Research Roundup - February 2018

Colorado

Healthcare Prices High in Colorado, Study Shows

By Joe Vaccarelli | The Daily Sentinel | Feb. 17, 2018

Colorado's total cost for healthcare is significantly higher than some other states, according to an article in The Daily Sentinel. A five-state study, led by the Network for Regional Healthcare Improvement and funded by the Robert Wood Johnson Foundation, revealed that Colorado's healthcare costs across all services are 17 percent above the average of the other states. According to the study, Colorado's rates are driven by a higher use of services—11 percent more than the other states—and higher costs—6 percent more than the other states. Extra spending experienced by Colorado varied by service: costs are 30 percent above the average for outpatient services, 24 percent above average for pharmacy costs and 16 percent above average for inpatient care. 

Connecticut

Connecticut Establishes Office of Health Strategy

Ct.gov | February 2018

In February, Connecticut launched a new Office of Health Strategy, designed to implement comprehensive, data driven strategies that promote equal access to high quality healthcare, control costs and ensure better health for the people of Connecticut. The office will bring together the formerly independent State Innovation Model (SIM) Project Management Office, Health Information Technology Office, Office of Health Care Access and the state’s All Payers Claims Database to combine critical data sets and health information exchange efforts and allow for collaboration with many stakeholders, including state agency partners. “Connecticut has made strong progress on healthcare coverage and accessibility, but there is much more we need to do to address health outcomes, healthcare costs, health inequities and care delivery and payment reforms. Healthcare isn’t a partisan issue, the Office of Health Strategy will help us move forward collaboratively to address these issues with our stakeholders,” said Executive Director Vicki Veltri.

Healthcare by the Numbers: Gathering Data on Racial Disparities

By Harriet Jones | WNPR | Feb. 7, 2017

Connecticut Voices for Children is partnering with Health Equity Solutions to propose legislation that would standardize guidelines across state agencies for collecting data related to race and ethnicity in healthcare outcomes, reports WNPR. The bill would provide better training for the healthcare professionals who collect the data and make the data easily shareable, in addition to increasing the specificity of the data collected so that outcomes for smaller ethnic groups can be more easily tracked. Advocates assert that increasing the availability of data on smaller racial and ethnic minorities will increase social justice, save money on costly disease management and get more of the state's population healthy and contributing to the economy.

Delaware 

Delaware Expands State Website with Information, Resources on Slowing Spending Growth

Delaware Department of Health and Social Services | Jan. 23, 2018

The Delaware Department of Health and Social Services issued a press release announcing the expansion of ChooseHealthDE, a state-run website offering information on coverage options through the state's Health Insurance Marketplace. The site now features two sections: the Health Insurance Marketplace and information about the state’s new the healthcare spending benchmark. With respect to the benchmark, resources detailing strategies for success and downloadable toolkits are available for four target audiences: individuals and families, employers, healthcare providers and legislators.

Delaware Medicaid Implements Value-Based Purchasing

By Jill Fredel | Delaware Department of Health and Social Services | Jan. 25, 2018

 The Delaware Department of Health and Social Services has entered into a value-based purchasing care initiative through contracts in its Medicaid Managed Care Program. The purpose of the agreement is to transition the system away from traditional fee-for-service, volume-based care to a system that focuses on rewarding and incentivizing improved patient outcomes, value, quality improvements and reduced expenditures. The initiative applies to all managed care organizations participating in the Delaware Medicaid program.

Iowa

Many Iowans See Mental Health System in Crisis, New Poll Finds

By Tony Leys | Des Moines Register | Feb. 10, 2018

Nearly three-quarters of Iowans believe the state’s mental-health system is in crisis or is a big problem, a new Des Moines Register/Mediacom Iowa Poll shows. The mental-health system is by far the leading area of concern for Iowans among nine possibilities tested, according to the poll. Thirty-five percent of Iowans say the lack of mental-health services is a crisis, and 38 percent believe it's a big problem. The poll's findings come as state leaders roll out an ambitious plan to expand mental-health services, including the addition of "access centers" for people who need immediate help and to encourage patients to stay on their treatment plans.

Kansas & Missouri

Cost Containment Initiatives Report

By Health Care Foundation of Greater Kansas City | February 2018

A new report by the Health Care Foundation of Greater Kansas City analyzes the results of five local initiatives aiming to improve patients' healthcare experience, lower the cost of care and improve health outcomes and access to care. Multi-stakeholder collaboration, building relationships with the target audience and achieving buy-in from organizational leadership were identified as key factors contributing to the initiatives' success. Challenges included barriers to data collection and educating and training staff. These initiatives highlight the potential for collaborative, patient-centered efforts to reduce unnecessary ED use and preventable hospitalizations and provide important insights to help inform Kansas and Missouri lawmakers as they explore strategies to reduce healthcare costs. 

Maryland

Hospitals Find Asthma Hot Spots More Profitable to Neglect than Fix

By Jay Hancock, Rachel Bluth and Daniel Trielli | Washington Post | Dec. 7, 2017

Baltimore paramedic crews make more asthma-related visits in zip code 21223 than anywhere else in the city, according to fire department records. This neighborhood is in the shadow of prestigious medical centers—Johns Hopkins, whose researchers are international experts on asthma prevention, and the University of Maryland Medical Center, according to the Washington Post. However, like hospitals across the country, the institutions have done little to address the root causes of asthma in their community. The perverse incentives of the healthcare payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.

School-Based Health Center Works to Keeps Kids in Class, Out of Emergency Rooms

By Talia Richman | The Baltimore Sun | Feb. 9, 2018

The clinic at KIPP Harmony Academy in North Baltimore is the only one in the city run by the Johns Hopkins Children’s Center and it offers comprehensive, in-house medical care to many of the 1,500 students who attend the elementary school, or the Ujima Village Academy middle school, reports The Baltimore Sun. Both schools are located in the same building and operated by KIPP, a national network of public charter schools. The center’s goal is to keep kids in classrooms and out of emergency departments by promoting healthy living and preventive care for chronic illnesses.

Ohio

OhioHealth Patients Can Access their Medical Records in Upcoming Version of Apple’s Health App

By Carrie Ghose | Columbus Business First | Feb. 5, 2018

OhioHealth patients soon will be able to access their medical records and test results on their iPhones with the upcoming release of Apple’s mobile operating system, according to an article in the Columbus Business First. The 10-hospital Columbus system was among a dozen nationwide that Apple chose for a beta test of the feature, along with Johns Hopkins Medicine in Baltimore, Cedars-Sinai in Los Angeles and Rush University Medical Center in Chicago. Apple selected systems representing a range in sizes that already had made significant technology upgrades to be able to integrate their records with the app. OhioHealth spent more than $200 million in a multi-year project to replace several legacy vendors with a single electronic medical record from Epic Systems at all its hospitals, clinics and physician offices.

Texas

In Texas Health System, Bundled Payments Saved More Than $5K per Joint Replacement

By Ryan Black | Healthcare Analytics News | Feb. 5, 2018

Medicare spending for joint replacements have increased by about 5 percent in recent years, but bundled payments could be a way to reverse that trend, according to an article in Healthcare Analytics News. In the Baptist Health System in San Antonio, Texas, participation in a series of CMS bundle programs cut the costs by more than 20 percent over the course of 7 years. From 2008 to 2015, the system participated in a pair of initiatives: the Acute Care Episodes and the Bundled Payments for Care Improvement program. Nearly 4,000 joint replacement of the lower extremity were documented with average savings of more than $5,000. In 3,738 cases without complications costs fell from an average of $26,785 per episode to $21,208; in the 204 patients who experienced complications the average dropped from $38,537 to $33,216.  

Washington

Unnecessary Medical Care is More Common Than You Think

By Marshall Allen | Pro Publica | Feb. 1, 2018

A study by the Washington Health Alliance found that in a single year more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million, reports Pro Publica. The report calls for overuse to become a focus of “honest discussions” about value in healthcare. It also said the healthcare system needs to transition from paying for the volume of services to paying for the value of what’s provided.

West Virginia

One Small Town, Two Drug Companies and 12.3 Million Doses of Opioids

By Lenny Bernstein and Katie Zezima | The Washington Post | Feb. 15, 2018

Two of the country’s largest prescription drug distributors shipped 12.3 million doses of opioids to a single pharmacy in a small, rural town of 1,779 residents, according to a report by The Washington Post. West Virginia had the highest rate of drug overdose deaths in the U.S. in 2016, and a congressional committee wanted answers from these national distributors on why such large volumes of opioids were sent. While the distributors work to answer questions from the congressional committee, a separate report found that more than $10 million was paid from five drug manufacturers to patient advocacy groups and doctors who promoted the use of painkillers. 

For more state news and to get alerts for your state, visit our state news page.

Recent Reports

The Effects of Household Medical Spending on Income Inequality in the U.S.

By Andrea Christopher, et al. | American Journal of Public Health | Feb. 7, 2018

In a study to assess the effect of a household’s outlay for medical expenditures on income inequality since the implementation of the Affordable Care Act (ACA), researchers analyzed data from the U.S. Current Population Survey from 2010-2014. By calculating the Gini index (the most commonly used measure of inequality of wealth distribution) with and without a household’s medical spending, researchers found way we finance medical care exacerbates income inequality and impoverishes millions of Americans.

EHRs Do Not Lower Administrative Billing costs, Study Finds

By Rachel Arndt | Modern Healthcare | Feb. 20, 2018

Electronic health records were thought to be able to reduce administrative costs, but that may not be the case, according to a story in Modern Healthcare. This article discusses a recent study where administrative costs accounted for as much as one quarter of professional revenue for some patient encounters. The researchers attributed much of the high cost to variable contracts between the hospital, health plans and payers, as well as price schedules. When costs associated with EHR software were taken into account, costs increased dramatically, suggesting that the health information technology has not reduced administrative costs.

Government as Innovation Catalyst: Lessons from the Early Center for Medicare and Medicaid Innovation Models

By Rocco Perla, et al. | Health Affairs | February 2018

Congress established the Center for Medicare and Medicaid Innovation (CMMI) to design, test, and spread innovative payment and service delivery models that reduce spending without reducing the quality of care or improve the quality of care without increasing spending. A recent Health Affairs article provides a perspective on the design and execution of CMMI’s five initial models, the resulting outcomes and how their core concepts evolved within and spread beyond CMMI. Authors identify three key insights that could inform future efforts by CMMI and public and private payers: a need for iterative testing and learning guided by market feedback, more realistic time frames to demonstrate impact on cost and quality and greater integration of models.

Despite Uncertainty, Fundamentals Will Drive Future Spending Growth

By Gigi Cuckler, et al. | Health Affairs | Feb, 14 2018

National health spending is projected to grow 5.5 percent annually from 2017-2026 under current law, which would represent 19.7 percent of the economy by 2026, according to this Health Affairs study. The CMS researchers concluded that the growth is largely driven by changes in projected income, increases in prices for medical goods and services and shifts in enrollment from private health insurance to Medicare.

Top Spenders Among the Commercially-Insured: Increased Spending Concentration and Consistent Turnover

By Bill Johnson and Sally Rodriguez | Health Care Cost Institute | February 2018

A new report by the Health Care Cost Institute explores the distribution of healthcare spending among commercially insured individuals, with a focus on the top 5 percent of spenders. Specifically, the report considers the share of spending incurred by this group, how those dollars are distributed among the healthcare service categories, turnover rates and how new top spenders differ from persistent top spenders. The HCCI authors contributed an accompanying piece to the NEJM Catalyst blog, entitled "Consistently High Turnover in the Group of Top Health Care Spenders."

Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients

By Ruben Amarasingham, et al. | The Commonwealth Fund | January 2018

The U.S. healthcare and social services delivery systems are not well equipped to effectively meet the needs of people with multiple chronic conditions and social needs, such as food, housing or substance abuse services. Community-level partnerships have emerged across the nation to bridge the gap between social service organizations and local healthcare delivery systems and improve outcomes for complex patients. Evidence on the effectiveness of these programs is emerging and there is much to learn about their approaches and challenges. A new report by the Commonwealth Fund profiles and classifies current initiatives to help us understand common challenges and potential solutions.

Interoperability is Biggest Barrier to Value-Based Payment Adoption, Hospital Execs Say

By Maria Castellucci | Modern Healthcare | Feb. 14, 2018
According to an article in Modern Healthcare, capabilities around interoperability have been the hardest area for hospitals to adopt in the push to value-based care. Interoperability, which is the ability to aggregate and share clinical information across different systems of hospitals and physician practices, is an important tool in the transition to value as data becomes central to track success in payment models. Only 33 percent of hospital leaders reported their facility was highly capable of interoperability even though 98 percent said it was either a "highly" important or "extremely" important asset in the move to value-based payment in the next three years. 

Bundled Payment Success Varies by Condition

By Harris Meyer | Modern Healthcare | Jan. 27, 2018

Finding success in bundled payment programs depends on the condition being treated, according to Modern Healthcare. One hospital found that hitting targets for congestive heart failure patients were often inconsistent, indicating there is a high cost variability for patients with this condition. By comparison, the same hospital found they consistently hit targets and earned Medicare savings payments for patients with sepsis. Understanding the differences in condition and how to develop strong programs for evidence-based clinical pathways is important, yet not all conditions easily lend themselves to be programmed as a bundled-payment.

Visit these pages for background on complex patients, bundled payment, narrow networks, telemedicine, state roles in healthcare value.

Commentary/News

CMS Cancels Second Model Aimed at Shared Decision-making

By Virgil Dickson | Modern Healthcare | Feb. 5, 2018

CMS is not moving forward with the Direct Decision Support Model (DDS) due to operational and technical issues with the proposed model design, according to an article in Modern Healthcare. The model was going to encourage the use of decision aids, such as pamphlets and brochures, that offer treatment options for particular conditions. The decision to cancel the DDS model comes two months after CMS quietly canceled a similar effort known as the Shared Decision-Making Model, which would have allowed Medicare beneficiaries to work with their clinicians to choose the best treatment plans, including surgery. The model applied to clinicians in Medicare Shared Savings Program or a Next Generation accountable care organization.

Why a Simple, Lifesaving Rabies Shot Can Cost $10,000 in America

By Sarah Kliff | Vox | Feb. 7, 2018

According to an article by Sarah Kliff, readers from across the country have been providing information about their emergency department costs in Vox’s emergency department bill database. In reviewing the reader submissions, Kliff noticed significant medical costs due to rabies treatments. She highlights a number of stories of people that have submitted bills from their emergency departments for thousands of dollars for lifesaving rabies treatments and focuses on the point that in England treatment is a fraction of the cost; in some cases hospitals in the U.S. charged six times what the identical drug in the U.K. would cost and pointing out the pricing failures occurring all over the U.S. 

Preventive Care Saves Money? Sorry, It’s Too Good to Be True

By Aaron Carroll | The New York Times | Jan. 29, 2018

Spending more on preventive care may not lead to reduced overall healthcare spending, according to the New York Times. The author discusses emergency department visits, wellness programs, care coordination initiatives, and preventive care and found there wasn’t much savings actually happening in preventive medicine. What does happen, however, is healthier people and improved quality of life and the author suggests that should be the focus, not saving money. 

Four More States Submit Bills to Import Prescription Drugs from Canada

By Jennifer Reck and Jane Horvath | NASHP | Feb. 6, 2018

With the addition of four more states, six states total – Colorado, Missouri, Oklahoma, Utah, Vermont and West Virginia – have introduced bills to import prescription drugs from Canada in an effort to decrease drug costs, according to NASHP. If the importation bills become law, they must then receive approval by the U.S. Dept. of Health and Human Services before being implemented. Specifically, the Secretary must determine whether the state programs meet federal requirements to ensure both product safety and consumer savings. NASHP has introduced model legislation to help states meet these federal requirements.