Alaska Anchorage. This comprehensive review describes how spending is divided among payers, healthcare costs, age of recipients and service.
The Attorney General’s second annual report examining cost drivers in the Massachusetts healthcare market with specific focus on the cost containment resulting from the inclusion of global payments. The study found continue wide price variation between providers not explained by differences in quality of care, globally paid providers do not consistently lower total medical expenses, total medical spending is higher for people with higher incomes, tiered network products have increased consumer engagement in value-based purchasing decisions, PPO products produce significant barriers to providing coordinated care and providers designed around primary care and global payments may encourage coordinated care; however, global payments pose significant challenges.
This WBUR article reflects on the Attorney General’s new findings that global payment reform may not result in lower total medical expenses, as expected. In reality, the reform has led to increased health costs, increasing payments to two provider groups by more than 26 percent between 2008 and 2009. Wide price disparities continue to exist within the Massachusetts healthcare market and are based on providers’ reputation rather than quality differences. Despite the increases observed, insurers believe cost savings may be observed in the long run.
A Michigan regional collaborative improvement program, which was paid for by a large private insurer, yielded improvements for a range of clinical conditions and reduced costs in several important areas, according to Health Affairs. For example, general and vascular surgery patients in the Michigan Surgical Quality Collaborative experienced a 2.6 percent drop in surgical morbidity rates. That translates to approximately 2,500 fewer Michigan patients with surgical complications each year. The results suggest that hospitals in regional collaboratives can improve upon healthcare quality metrics more quickly than hospitals abstaining from participation.