As health plans prepare to submit rate filings, a new report from Oregon’s Division of Financial Regulation’s Prescription Drug Price Transparency Program illuminates just how much prescription drug prices impact insurance premiums. Oregon requires health plans to report on: per member, per month (PMPM) drug costs; top 25 drugs responsible for the greatest increase in planning spending; top 25 most costly prescription drugs; and the top 25 most frequently prescribed medications. Based on 2018 data, on average, drug costs represented 14 percent of premium rates in Oregon. Abbvie’s Humira, a biologic used to treat various autoimmune diseases, topped the list as both the most costly and the largest contributor to increases in plan spending.
Air ambulance companies have begun advertising memberships to rural Kansans in the wake of recent hospital closures, prompting concerns that the companies are exploiting vulnerable patients, reports KCUR. Although the membership programs promise to protect customers from out-of-pocket expenses, the contractual fine print often undermines the advertised intent. For example, privately insured patients who purchase memberships would still receive a bill and must work through their insurance company’s claims, denial and appeal processes. Additionally, air ambulance companies can end memberships at any time without obligation to notify the customer. North Dakota and Montana ban or heavily regulate the memberships in attempt to better protect consumers.
University Hospital in Newark, New Jersey, has partnered with Hitch Health to help patients with appointments for select services to get free rides to and from those appointments via Lyft or medical transport vehicles, if necessary, according to NJ Spotlight. The service was designed to help the overwhelming majority of Newark parients who frequently use its services and for whom getting to the facility is a major challenge. Hitch's system integrates patients' electronic health records, allowing them to identify eligible patients and connect with them in advance, making the service easier for both doctors and patients.
A recent report by the Wisconsin Collaborative for Healthcare Quality revealed wide variation in how people in the state experience health outcomes and care, which is influenced by many factors. The report found substantial disparities across several measures. For example, the data show that Black Wisconsinites experience substantial disparities (defined as 10 percent lower than the best performing group) for childhood vaccinations, weight management, blood pressure control, tobacco use, and diabetes or heart disease prevalence. Many outcomes were stratified by race and payers or insurers. For instance, those who were uninsured or have Medicaid experienced similar and substantial disparities in nearly every measure compared to those with commercial or Medicare coverage. The Wisconsin Collaborative for Healthcare Quality hopes this data will be used to increase health equity within the state.
Marketwide price information at the insurer-provider-service levels could help target policy interventions to reduce healthcare spending, according to a simulation reported in Health Affairs. Researchers examined variation in fee-for-service commercial prices in Massachusetts for 291 predominantly outpatient medical services and found that prices varied considerably across hospital service areas. Prices for medical services at acute hospitals were, on average, 76 percent higher than at all other providers. The service categories with the widest price variation were ambulance/transportation services, physical/occupational therapy and laboratory/pathology testing. In this market, simulations suggested that steering patients toward lower-price providers or setting price ceilings could generate potential savings of 9–12.8 percent.
The North Carolina Department of Health and Human Services will partner with Phreesia, a patient intake platform, to address individuals' social determinants of health using real-time data and screening questions, according to HealthITAnalytics. The platform provides screening questions to help healthcare organizations identify patients with unmet social needs and can send real-time alerts to providers and care coordinators about patients' individual needs. A large number of North Carolina residents struggle in finding affordable housing and with food insecurity. It is hoped that this initiative will reduce costs, improve outcomes and increase patient satisfaction, as previous studies have shown addressing social determinants of health can do.
Residents say the only hospital in Carlsbad, N.M. is notorious for suing its patients, adding in lots of mystery charges and refusing to give itemized bills, reports CNN. When patients can’t pay, the hospital will sometimes sue them to collect the money. An investigation of court records shows that in the past 10 years, Carlsbad Medical center has sued more than 3,000 people to collect debts. In a statement, the hospital CEO said they sue fewer than one percent of the patients who receive care at the hospital. Still, most other hospitals in the area haven’t sued any patients for debt collection over the past 10 years.
Commercial inpatient healthcare spending has increased in Massachusetts despite declining volumes, according to Modern Healthcare. Commercial inpatient spending across the state grew 10.7 percent from 2013 to 2018, while service use decreased by 12.8 percent, according to a report from the Massachusetts Health Policy Commission. In addition, the average commercially insured patient risk score increased 11.3 percent from 2013 to 2017, which theoretically should have increased intensive care unit and cardiac care unit volumes and lengths of stay. Instead, the data suggest that hospitals are maximizing coding rather than treating sicker patients.
More than half of Floridians delay or skip medical care, struggle to pay their medical bills or are uninsured because health care is too expensive for them, according to a new survey from the Healthcare Value Hub. These results were especially pronounced in Central Florida, where four out of five respondents said they were worried about not being able to afford healthcare. The majority, regardless of political affiliation, said the government had to solve the problem, particularly the high cost of care and prescription drugs, the Orlando Sentinel revealed.
Due to a recently-legislated incremental minimum-wage increase from $8.85 in 2019 to $15 by 2024, some New Jersey workers could lose Medicaid eligibility, according to a report by the Urban Institute. However, the report notes that the number of those who will lose eligibility and coverage will be small relative to the number who will experience a wage increase. Those at risk of losing Medicaid coverage constitute less than 5 percent of all nondisabled, nonelderly adult Medicaid enrollees in the state, and all of those who would lose Medicaid eligibility would remain in the income range allowing them to qualify for subsidized coverage on the marketplace.