State News

In 2016, nearly 70 percent of Alabama’s pregnancy-related deaths were preventable, according to a report from the state's Department of Public Health and Maternal Mortality Review Committee. The committee recommended that Alabama improve maternal health by: expanding Medicaid coverage; increasing resources and services for women with mental health and substance use disorders; improving Medicaid reimbursement for providers; and encouraging broader education of mothers and families on maternal death risk factors. In this opinion piece in the Montgomery Advertiser, the author notes that Black women in the state die at three to four times the rate of white women from pregnancy-related complications, showing the importance of eliminating racial disparities in access to quality and affordable healthcare.

A new report from the University of Alabama’s Education Policy Center found that physical access to healthcare is a luxury that Black Belt communities don’t enjoy, reports the Alabama Political Reporter. The Education Policy Center defines the Black Belt of Alabama as comprising of 24 counties. Of those, 17 have fewer than the statewide average of 3.9 hospital beds per 1,000 people, according to the report. Indeed, four of the Black Belt counties have no hospitals, with some hospitals over an hour away. Even before the COVID-19 pandemic, access to healthcare for rural residents was tenuous. Researchers note that hospitals in states that chose to expand Medicaid were 84 percent less likely to close, because the increased coverage for poorer rural residents encouraged care access and boosted revenue for hospitals that care for high numbers of uninsured residents.  

The Department of Family and Community Medicine at the University of Alabama at Birmingham has been awarded a $7 million grant to address the need for training additional family medicine physicians to serve in rural and underserved areas of the state, reports the Birmingham Times. The grant, from the U.S. Department of Health and Human Services, will enable the department to develop high school and college pipeline programs, medical student programming and faculty development programs to enhance curriculum and mentoring efforts. The University of Alabama at Birmingham has laid the groundwork for the enriched training program – the Comprehensive Urban Underserved and Rural Experience (CU2RE). 

Alabama will receive more than $4.6 million in federal funding to increase the state’s health workforce in rural and underserved communities, reports the Birmingham Business Journal. The funding from HHS is part of a nationwide effort to improve the quality distribution and diversity of health professionals serving in communities across the country. Workforce development has been a significant concern in Alabama’s healthcare sector for many years, but that’s particularly true in rural areas.

Expanding Medicaid to cover adults with low incomes would build on the program’s successes and save hundreds of lives every year, according to a report from Alabama Arise. Though more than a million people – mostly children, seniors and those with disabilities – benefit from Alabama Medicaid, 340,000 uninsured and underinsured Alabamians who could gain coverage under Medicaid expansion remain. Expansion would particularly benefit the 65,000 rural Alabamians caught in the health coverage gap, as their rural hospital network is fraying from a lack of healthcare funding and had been significantly impacted by caring for uninsured or underinsured rural populations.

Alabama’s rural areas are at particular risk for not being prepared for disasters, given that the large number of rural hospital closures since 2010, according to WBHM. Many of the hospitals that remain open are struggling with financial problems – 88 percent of rural hospitals in the state have negative operating margins, making the necessary spending during a disaster more challenging. Alabama is among the states with the most rural hospital closures, according to a study from the Chartis Center for Rural Health, which describes the difficulty of maintaining hospital revenues when they have large uninsured populations but their state has not expanded Medicaid.

Pickens County Medical Center is the most recent rural hospital to close in Alabama, reports WSFA12 News. Alabama Hospital Association Executive Vice PResident Danne Howard said more closures are possible, as this last closure becomes the 17th privately-run hospital to close in the state over the last decade. Howard said one of the most significant factors to hospital closures is the number of uninsured patients - hospitals are picking up the tab without receiving full compensation for caring for those without insurance.  

An Alabama woman and her husband were sued by Flowers Hospital for the entire amount of her bill for an emergency appendectomy, plus interest, even after they paid what they could monthly for three years, reports CBS News. The couple are small business owners and could no longer afford health insurance in 2015, when she had her emergency surgery. Had the couple had insurance, the original $31,000 bill would have been significantly lower; Medicare would have been charged by a hospital, on average, around $5,800. 

The highest numbers of vulnerable rural hospitals are in the South and Midwest, reports Advance Local. Researchers from the healthcare analytics firm Chartis Group issued a report that found that 12 of Alabama’s 45 rural hospitals are considered “most vulnerable” to closure based on several factors, including revenue, system affiliation and the lack of Medicaid expansion. Seven rural hospitals have closed in Alabama since 2010, and the overall percentage of rural hospitals nationally operating in the red has increased from 39 to 47 percent in the last five years, with Alabama being one of the most affected states for closures. 

In accordance with an unfortunate national trend, the non-profit hospital Jackson Hospital filed suit against at least 1,302 Alabamians in 2019, according to AL.com. At least a half dozen patients were sued for less than $200. As a non-profit hospital, Jackson has obligations to provide charity care for needy patients in exchange for tax exemption; however, there are few specific requirements for the level of charity care or how aggressively hospitals may pursue debt collections. Jackson Hospital sued more patients than any other non-profit hospital in Alabama in 2019.

UAB Health System and Ascension St. Vincent’s have gained approval of the University of Alabama System Board of Trustees to move forward with a strategic alliance, according to AL.com. While not a merger, the move allows UABHS facilities to retain the UABHS or UAB Medicine brands, and Ascension St. Vincent’s facilities to remain Ascension St. Vincent’s. Those spearheading the alliance argue that it will allow for better care coordination of programs and increase patient access to diabetes and mental healthcare services. The alliance will not change physicians or insurance coverage for patients, organizers say, and medical records are still accessible through existing patient portals.

Huntsville Hospital and University of Alabama Birmingham Health System (UAB) are partnering to create a value-based Medicare Advantage plan through managed care company Viva Health, according to HealthPayerIntelligence. Though uninsurance in the state has decreased, outcomes for seniors have gotten worse in Alabama, according to the UnitedHealth Foundation’s 2019 Senior Report. The Medicare Advantage plan will serve seniors in the North Alabama region, through which hospitals will focus on value-based care, population health and rural health, including services such as home health agencies, skilled nursing facilities, pharmacies and durable medical equipment providers.

Since Keshee Dozier-Smith took over Rural Health Medical Program four years ago, the company has opened three new clinics in Alabama, according to AL.com. This group of South Alabama community health clinics serve some of the state's poorest and most rural communities. Thirteen Alabama hospitals have closed since 2011, with more than half of those once serving rural populations, and of the rural Alabama hospitals still open, almost 90% operate in the red. Dozier-Smith and Rural Health Medical Program provide an example of how to assuage the health access issues impacting rural America. 

Alabama Medicaid reforms will bring regional control and coordination of primary care services through seven Alabama Coordinated Health Networks (ACHNs) serving more than 700,000 Alabama Medicaid enrollees, according to Alabama Arise. Every ACHN will have a Consumer Advisory Committee, a new accountability provision that advocates hope will increase consumer oversight. Moreover, each ACHN will receive funding to develop and implement Quality Improvement Projects focused on three initial priorities (childhood obesity, infant mortality and birth outcomes, and substance use disorders). Alabama’s Medicaid reforms are an encouraging move toward improved patient-centered care.

More than 100,000 Alabamians are employed but cannot afford healthcare, according to the Alabama Political Reporter. Around 50,000 Alabamian women who are employed cannot afford the healthcare provided by their employers or private insurance, as well as 58,000 employed men in the state, according to a report by Alabama Arise. Alabama is one of 14 states that has yet to expand Medicaid, which advocates and the Alabama Hospital Association say would help provide affordable and rural medical care to those who are working but cannot afford care. 

Following months of negotiations, the contracts are set to expire between UnitedHealthcare and several University of Alabama Birmingham Health System entities this month, according to WSFA12. UnitedHealthcare claims that the UAB Health System is more expensive than other facilities – if no agreement is reached, UnitedHealthcare members who receive care at UAB facilities may be personally responsible for the cost of services received, though the emergency department at each hospital will remain open to members without additional out-of-pocket costs.

The Strategic Health Information Exchange Collaborative announced a joint effort with Alabama One Health Record to improve health data access and patient care delivery for patients in rural, underserved areas, according to an article in EHR Intelligence. The health information exchange provides health data exchange services to patients and providers across Alabama and works to promote patient participation in clinical decision making to improve health outcomes statewide.

Every year, physicians are required to participate in the continuing medical education program, advertised as a way to keep doctors up to date on new findings and treatments for various healthcare needs. Although these requirements sound like a good idea many doctors find that some of the tests add no value to themselves or their patients, and some believe they are contributing to the rise of healthcare costs. According to an article in Alabama Today, one test that has come under fire lately is the Maintenance of Certification (MOC) test. According to The Hospitalist, the MOC program could cost $5.7 billion in physicians’ time and fees over the next decade. 

According to an article in WDHN, Statera Health announced they have signed a Value-Based Medicare Advantage agreement with United Healthcare for its Medicare subscribers in Houston County, Alabama. Statera is southeast Alabama’s population health organization, and is an affiliation between local physicians, Statera and Southeast Alabama Medical Center (SAMC). Statera’s mission is to enable SAMC, and local physicians, and payers like United Healthcare to collaborate together with the goal of balancing healthcare costs in the community with improving quality healthcare for our patients. The goal of Statera’s coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

Alabama Receives More than $1 Million from HHS to Improve Community Health Centers. Alabama has been awarded fourteen grants totaling $1.2 million from the Department of Health and Human Services, according to the Birmingham Business Journal. The money will be used by the state to invest in quality improvements at its community health centers.

A task force appointed by Gov. Robert Bentley today recommended that the governor and the Legislature find a way to provide health insurance for Alabamians without coverage, according to AL.com. The Alabama Health Care Improvement Task Force approved a recommendation that said the biggest obstacle in improving health is the "coverage gap that makes health insurance inaccessible to hundreds of thousands of Alabamians."