Federal officials rejected one of Idaho’s requests for a waiver for Medicaid expansion, reports the Associated Press. The Idaho governor said the state is already taking steps to submit additional information to get the waiver approved. The waiver would allow those earning between 100% and 133% of the federal poverty level to stay on the state’s health insurance exchange, called Your Health Idaho. Backers said it would save the state millions of dollars, while those opposed said it would leave poor residents unable to pay medical bills.
Connecticut is using certificate of need (CON) regulations to hold hospitals accountable for making meaningful investments in their communities’ health, according to the National Academy for State Health Policy. In a recent CON agreement, the Connecticut Office of Health Strategy mandated that merging hospitals: adopt evidence-based interventions to address community needs; explain how patient outcomes will be measured and reported to the community; and increase the total dollars spent on community benefit activities by at least one percent each year for the next five years. These activities must directly address the health and health-related social needs identified by the hospital’s Community Health Needs Assessment. While the CON conditions are time-limited, they demonstrate what is possible when states use their policy levers to maximize community benefits investments.
Health systems and physician groups have dominated the Denver healthcare market in recent years, but employers and health plans are poised to disrupt that dynamic, reports HealthLeaders. Four major health systems accounted for 85 percent of patient admissions in 2017, according to a report by Catalyst for Payment Reform and the Colorado Business Group on Health, which may be enough to stifle price competition. Indeed, the study revealed that Coloradans face 13 percent higher prices compared to the national average and 5 percent higher utilization rates. Authors of the report indicate that a statewide purchaser cooperative may be an effective method to change the market dynamics in Denver.
The MercyOne ACO is a statewide organization comprised of more than 2,300 doctors and 500 practice sites organized into regional accountable care organizations (ACOs) and clinically integrated networks in Iowa. The organization is moving spending “upstream”- shifted from just looking at claims and electronic health record data to help predict individual patient risk to a broader view of the patient experience, including social determinants, reports Healthcare Innovation. In an August 27 webinar, MercyOne ACO executives described their efforts to engage patients in discussions about food, transportation, and housing issues and the addition of community health workers to help them navigate the relationship between health systems and social service agencies.
The District’s largest Medicaid managed care organization and a nonprofit law firm are teaming up to reduce healthcare costs by going after mold and infestations, according to the Washington Business Journal. AmeriHealth Caritas D.C, a local insurance provider with more than 100,000 members, has formed a partnership with Children’s Law Center (CLC), a network of lawyers who serve more than 5,000 families each year, to reduce asthma-related hospital visits by targeting unsafe housing conditions. Under the collaboration, AmeriHealth care managers refer members to the CLC team, which speaks with those families to understand their living environments and what needs to change. The attorneys then work to get landlords to fix poor housing conditions or relocate the residents to safer homes. The goal is to reduce the number of medical interventions needed by children with asthma in the District over time.
In late August 2019, the Centers for Medicare and Medicaid Services (CMS) and the Department of Treasury approved a waiver application from Rhode Island to operate a state-based reinsurance program, according to a Health Affairs blog post. Rhode Island’s reinsurance program will operate through 2024 and is expected to reduce 2020 premiums by 6 percent. For 2020, the program will cost about $14.7 million, with state funds accounting for about $8.3 million. The state’s portion of the reinsurance program will be funded by penalties from Rhode Island’s new individual mandate, which is set to go into effect in 2020.
Insurance premiums for Washington’s individual market are rising less than 1 percent on average in 2020, which may be due to market domination by homegrown insurance companies, according to The Seattle Times. Homegrown insurers are tied to the local community and must succeed in Washington or in the Pacific Northwest region to stay in business. Presumably, this motivates them to try harder to meet their customers’ needs. Other ways that local plans can help stabilize their state-based marketplaces include helping fill geographical market gaps, building better partnerships with local doctors and hospitals and reaching underserved populations more effectively.
An integrated data system is allowing officials in Rhode Island to develop a more thorough understanding of the health needs of residents, reports HealthITAnalytics. In Rhode Island, government agencies worked together to create the Executive Office of Health and Human Services (EOHHS) Data Ecosystem. This integrated data system blends data sources from multiple organizations to help create a holistic view of Rhode Islanders. The goal of the Data Ecosystem is to help agencies improve their performance and understand the individuals they serve.
North Carolina is in the early stages of turning away from te traditional fee-for-service model and towards a model based on health outcomes, according to the New York Times. Under the new model, providers will be paid based on health outcomes, whereby the better they perform, the more they can earn - the goal is to keep people healthy and out of the hospital and to save money on healthcare spending. It's estimated that the state's changes will increase the share of total healthcare dollars that go to primary care physicians, as opposed to specialists, hospitals and other places.
Blue Cross Blue Shield of Minnesota announced that they will cover insulin costs next year with $0 co-pay, according to Alpha News MN. The insurance company's CEO cited the skyrocketing costs of insulin as a reason for the measure, which have risen by over 300 percent, noting that their first responsibility is to improve the health and financial stability of their members. Previously, Minnesota Medical Insurer Medica and UCare announced that they will cap insulin costs at $25 a month.