The Department of Family and Community Medicine at the University of Alabama at Birmingham has been awarded a $7 million grant to address the need for training additional family medicine physicians to serve in rural and underserved areas of the state, reports the Birmingham Times. The grant, from the U.S. Department of Health and Human Services, will enable the department to develop high school and college pipeline programs, medical student programming and faculty development programs to enhance curriculum and mentoring efforts. The University of Alabama at Birmingham has laid the groundwork for the enriched training program – the Comprehensive Urban Underserved and Rural Experience (CU2RE).
Two large, highly integrated health systems in California’s Central Coast are using their market leverage to obtain higher reimbursements from private insurers, raising the overall cost of care, reports New Times. Data from the California Office of Statewide Health Planning and Development revealed that the two systems made three times more revenue on privately insured patients than they did on Medicare patients in 2018. In 2017, prices charged by hospitals affiliated with the systems were five- to nine-times higher than what Medicare determined their costs to be—bigger markups than most hospitals in the state. High prices, combined with a lack of alternatives, make it difficult for local patients to afford needed care.
The Connecticut General Assembly passed legislation that will cap the monthly cost of insulin, supplies and emergency insulin for people with insurance, according to the CT Examiner. Beginning Jan. 1, 2022, the maximum monthly out-of-pocket cost for insulin will be $25, while non-insulin medication and devices/equipment will cost $25 and $100, respectively. Additionally, anyone with diabetes will be eligible for a 30-day emergency supply of insulin at any pharmacy in the state one time per year. The law is a major win for roughly 25 percent of patients with diabetes who report rationing insulin because of cost.
Proponents are continuing to set up the Colorado Purchasing Alliance, despite setbacks caused by the coronavirus, reports the Colorado Sun. The alliance, a group that brings together employers and individuals to use their collective leverage to negotiate better deals from providers and insurance companies, will launch in 2021 with as many as 200,000 people enrolled. Similar to the other purchasing alliance in Colorado, the Peak Health Alliance, the Colorado Purchasing Alliance aims to significantly reduce healthcare costs and improve coverage.
Delaware, Maryland and Louisiana laws implementing out-of-pocket price caps for expensive specialty drugs reduced patient spending on these medications by $351 per month, according to a study published in The New England Journal of Medicine. Although the laws resulted in a 32 percent decrease in spending for patients in need of these drugs, they did not lead to any changes in health plan spending per patient. The study highlighted that health plan spending for specialty drugs has increased from approximately 26 percent of total drug spending to 49 percent in the past 10 years, even though these medications make up less than 2.5 percent of prescriptions overall.
Three out of four Kentuckians (77 percent) are worried about affording healthcare, according to a survey conducted by the Healthcare Value Hub in collaboration with the ThriveKY campaign. Kentucky adults reported numerous affordability problems. Almost a third of respondents delayed going to the doctor and 1 in 5 rationed medicine in the past year due to cost. Additionally, dissatisfaction with the current healthcare system is both statewide and bipartisan. The majority of respondents (71 percent) agreed or strongly agreed that the healthcare system needs to change, and 69 percent of respondents identified healthcare as the priority issue the government should focus on. Respondents endorsed a number of strategies to lower healthcare costs, but the clear front-runner, at 91 percent, was to “expand health insurance options so that everyone can afford quality coverage.”
A volunteer program in Maine that provides transportation to patients who would otherwise not be able to attend their healthcare appointments may serve as a good model for other states, according to a study in Preventing Chronic Disease. The Kennebec Valley Community Action Program consists of 93 volunteer drivers, who are reimbursed for mileage with Medicare and Medicaid dollars, in addition to a staff of drivers and office staff members to address the need of rural residents without access to transportation. The program’s volunteer training and recruitment process and coordination between volunteers and patients provide a model for rural communities to fill in gaps in transportation access.
Payers can reduce unnecessary healthcare spending by incentivizing consumers to choose lower-cost healthcare providers, reports HealthPayerIntelligence. Focusing on Suffolk County, Massachusetts, the study from the Pioneer Institute used data from the Massachusetts Center for Health Information and Analysis to track resident healthcare spending on 16 services. They compared the cost difference between services used in 2015 and what they would have been had residents gone to lower-priced providers. The health system could have saved nearly $22 million in one year. To incentivize members to transition toward lower-cost providers, researchers recommend rewards and cash-back programs.
School-based health clinics have begun to use telemedicine, videos and an app to connect with and treat students, reports Fox 9. The clinics, which regularly help thousands of kids each year with many services, from physicals to mental health support, have had to adapt during the pandemic. Minnesota Community Care, which runs 10 clinics in St. Paul Public High Schools, adapted out of concern about meeting unmet student medical needs with students out of school.
Mental health drugs now account for a fourth of all pharmacy spending by private insurance and about a third of pharmacy spending by public payers, such as Medicaid. Spending is expected to increase 60 percent over the coming decades, according to a CMS prediction cited by the Clarion Ledger. This will have a large impact in Mississippi, where approximately 77,000 Medicaid beneficiaries had behavioral health diagnoses (a number that includes children but not infants) in state fiscal year 2019. Restricting access to needed medications can be detrimental in the long run— “69 percent of patients with medication access problems had adverse events compared to 40 percent for patients with no access problems,” according to Joyce West, director of the American Psychiatric Research Network.
Half of New Jersey adults experienced problems affording healthcare in the past year and three-fourths worry about affording it in the future, according to the latest Consumer Healthcare Experience State Survey by the Healthcare Value Hub. In a press conference consumer advocates from New Jersey, a patient facing high drug costs, U.S. Senator Cory Booker and New Jersey Assemblyman John McKeon all spoke on the issues of high drug costs facing their communities and constituents. Assemblyman McKeon has sponsored a bill to create a Prescription Drug Affordability Review Board, reports New Jersey 101.5, to meet every six weeks, evaluate drug prices and set limits on how much payers pay for high-cost prescription medications – a policy that received widespread bipartisan support in the Hub’s New Jersey survey.
A new New Jersey law imposes a 2.5 percent tax on health insurance companies in order to help subsidize individual marketplace premiums, reports NJ.com. The Department of Banking and Insurance will levy the tax based on the amount of money insurance companies collect in premiums. The proceeds – estimated at about $200 million – will be deposited into the Health Insurance Affordability Fund and used to subsidize the cost of insurance for people who earn no more than four times the federal poverty level. An estimated $77 million of the tax money will bolster the state’s existing reinsurance program to cover high-cost claims and lower premium costs in the individual market.
A 2016 New Jersey law gave the state flexibility to share bid information submitted by all pharmacy benefit managers (PBMs) in order to incentivize them to submit lower offers in additional bidding rounds – known as a reverse auction. This approach was implemented in 2017 and is now projected to save $2.5 billion in drug spending for public employees between 2017 and 2022, according to NASHP. Several other states have followed New Jersey’s lead, with Maryland approving legislation to conduct reverse auctions for PBM procurement in 2020 and the New Hampshire State Senate passing similar legislation (however, the House suspended consideration of the bill in late June 2020).
New York is cracking down on healthcare providers who may be charging patient fees for personal protective equipment and other charges related to increased costs from the coronavirus, reports the Times Union. The state’s Department of Financial Services issued new guidance for health insurers to protect patients from being improperly charged with these equipment fees, with the governor citing the financial burdens this practice places on patients. The guidance notes that a participating provider should not charge patients fees or other charges in addition to the patient’s financial responsibility for covered services nor should insurers cover the charges. The state financial department has received complaints of healthcare providers, particularly dental providers, charging these patient fees, which are passed to patients’ insurers and go beyond the patient’s applicable cost-sharing. Among other things, state officials are asking insurers to immediately notify participating providers not to charge PPE fees and patients should be held harmless for these charges.
New York has slashed health insurers’ requested rate hikes by an average of 85 percent, reports Syracuse.com. Health insurers had asked the state for an average increase of 11.7 percent for policies sold in the individual market. The state gave them an average increase of 1.8 percent, which the state Department of Financial Services said is the lowest increase for individual health plans in a decade. This decision comes in light of the fact that some insurers reported record profits for the first half of the year due to postponement of elective and non-emergency services, resulting in lower than expected claim payouts. The Department says these profits could be offset by higher than expected claim payouts in the second half of 2020 and in 2021.
North Carolina’s largest insurer says that its push to reform its payment system through value-based care has already saved more than $153 million in its first year of operation, reports the Triangle Business Journal. Blue Cross Blue Shield of North Carolina launched its value-based care plan, Blue Premier, in January 2019, alongside five of the state’s largest hospital systems, replacing the traditional “fee-for-service" model and reimbursing providers on quality of care rather than quantity of services provided. The company says it has generated an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on healthcare. In addition, Blue Premier physicians increased screenings for colorectal cancer by 3,041 members and controlled blood pressure for 13,412 more members than in 2018, showing health benefits alongside cost savings.
Ohio’s “minority health strike force” has issued a report containing 34 recommendations aimed at dismantling racism, removing public health obstacles, improving the social, economic and physical environments and strengthening data collection to better track disparities. These efforts are part of the state’s developing blueprint to reduce health inequities, the Columbus Dispatch reports. African Americans make up around 14 percent of Ohio’s population but comprise close to 19 percent of the state’s COVID-19 deaths, according to data from the Ohio Department of Health.
A new report from the Center for Community Solutions found prices for the same medical procedures varied widely among hospitals in Ohio, reports AboutHealthTransparency.org. The research found that not only did the price vary widely from hospital to hospital, but also, for each procedure the average cost in Ohio was much higher than the national average. The authors highlighted recommendations for controlling prices in Ohio, including one to create an independent oversight entity to set a cost benchmark.
While some Oklahoma hospitals have suspended or pulled back on filing lawsuits against their former patients in light of COVID-19, others are continuing with business as usual, according to Oklahoma Watch. At least 1,178 lawsuits were filed since the governor declared a statewide health emergency on April 2. In the bulk of those cases, hospitals have sought to collect anywhere from a few hundred dollars to more than $10,000. Although the vast majority of bills stem from hospital visits that occurred during or before 2019, patient advocates point out that the lawsuits are ill-timed as many families are struggling financially during the pandemic.
State regulators are expected to start combing through the finances of thousands of Oregon medical practices with a goal of capping per-patient spending growth at 3.4 percent, according to the Lund Report. The state’s Sustainable Health Care Cost Growth Target Implementation Committee has been working to craft a workable plan to slow the increase in healthcare spending. The committee is using a collaborative approach to cap rates, but committee members and Oregon Health Authority staff have not yet decided which entities will be subject to agency scrutiny and enforcement. Hospitals and major practices will likely be on the list, but the inclusion of large specialty clinics and small medical practices is still up for debate.
The Governor of Pennsylvania announced that Pennsylvania’s Section 1332 Waiver application for a reinsurance program has been approved. Pennsylvania’s Reinsurance Program is authorized to operate under section 1332 of the Affordable Care Act (ACA) from 2021 through 2025. “By having a reinsurance fund that will directly pay some of the healthcare costs for high-cost individuals, we can lower premiums for other insured Pennsylvanians on the individual market and reduce the cost for subsidies to help low-income individuals,” the governor said.
In mid-April, Pennsylvania state officials announced the creation of a COVID-19 Response Task Force for Health Disparity to help communicate issues about how the pandemic is affecting the state’s minority and marginalized populations. After months of weekly meetings and outreach from task force members to marginalized community members, the task force completed a report that includes six recommendations focused on these policy topics related to health disparity, ranked in order of urgency: housing, criminal justice, food insecurity, health disparity, education and economic opportunities. According to the report, each area either directly or indirectly affects the health of Pennsylvanians and must be addressed to appropriately remove the disparities that have existed for generations and have been exacerbated by the pandemic.
The Pennsylvania Insurance Commissioner released the 2021 requested rate filings for health insurance plans under the ACA, highlighting that the average rate requests would result in an average decrease in premiums in the individual market, allowing consumers greater flexibility and increased access to affordable, comprehensive coverage, reports the Pennsylvania Pressroom. Key initiatives, like establishing a state-based health insurance exchange and reinsurance fund, have driven down premium rates for 2021 and are the reason that premiums are, on average, going down in the individual market.
Blue Cross Blue Shield of Rhode Island will provide coverage for telehealth services for primary care, behavioral care and specialist care with no cost-sharing for commercial members, reports the Providence Journal. The insurer is also waiving cost-sharing for COVID-19 testing and treatment. In addition, the insurer will be providing $11 million in premium relief to its small-group and fully insured customers, following earlier premium relief in June.
Tennessee was one of 21 states to temporarily suspend scope-of-practice requirements in an effort to expand access to care during the coronavirus pandemic, according to the American Association of Nurse Practitioners. The order, which lapsed on May 18, cleared the way for nurse practitioners to write prescriptions without consulting a physician, waived a requirement for chart review and waived a requirement that a supervising physician visit remote sites every 30 days, among other things. Nursing groups have pushed the governor to extend the executive order.
Virginia has been approved to proceed with a state-based health insurance exchange, according to the Office of the Governor of Virginia. Approval from the Centers for Medicare & Medicaid Services allows Virginia to take over some functions of its current federal exchange beginning with open enrollment this November and puts the Commonwealth on a path to full control by 2023. This move will enable the state to implement policies to better address costs and provide more targeted outreach and enrollment services to Virginians.
The federal Health Resources & Services Administration (HRSA) has ranked Wisconsin the third best state in the nation for the quality and performance efforts of its Critical Access Hospitals, reports Aspirus. HRSA’s measures are from its Medicare Beneficiary Quality Improvement Project, which includes more than 1,350 hospitals across 45 states. The program is intended to reduce hospital closures in rural areas, promote a process for improving rural healthcare and focus on community needs.
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