State News

Patients in the Kansas City region who are fed up with the bureaucracy of the health insurance industry are ditching the copays and high deductibles for a different way to get primary care, reports KCUR. Instead of using the traditional system, patients are turning to “direct primary care” clinics consisting of doctors who offer membership-based healthcare services, rather than accepting insurance. At one clinic, patients pay a monthly fee for unlimited routine visits and direct phone/email communication with their provider. Although their services are limited to primary care, these clinics offer a lifeline for patients who cannot afford the high cost of health insurance.

Governor Gavin Newsom announced that Los Angeles county, one of the largest public purchasers of prescription drugs in California, will partner with the state to use their combined market power in an attempt to lower the cost of prescription drugs, reports The State Network. This announcement follows an executive order the governor signed directing California agencies to consolidate pharmacy purchasing authorities. The state Legislative Analyst’s Office reported that the Medi-Cal component of the executive order could potentially save the state hundreds of millions of dollars annually by increasing Medi-Cal’s bargaining power.

Policymakers in Grand Rapids, Michigan worked with Invest Health, a project of the Robert Wood Johnson Foundation and Reinvestment Fund, used data from the NYU School of Medicine’s City Health Dashboard (CHDB) to compare Grand Rapids’ data to the national average for many social and economic factors, physical environment, health outcomes, health behavior and clinical care, according to a blog post. The project’s Economic Opportunity Dashboard shows economic inequities and brings together historical data on city investments, citywide and by neighborhood. Based on findings from the Dashboard, academics and policymakers developed strategies to address the social and economic barriers identified as leading to disparate health outcomes in the Neighborhoods of Focus (the city’s first and third wards).

New billing practices at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) could ease the financial burdens of patients seeking care at the community hospital — 94 percent of whom are uninsured or covered by Medicare or Medi-Cal, according to TIME. The new policies would create income-based, out-of-pocket maximum costs for patients; make more patients eligible for financial assistance; ensure that out-of-network patients are billed the same amount as in-network patients; and end the practice of balance billing, through which patients are charged for costs their insurer declines to cover. The recommended changes were developed by San Francisco’s public health department at the request of the Mayor and Supervisor.

Creating health equity through public policies is the focus of a new report. The report identifies 13 policy priorities for improving health and well-being in the state, and recommends a comprehensive series of actions to close health gaps, broaden opportunity and ensure that everyone in New Jersey—no matter who they are, where they live or how much money they make—can live the healthiest life possible.

A collective in Summit County, home to 30,000 people in Colorado, is implementing a novel strategy to address high healthcare costs, according to Modern Healthcare. A knee replacement in the county costs 89 percent more, on average, than in the Denver metro area, while a craniotomy can cost a patient 163 percent more, on average. Peak Health Alliance, a collective of small and large businesses and individuals, representing roughly 6,000 people, has launched a unique model to negotiate discounted rates for medical services directly with the county’s main health system and only hospital provider, Centura Health. Following this negotiation process, Peak sends those contracted rates to health insurers to see who can craft the best plans. The effort was strengthened by a wealth of claims data that revealed that the county’s providers collected more than 500 percent of Medicare rates for outpatient hospital services in 2015 and 2016, driving many residents out of the county for care. Some of Peak’s success will depend on how well the selected insurer is able to manage the small population of members that drive 50 percent of the spending.

The Maryland General Assembly passed a slate of related measures to make health coverage easier to secure for uninsured Marylanders and prescription drugs cheaper for government workers, reports The Baltimore Sun. One law would require uninsured people to check a box on their state tax returns to report whether they’re interested in obtaining health coverage through the state. Another would establish a board to study the controversial idea of capping prescription costs for state and municipal employees. The legislature also enacted a patient’s bill of rights and approved sustained funding for a reinsurance program that helps insurers offset costs for the biggest healthcare users. Collectively, these measures are expected to make a significantly improve healthcare access and affordability for consumers.

Using a $2.2 million grant from Arnold Ventures, the Virginia Center for Health Innovation (VCHI) is launching a statewide pilot to reduce the use of low-value services, according to Health Data Management. In 2012, the American Board for Internal Medicine identified 550 tests and procedures as having a low value. Accessing insurance claims data, VHCI looked at 42 measures for 5 million patients using a health-waste calculator and found more than 2 million unnecessary services, costing approximately $747 million. The pilot will be implemented across 900 clinical sites in Virginia and will involve an employer task force on low-value healthcare.  VCHI will initially focus on providers and seven sources of low-value care and then will expand to include a set of consumer-driven measures.

Proposed legislation in Oklahoma would establish a pilot program to attract physicians to rural parts of the state, according to The Journal Record. If signed into law, the bill would provide an income tax credit of up to $25,000 annually for up to five years for doctors who set up practices in communities of less than 25,000 people. To qualify for the income tax credit, doctors would have to have completed their medical training or medical residency in Oklahoma and would have to live in the same rural counties where they practice.