State News

After an audit revealed that a 8.8 percent spread between what pharmacy benefit managers (PBMs) charged Medicaid managed care plans and what they paid to pharmacies, Ohio Medicaid directed managed care plans to end their contracts with pharmacy benefit managers, effective January 2019. Plans were instead asked to adopt a transparent “pass-through” pricing model whereby the managed care plan would pay the PBM the exact amount paid to the pharmacy for the prescription drug, a dispensing fee, and, in lieu of spread-based revenue, an administrative fee, according to JAMA. Ohio policymakers also pursued the prohibition of gag clause by PBMs, which prevent pharmacies from sharing with patients the most cost-effective option when purchasing medications. Uniquely among states, Ohio’s approach includes assessing the potential effect of these reforms on outcomes and evaluating gains after reform implementation.

The University of Maryland School of Medicine will receive $750,000 in federal funds from the U.S. Health Resources and Services Administration to train more doctors for posts in rural areas, according to The Baltimore Sun. The residency program will send doctors-in-training to the University of Maryland Shore Regional Health and the Choptank Community Health System, which are in the Eastern Shore region facing significant provider shortages, an aging population, and high levels of chronic diseases.

A state sponsored report curated by Deloitte provides an environmental scan of current uninsured Georgians. This study focuses on the uninsured rate if Georgia does not expand Medicaid, according to AJC. Researchers found that 666,000 Georgians could benefit from Medicaid expansion, indicating that uninsured rates are higher than previous estimates. Additionally, this study provides recommendations on waivers that state agencies and policymakers could pursue to seek more federal funding for their Medicaid program.

New York’s 2013 mandate for protocolized sepsis care produced sepsis mortality rates significantly lower than those in four states without such regulations, according to FierceHealthcare. New research published in JAMA found that the unadjusted 30-day in-hospital mortality rates in New York dropped from 26.3 percent before the regulations were implemented to 22 percent afterwards. However, these results may not be guaranteed for other states, as New York had a specific environment in which to implement the regulations. First, mortality rates in New York were already higher than most other states, and secondly, this solution came during “a perfect storm,” with an engaged department of health, active hospital associations, willing partners and grassroots advocacy.

The Idaho Department of Health and Welfare recently enacted new rules bolstering patient access to their Electronic Health Record (EHR) data, according to EHR Intelligence. Previously, many of the EHR access regulations didn’t apply to critical access hospitals, which will need to implement new procedures to comply with the new rules. For example, one rule gives patients more control over their health information, while another requires healthcare organizations to send patients their EHRs within three business days of submitting a request. Other aspects of the new rules address patient privacy, video and audio monitoring and recording and patient safety and informed consent.

The University of Montana Health and Medicine’s physician retention program has led to over 70 percent of residency graduates remaining in Montana as primary care rural physicians, according to KPAX. Five years ago, there was growing concern of finding enough physicians to meet demand in urban centers and rural hospitals.

Colorado state officials will purchase six vans from New York-based Medical Coaches to expand the treatment of people with substance abuse issues, according to mHealthIntelligence. The vans will be equipped with connected health tools that allow healthcare providers to deliver Medication Assisted Treatment (MAT) therapy. Healthcare providers are increasingly turning to MAT therapy as a means of treating people with substance abuse disorder – Colorado is using a $30 million State Opioid Response (SOR) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA).

A report from the California Health Care Foundation examines the legal and economic implications of collecting and releasing data on amounts paid for healthcare services, reviews the practices of existing all-payer claims databases (APCDs), and concludes with recommendations for California’s policymakers about best practices to ensure the effective use of increased transparency to control costs and increase access to healthcare services. Authors found that while some negotiated prices may constitute trade secrets in some circumstances, no court has definitively ruled on the issue of whether negotiated healthcare rates can be protected as trade secrets. Therefore, California can allow or require such disclosures if they are in the public interest. The authors also noted that, to date, no state with an existing APCD has experienced competitive harm and that public disclosure of negotiated rates resulted in increased competition in New Hampshire. Additionally, though all states with active APCDs collect information about paid amounts and release reports of aggregated information, a few states, including Maine and New Hampshire, disclose plan- and provider-specific median paid amounts for the most commonly used healthcare services on publicly accessible websites. Based on these findings, recommendations to California include: requiring the Office of Statewide Health Planning and Development (OSHPD) to provide data submitters with clear information on policies regarding data collection; monitoring annual claims for anticompetitive behavior; creating a data release committee and declaring that all information submitted to the APCD will be released in accordance with guidelines; and establishing guidelines for data release that weigh competitive effects and public interest.

Enabled by a 2015 state law creating the Arkansas Healthcare Transparency Initiative, the Arkansas all-payer claims database (APCD) now has several new types of data available to supplement healthcare claims and enrollment data, reports the Arkansas Center for Health Improvement (ACHI). This infographic provides an overview of what is available. The database is a key resource for pulling back the curtain on healthcare quality and prices. State agencies, academic researchers, analytic groups and private industry are using the Arkansas APCD to assess healthcare utilization, quality and price information.