State News

An analysis of New Jersey data on Medicare’s mandatory bundling program shows that, while there are noticeable changes in discharge status trends correlated to types of bundled payment programs, more research is needed, according to Yahoo Finance. The recent report by NJHA’s Center for Health Analytics, Research & Transformation compared data for hospitals participating in the Comprehensive Care for Joint Replacement (CJR) bundle, hospitals participating in the Bundled Payment Care for Improvement “Classis” program (BPCI) and hospitals that participated in neither initiative. Results show that since CJR was mandated for 38 New Jersey hospitals in 2016, length of stay for joint replacement patients declined for all the hospital groups; CJR hospitals saw a 19-percentage point decrease in patients discharged to skilled nursing facilities and a 26-percentage point increase in patients discharged to home with home health assistance. Meanwhile, BPCI hospitals saw a large uptick in discharge to home with self-care and a large decrease in discharge to home with health assistance. Hospitals not participating in a bundling initiative, however, saw the greatest change in the increase of patients discharged to home with self-care, from 28 to 46 percent. Though the findings show that CJR bundles worked to reduce length of stay, there is a need for more investigation of whether complex patients who would have previously gone to inpatient rehabilitation are receiving the required services at skilled nursing facilities or outpatient care.

All-payer claims databases (APCDs) are a promising, high-quality tool for cancer surveillance, according to a Utah study published in Health Services Research. Medicare data has previously proven beneficial in capturing cancer treatment that is under-reported to cancer registries for the 65 and over population. Researchers looked at the Utah APCD to assess the potential of these databases to offer similar benefit to cancer surveillance, including information on comorbidities at diagnosis, recurrence and late effects of treatment. The study concluded that an APCD can act as a high-quality surveillance tool when accurate identifiers exist to support linkage to cancer registry data, if claims for the same patient can successfully be linked in the ACPD, and if the population of patients diagnosed with cancer have adequate coverage. 

Wisconsin Medicaid’s 2014 coverage expansion had a tremendous impact on making antidiabetic drugs more affordable for childless, low-income adults, according to the University of Wisconsin-Madison News. The study, published in Health Affairs, revealed that before the expansion, this population was covered by the BadgerCare Plus Core Plan, which covered fewer medications and had higher copays for generic and brand-name drugs. The expanded coverage was also correlated with a 4 percent increase in childless adults using antidiabetic medications, such as insulin and oral medications.

A first-in-the-nation measure in Maryland to create a prescription drug affordability board will become law without the Governor’s signature, according to The Associated Press. The law creates an independent board with the authority to evaluate expensive drugs and recommend methods for addressing high costs. The measure was scaled back significantly from an initial proposal. For one thing, it will only apply to state and local governments, not all Maryland residents. Also, the board could only set upper-payment limits with approval from a legislative panel beginning in 2022. 

Colorado Governor Jared Polis signed legislation that caps insurance co-payments on insulin at $100 a month, no matter the type of insulin. According to The Denver Post, the measure goes into effect in January and insurers are expected to pay the difference in price. The cost of insulin has continued to increase in the U.S., with prices doubling since 2012. 

Montana has seen an increase in the number of direct primary care facilities, where the billing and payment agreement made between a doctor and their patient does not involve insurance. According to KULR 8 News, these direct primary care facilities provide monthly membership plans and are now being offered in several cities in the state. One of the founders of a Montana direct primary care facility claims that they are already seeing a huge decline in emergency room visits and hospitalizations in their community, saving the healthcare system money.  

New York City has the largest homeless population in the country, an issue the city has tackled through prevention, affordable housing and healthcare initiatives, according to this article in Harvard Business Review. The safety-net health system for the city, New York City Health + Hospitals, which serves more than one million people a year, is using data science to identify homeless patients and tailor their care and match them to the right hospital or community-based supports—ultimately including housing itself. 

48 of Minnesota's 87 counties have no practicing psychiatrists and most psychiatrists in the state practice in the major metropolitan areas. According to MinnPost, telepsychiatry may be a workable option for many rural Minnesotans, in which psychiatrists see patients remotely via video uplink and help them manage their symptoms through the use of carefully monitored medications. Some clinics and practices in Minnesota have begun using telepsychiatry, but the technology has yet to take off in the state. 

Early results of Minnesota’s certified community paramedic programs indicate that these house calls improve patient satisfaction and reduce spending on medical care. According to Minnesota Public Radio, these paramedics visit patients at home to help them transition out of the hospital and manage chronic conditions. A local hospital, Region Hospital, implemented a three-year pilot project that made nearly 1,000 home visits to help people manage diabetes and high blood pressure and resulted in large improvements in patient health and cost savings.