The Illinois Department of Healthcare and Family Services has proposed a new equity-centric plan to transform healthcare in the state, reports the Center Square. The plan recognizes social and structural determinants of health, as well as medical ones, and proposes ways to address them. The new plan, if implemented, will fund pilot projects and planning grants to address both healthcare and social determinants of health, emphasize collaboration between community-based organizations and one unrelated healthcare provider, and ensure that health equity is both measurable and the primary focus of each project. Pilots would fall into three collaboration categories: cross-provider partnerships, safety net hospital partnerships and critical access or distressed hospital partnerships.
Between 2014 and 2019 the Minnesota Department of Revenue took $81.6 million in refunds from about 24,000 taxpayers per year to pay medical debt that some of the state’s largest nonprofit hospitals said they were owed, reports the Star Tribune, with some Minnesotans’ refunds seized more than once. Only one other state, South Carolina, takes individual tax refunds on behalf of private healthcare companies. In Minnesota, hospitals and other healthcare firms do not need a court judgement or order before retaining the state to take tax refunds on their behalf, and the Department of Revenue earns a $15 fee for every collection made through this program and does not check to ensure a health provider’s claim is valid before seizing a refund. Hospitals insist that they have begun to take on dangerous amounts of debt from uncompensated care – in 2017, Minnesota hospitals provided $691 million in uncompensated care, with 25 percent of that total considered bad-debt, according to the Minnesota Hospital Association’s 2018 Community Benefit Report.
The U.S. Supreme Court upheld Arkansas’ law regulating pharmacy benefit managers (PBMs), ruling that it is not preempted by ERISA, reports Fierce Healthcare. Arkansas’ law prohibits PBMs from reimbursing pharmacies at lower rates than the cost required to dispense prescriptions and allows pharmacies to refuse to sell a drug if the upper limit that plans will pay for it is too low. Opponents of the law argue that it increases costs for patients and could potentially result in pharmacies not carrying needed medications; proponents argue that the law protects rural and independent pharmacies from too-low reimbursement rates. The ruling paves the way for other states to pass laws regulating PBMs and explore other cost-regulating measures.
The Department of Health announced that four additional hospitals will join the 13 hospitals and six payers participating in the Pennsylvania Rural Health Model (PARHM), reports the Pennsylvania Pressroom. The PARHM will test a more sustainable financial model for hospitals serving rural areas to help ensure that they stay open, are financially stable and improve population health in rural communities. It is projected to serve more than one million Pennsylvanians living in rural areas and have $725 million in net patient revenue in the global budget model.
Massachusetts’ top insurance lobbying group will launch a research study and has started a pledge focused on racial disparities in healthcare, reports the Boston Business Journal. The Massachusetts Association of Health Plans, which includes 17 of the state’s insurance carriers, has created a compact among members for diversity and inclusion in the healthcare workforce. The insurance plans have committed to promoting a diverse culture, supporting workforce diversity through the creation of a pipeline to employment and developing and increasing opportunities for diverse candidates through targeted entry level healthcare jobs. The group will also sponsor a $200,000 research study looking at racial disparities within telehealth use which would seek to further understand how COVID-19 has changed telehealth usage and how insurance, socioeconomic status, race and ethnicity have further shaped use. The study, to be led by researchers from the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and advisors from the state’s Health Policy Commission, will identify communities with equity gaps and develop a plan to address them.
Larimer County, Colorado, partnered with Healthcare Bluebook to find ways to guide their health plan members to high-value providers, resulting in significant savings for both patients and the county, reports American City and County. Through this partnership, Larimer County employees use an online tool compiled by Healthcare Bluebook that shows provider scores on both quality and costs based on healthcare providers’ health outcomes. Consumers receive a portion of the overall savings from the program—in its first year, the program produced a return on investment of over 340 percent. In the coming year, the county will launch a new pilot program with Healthcare Bluebook to eliminate member cost sharing for certain procedures when members choose a high-value provider.
Recently released 2019 data from the biennial Louisiana Health Insurance Survey (LHIS) found that the state uninsured rate for nonelderly adults age 19-64 (11.1%) measured lower than the national average, as did the state uninsured rate for children (3.8%). Moreover, 32 percent of respondents felt their costs were unreasonable a majority of the time. Other topics measured by the survey include whether respondents felt their healthcare needs were being met, healthcare provider availability and the reasonability of healthcare costs in the state.
A recent analysis of Montana’s 47 nonprofit hospitals’ community benefit spending—required in exchange for their tax-exempt status—found that the millions of dollars spent on community needs had no impact on residents’ health, reports NASHP. Montana’s Legislative Audit Division completed a report that calculated that the state’s nonprofit hospitals received more than $146 million in tax exemptions in 2016 and self-reported more than $257 million in community benefit spending—4 percent of which went to community health improvement, while 87 percent directly funded hospital services, raising concerns about efficiency. This finding is consistent with national research showing that only a small percentage of community benefit spending goes to community-based activities aimed at upstream drivers of health. The Division recommended the state enact laws defining reporting expectations for hospital community benefit spending and its impact on community health to ensure community benefit spending reflects state and community health goals.
Hawaii faces a unique set of challenges inhibiting the recruitment and retention of physicians to address its decade-long workforce shortage, including lower average salary, a high cost of living and an aging workforce, according to State of Reform. The Hawaii Physician Shortage Crisis Task Force is considering solutions to improve the economic attractiveness of working in the state, including: (1) increasing Medicare payments in Hawaii to reflect delivery challenges such as geographic isolation, small population, the limited number of providers/specialists and reduced competition and (2) exempting physician medical practices from paying General Excise Tax. If gone unchecked, the Big Island will have a 72% physician shortage by the year 2030.
Adam Woodrum was biking with his wife and kids when his 9-year old son Robert crashed his bike. Robert received anesthesia and stiches in the emergency department. In this edition of Kaiser Health News’ Bill of the Month, it is revealed that the insurance company denied the medical claim and the Woodrums were charged the entire bill of $18,933.44. This is an example of subrogation, where health insurers try to save money when an accident is involved by passing the buck to other insurers (such as auto or homeowners). Eventually, the insurance company reconsidered the claim after Adam completed an accident questionnaire stating that there was no liable third party responsible for the bike crash.