State News

Both Medicaid members and commercially insured Coloradans have relatively good access to healthcare, according to a new analysis by the Colorado Health Institute (CHI). CHI’s Access to Care Index scores 25 measures of access on a scale of one to 10, with 10 being the best. Overall, Medicaid members scored 7.4 and commercially insured Coloradans scored 8.2. However, the index suggests that access to care for Medicaid members has room for improvement: those with commercial insurance have a better chance of finding a provider; the logistics of getting to the doctor are harder for Medicaid members; and that regardless of payer, obtaining preventive care remains hardest.

Using 2017 claims data available through the Colorado All-Payer Claims Database, an interactive map from the Center for Improving Value in Health Care (CIVHC) illustrates regional variation for 11 common services, according to AboutHealthTransparency.org. Though no one region had consistently high or low prices, some regions stand out. For example, the West region is the highest with respect to prices for five procedures – breast biopsy, C-section, hip replacement, knee arthroscopy and tonsillectomy. 

Hawaii Medical Service Association, the Blue Cross Blue Shield of Hawaii, introduced Population-based Payments for Primary Care (3PC), a new capitation-based primary care payment system, in 2016. A study published in JAMA found that, in its first year, 3PC was associated with small improvements in quality and a reduction in primary care physician visits, but no significant difference in the total cost of care. Additional research is needed to assess longer-term outcomes as the program is more fully implemented and to determine whether results are generalizable to other healthcare markets.

A group of 10 Baltimore hospitals have pledged $2 million over two years towards a program that provides housing and medical services for people experiencing homelessness, according to the Baltimore Fishbowl. Funds from the partnership will provide homes and aid for 200 individuals and families, with medical organizations providing medical care and other services to break the cycle of homelessness. The program is designed to show that homeless individuals who receive treatment in permanent housing will ultimately see a reduction in healthcare costs.

New Jersey has passed a state law creating a state-based health insurance exchange to be funded by a 3.5 percent user fee on premiums, which currently goes to the federal government, according to Medical Daily. New Jersey estimates that the user fee will allow it to collect around $50 million a year to pay for marketing and enrollment fees. This action follows a 2018 law requiring all New Jersey residents to have health coverage or pay a penalty.

Healthcare spending in New York State is both higher and rising more sharply than the national average, reports NYS Health Foundation, with price growth being the primary driver of healthcare spending. A recent report examined healthcare spending, utilization, and prices for New Yorkers covered by employer-sponsored health insurance from 2013 to 2017, drawing data from the Health Care Cost Institute commercial claims database. The report found that per-person spending grew faster in New York during the five-year period than in almost all other states, though New Yorkers had lower average out-of-pocket costs compared to national spending. In addition, with few exceptions, price growth was the driving factor in healthcare spending across all categories of services examined. 

An analysis conducted by the Henry J. Kaiser Family Foundation found that Kentucky has one of the lowest rates of surprise medical billing in the nation, reports Louisville Business First. The state has the eighth lowest rate for inpatient hospital stays and ninth lowest rate for emergency room visits with unexpected out-of-network charges in 2017, at 7 percent and 8 percent respectively. However, unlike other states, Kentucky lacks protections for residents who receive surprise medical bills as of 2019.

Hospitals in Wyoming charged private insurance plans more than three times what Medicare would pay for the same care in 2017, according to a national study that looked at 14 hospitals in the state and nearly 1,600 facilities statewide, according to the Casper Star Tribune. Of the 25 states studied, Wyoming had the second-highest disparity between Medicare and private insurance for outpatient services: Private plans were charged 302 percent more than Medicare, a difference of $8 million. Only Indiana had a higher disparity. SageWest Health Care in Fremont County had the highest relative price in the state: The hospital charged private insurance more than eight times what the facility was paid by Medicare. Representatives of the Wyoming Hospital Association responded to the report suggesting that Medicare “doesn’t pay the actual cost of delivering care,” and therefore should not be used as the “measuring stick.”

A study that examined the network adequacy in New York State provides an overview of hospital network size and quality in the commercial, Medicaid, and NY State of Health markets, according to the New York State Health Foundation. The report found that some New York State regions offer residents access to primarily low-quality hospital networks, that differences exist in network size both within and across plan-product lines and there is a weak correlation between network quality and size. This project demonstrated that it is possible to measure health plan hospital network quality using publicly available sources.