State News

LifeBridge and Johns Hopkins are among the local health systems partnering with ride-hailing service firms to provide on-demand transportation to patients in need and reduce overall care costs, according to the Baltimore Business Journal. The program targets specific patient populations who demonstrate the most need, and do not have easy access to reliable transportation options, namely patients residing in areas of West Baltimore who need access to services at LifeBridge's Sinai and Levindale Hebrew hospitals. The goal is to ensure community members are able to get to preventative care appointments more easily, reducing the costs associated with missed healthcare appointments and helping community members remain healthy.

Nevada passed a law creating a Patient Protection Commission (PPC) that will examine healthcare costs and the primary factors that are driving those costs, reports KTV News. The PPC will also review the roots of disparities in care among different communities, including the adequacy of healthcare providers and availability of health insurance plans. The PPC will have 11 members appointed by the governor with recommendations from legislative leadership. Membership will include representation from across the industry – health plans, providers, hospitals, and pharmaceuticals – an academic experienced in healthcare policy and patient advocates to represent healthcare consumers.

Vermont is eyeing birth control, insulin and pricey medications for HIV and multiple sclerosis as possible candidates for the state's landmark program to import cheaper drugs from Canada, reports Politico. State officials determined that the importation program could save insurers up to $5 million annually, based on this list of drugs, which the state has yet to finalize. A potential barrier is that Vermont must prove that the importation program wouldn’t pose additional risks to patient safety and that consumers will pay less for drugs under the new model in order to receive approval from HHS. HHS set up a working group last summer to study importation, but many of the details have been kept secret.

A resolution, passed in 2017, directed the Cabinet Secretary for Health and Social Services to develop a strategy to reduce healthcare cost growth and improve health outcomes in Delaware, according to a Health Affairs blog. Delaware was the first state to set both a healthcare spending growth target and implement a suite of associated quality and population health measures. This article describes the evolution and implementation of the cost and quality benchmarks and the use of transparency (rather than incentives, penalties or regulatory levers) as the primary strategy for meeting the initiative’s goals. It is currently unclear whether transparency alone will help stakeholders lower cost growth and seek strategies to improve primary prevention and better manage care for high-risk patients.

A new West Virginia will enable residents to access life-saving medicines when their supply runs out, the prescription is expired and the doctor can’t be reached to 'OK' it, according to WV Metro News. HB 2524 grants pharmacists the discretion to fill those prescriptions under specified conditions and certain circumstances. This bill allows pharmacists, under specified conditions, to extend 30-day prescriptions to 90 day and requires payers to cover the cost if it is consistent with the patient's benefit plan.

Drug benefit managers are increasingly profiting off pharmacies and insurers, driving up Massachusetts’s spending on healthcare, according to the Boston Business Journal. A new state report, issued by the Health Policy Commission, shows that pharmacy benefit managers have bolstered their own profits through a practice of “spread pricing” - negotiating a far lower price than what it passes on to the insurer. In 2017, total prescription drug spending at pharmacies grew 4.1 percent in Massachusetts – one of the highest healthcare spending increases in the state.

Pennsylvania is moving to take over the online health insurance exchange that has been operated by the federal government since 2014, saying it can cut health insurance costs for the hundreds of thousands who buy individual Affordable Care Act policies, according to the Lexington Herald Leader. State leaders assert that this move will reduce premiums for residents. Currently, the federal government takes 3.5 percent of the premium paid on plans sold through the exchange, or an estimated $94 million this year, though state can operate the exchange for $30 million to $35 million and use the difference to draw down extra federal dollars for a reinsurance program that reimburses insurers for certain high-cost claims. The state's share would be about one-quarter of the reinsurance program cost, according to estimates. Those reimbursements allow insurers to lower premiums across the board within the state's insurance marketplace. Evidence from seven states that already have reinsurance program shows that they reduced insurance premiums paid by consumers.  

An analysis of New Jersey data on Medicare’s mandatory bundling program shows that, while there are noticeable changes in discharge status trends correlated to types of bundled payment programs, more research is needed, according to Yahoo Finance. The recent report by NJHA’s Center for Health Analytics, Research & Transformation compared data for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) bundle, hospitals participating in the Bundled Payment Care for Improvement “Classis” program (BPCI) and hospitals that participated in neither initiative. Results show that since CJR was mandated for 38 New Jersey hospitals in 2016, length of stay for joint replacement patients declined for all the hospital groups; CJR hospitals saw a 19-percentage point decrease in patients discharged to skilled nursing facilities and a 26-percentage point increase in patients discharged to home with home health assistance. Meanwhile, BPCI hospitals saw a large uptick in discharge to home with self-care and a large decrease in discharge to home with health assistance. Hospitals not participating in a bundling initiative, however, saw the greatest change in the increase of patients discharged to home with self-care, from 28 to 46 percent. Though the findings show that CJR bundles worked to reduce length of stay, there is a need for more investigation of whether complex patients who would have previously gone to inpatient rehabilitation are receiving the required services at skilled nursing facilities or outpatient care.

All-payer claims databases (APCDs) are a promising, high-quality tool for cancer surveillance, according to a Utah study published in Health Services Research. Medicare data has previously proven beneficial in capturing cancer treatment that is under-reported to cancer registries for the 65 and over population. Researchers looked at the Utah APCD to assess the potential of these databases to offer similar benefit to cancer surveillance, including information on comorbidities at diagnosis, recurrence and late effects of treatment. The study concluded that an APCD can act as a high-quality surveillance tool when accurate identifiers exist to support linkage to cancer registry data, if claims for the same patient can successfully be linked in the ACPD, and if the population of patients diagnosed with cancer have adequate coverage.