Research Roundup - February 2019

California

New State Law is Forcing San Diego to Grapple with Its Lack of Options for Homeless Patients Post Discharge

By Lisa Halverstadt | KPBS | Feb. 21, 2019

A new law requires California hospitals to establish plans for discharging homeless patients and provide resources that might keep them from returning to the street, according to KPBS. For example, hospitals must provide meals and weather-appropriate clothing to homeless patients when needed and offer them transportation to their destination after discharge if it is within 30 miles or 30 minutes of the hospital. The law does not, however, require that homeless Californians be given temporary housing or provide new resources to deliver it. The legislation has spurred conversations among numerous stakeholders on how to better address homelessness in California communities.

Colorado

Survey: Coloradans Skipping Healthcare Because of High Cost

By Mary Shinn | Durango Herald | Feb. 24, 2019

A new survey conducted by the Healthcare Value Hub discovered that more than half (58%) of Coloradans were burdened by healthcare costs, according to the Durango Herald. Healthcare continues to be an important topic of conversation for Coloradans, especially those outside the Denver metro area, where nearly two-thirds of those surveyed indicated they were burdened by these high healthcare costs. The survey found that the majority of Coloradans (82%) agreed that the healthcare system needed to change to better meet the needs of the consumers. Coloradans should not have to delay or forgo healthcare due to cost: more than 40 percent delayed going to a doctor or having a procedure done, 38 percent avoided going altogether, 21 percent did not fill a prescription and 19 percent cut pills in half or skipped doses to save money.

Florida

Does Health Information Exchange Improve Patient Outcomes? Empirical Evidence from Florida Hospitals

By Min Chen, Sheng Guo and Xuan Tan | Health Affairs | February 2019

Achieving widespread exchange of health information is a national health policy objective to boost treatment efficiency, reduce healthcare costs and improve patient outcomes. A recent study of Florida hospitals found that participation in health information exchange (HIE) was associated with a greater reduction in the probability of unplanned, thirty-day readmissions for acute myocardial infarction compared to nonparticipating hospitals. These findings indicate that HIE can be leveraged to improve quality measures targeted by the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program and may hold promise for achieving broader policy goals.

Maryland

Maryland Total Cost of Care Model: Transforming Health and Healthcare

By Katherine Sapra, et al. | JAMA | Feb. 21, 2019

The state of Maryland and CMS signed an agreement to implement the Maryland Total Cost of Care Model, which marks the first time CMS will hold a state accountable for total cost of care incurred by resident Medicare fee-for-service beneficiaries, according to JAMA. This 8-year model began on Jan. 1, 2019, and will test whether accountability for Medicare spending will spur statewide healthcare delivery transformation, potentially reducing expenditures, preserving or enhancing quality for beneficiaries and improving individual and population level outcomes. This model builds on Maryland’s All-Payer Model, providing incentives for hospitals to increase high-value care for patients seeking care from their institutions and their community services by centering improved population health as the foundation for the model to achieve savings.

New Mexico 

New Mexico Reverses Course on Medicaid Charges for Patients

By Morgan Lee | AP News | Feb. 13, 2019

The Governor of New Mexico announced that the state will seek federal approval to reverse cost-sharing and enrollment provisions instituted by the previous Governor that were designed to conserve state spending on Medicaid, reports AP News. Specifically, the state will reverse course on its plans to charge some Medicaid patients a monthly insurance premium of $10 and co-payments of $8 on certain brand-name drugs and visits to the emergency room for routine medical care. According to the Governor, these provisions threaten to limit access to emergency services and disrupt health coverage for hundreds of thousands of state residents who are poor and disabled.

North Dakota

Dental Therapist Bill Fails in the House

By Blair Emerson | The Bismarck Tribune | Feb. 12, 2019

North Dakota lawmakers voted down legislation that would have enabled dental therapists to practice in the state by a margin of 2 to 1. Report by The Bismarck Tribune, the bill would have allowed dentists to hire dental therapists, mid-level clinicians comparable to physician assistants and nurse practitioners, in certain settings including Indian Health Service clinics and nonprofit dental practices. Sponsors and advocates of the legislation believed that it would increase access to dental care for vulnerable populations such as Native Americans, children, the elderly, and low-income families, while opponents cited quality and safety concerns as the main reason for voting against the bill.   

Texas

Thousands of Texans Were Shocked by Surprise Medical Bills. Their Requests for Help Overwhelmed the State.

By Jay Root and Shannon Najmabadi | The Texas Tribune | Feb. 12, 2019

A large backlog in patients seeking government help left state regulators unable to provide timely support to thousands of Texans who requested mediation from the short-staffed Texas Department of Insurance, according to the Texas Tribune. The overwhelmed state mediation program highlights the widespread problem of surprise emergency medical bills after the Texas Legislature gave state regulators increased authority to force insurers and providers to the negotiating table. The demand for the mediation program has increased from just 43 requests in 2013 to 4,519 in 2018, accounting for $8.8 million in qualifying surprise bills. Though the agency is able to get insurance companies to agree to pay more, lowering the amount a consumer owes, the department does not keep track of how much the consumer pays at the end of the mediation process.  Agency officials said they have already made strides to improve internal processes to prevent another backlog from choking the system.

Utah

Utah GOP Shrinks Medicaid Expansion, Defying Voters

By Rachana Pradhan | Politico | Feb. 11, 2019

Utah Gov. Gary Herbert signed legislation adopting a limited expansion of the state’s Medicaid program, defying voters who in November approved the full Obamacare program through the ballot, according to Politico. Under the new GOP-written plan, Utah will ask the Trump administration for permission to implement unprecedented restrictions on the health coverage program for the poor, while insuring about 60,000 fewer people than the Obamacare expansion would have and initially costing the state tens of millions of dollars more.

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Recent Reports

Integrating Clinical and Mental Health: Challenges and Opportunities

By Katherine Hayes, et al. | Bipartisan Policy Center | January 2019

Sources of national data show that more than one million Americans have died in the past decade as a result of suicide, drugs and alcohol, and another two million could die by 2025 if current trends continue. The Bipartisan Policy Center has published a report examining current barriers and challenges to the integration of clinical and mental healthcare services, as well as potential policy solutions to advance the integration of services to help address behavioral health in the U.S. Additionally, the report recommends early intervention and the necessity of school-based screenings and treatment to focus on children and delay or prevent the progression of more serious conditions.

Study: Physician Consolidation Doesn't Improve Healthcare

By Sam Baker | Axios | Feb. 14, 2019

According to Axios, a new study contributes to an existing body of research that shows physician consolidation does not improve quality of care. Researchers compared 29 CMS quality measures between hospitals that contract with physicians versus hospitals that employ physicians found that not only was quality comparable between the two groups, but patients reported lower satisfaction in consolidated markets. The study recommends that regulators continue to work to maintain competition, reduce unnecessary barriers to market entry and scrutinize proposed hospital mergers.

Healthcare Spending Slowed After Rhode Island Applied Affordability Standards to Commercial Insurers

By Aaron Baum, et al. | Health Affairs | February 2019

States are instituting regulations in efforts to slow healthcare spending growth, but which regulations are effective remains unclear. A recent report in Health Affairs assessed Rhode Island’s 2010 affordability standards, which imposed price controls on contracts between commercial insurers and hospitals/clinics and required commercial insurers to increase their spending on primary care and care coordination services. Researchers concluded that total spending growth decreased, driven by lower prices concordant with the adoption of price controls, and quality measures were unaffected or improved. The Rhode Island experience indicates that states may be able to slow total commercial healthcare spending growth through price controls while maintaining quality.

The Effect of Health Insurance on Home Payment Delinquency: Evidence from ACA Marketplace Subsidies

By Emily Gallagher, Radhakrishnan Gopalan and Michal Grinstein-Weiss | Journal of Public Economics | April 2019

A study published in the Journal of Public Economics found that access to health insurance subsidies is associated with lower rates of rent and mortgage payment delinquencies. Survey responses and administrative tax data were used to quantify the impact of health insurance subsidies on home payment delinquency. States that expanded Medicaid were compared to states that did not expand under the Affordable Care Act, and among households that qualified for health insurance subsidies there is approximately a 25% decline in home payment delinquency rates. The report also found that the social benefits from lower numbers of delinquencies could add up to $441-$683 per subsidy eligible individual.

Slow Growth in Medicare and Medicaid Spending Has Implications for Policy Debates

By Holahan J, and McMorrow S | Urban Institute | Feb. 11, 2019

Medicare and Medicaid per person spending has grown at slower rates than private insurance in recent years, according to a report by the Urban Institute. Private insurance spending per person grew 4.4 percent per year between 2006-2017, compared to 2.4 percent and 1.6 percent for Medicare and Medicaid, respectively. During this same time period, average annual enrollment for Medicare and Medicaid increase while private insurance enrollment stayed relatively the same, explaining why overall average spending of public programs exceeded private plans. Report authors concluded that major reductions in Medicaid and Medicare spending growth would likely have negative consequences for enrollment, and reduce coverage and increase financial and medical hardship for consumers.

Hospital Prices Grew Substantially Faster Than Physician Prices for Hospital-Based Care in 2007–14

By Zach Cooper, et al. | Health Affairs | February 2019

In hospital-based outpatient and inpatient services, hospital prices grew significantly faster than physician prices, according to a study published in Health Affairs. From 2007-14, hospital outpatient prices grew 25 percent and inpatient grew 42 percent, compared to prices for physician services, which grew 6 and 18 percent respectively. Health Care Cost Institute claims data compared people enrolled in employer-sponsored United Healthcare, Humana and Aetna plans and included plan-negotiated pricing for hospital and physician services. Although not tested in this study, the authors put forth four evidence-based policy recommendations to slow hospital price growth: active antitrust enforcement; regulating hospital payments, especially in high concentrated markets; reference pricing by private payers; and incentivize provider referrals to most efficient hospitals.

2017 Healthcare Cost and Utilization Report

Health Care Cost Institute | February 2019

Healthcare spending grew 4.2 percent per privately insured person, the second year in a row of over 4 percent growth, according to the Health Care Cost Institute. The major driver of the spending growth was price increases. The report examined claims data from 2013-2017 among four major insurance companies: UnitedHealthcare; Kaiser Permanente; Aetna and Humana. During this five-year period, total annual per consumer spending increased 16.7% while utilization decreased by 0.2%.

Visit the Hub website for more on provider consolidation, consumer harm from high costs,  healthcare cost drivers, a road map to a patient-centered, high-value health system, and more!

Commentary/News

Governors Set the Agenda for Healthcare

By Heather Howard | Health Affairs Blog | Feb. 1, 2019

A Health Affairs blog post examined the priorities of the 36 newly elected and incumbent incoming governors and found healthcare initiatives--including expansion of coverage, addressing affordability, and the opioid crisis and behavioral health services--are a top priority. To address affordability, Rhode Island, California and Nevada are considering state level individual mandates, and the Colorado Governor has proposed the creation of the Office for Saving People Money on Healthcare. The Governor of California, by executive order, consolidated California’s purchasing authorities to create the biggest single purchaser for prescription drugs and will eventually include private purchases.

Changing How We Pay for Healthcare to Promote High-Quality Care, Eliminate Waste

By Suzanne Delbanco, Maclaine Lehan and Roslyn Murray | Healthcare Dive | Feb. 4, 2019

Fee-for-service payment mechanisms have contributed to both the growth of low-value care as well as shortages of certain services, such as primary care, according to Healthcare Dive. The authors recommend that we stop paying for harmful care and reduce fees for overpriced services, as alternative payment methods are not always equipped to address the problems of the fee-for-service foundation in our healthcare system.

The Government Quashes a Nasty Stunt Used by Big Pharma to Keep Drug Prices High

By Michael Hiltzik | Los Angeles Times | Feb. 20, 2019

The Federal Trade Commission announced another victory against high prices of pharmaceuticals, according to an article in the Los Angeles Times. The settlement closed two existing loopholes that enabled “pay-to-delay” schemes to continue, where brand-name drug companies pay generic drug makers to wait to sell their competing products, sometimes until years later. The new settlement, made with Teva Pharmaceutical Industries, will be in place for 10 years, according to the FTC.

Nearly a Quarter of Rural Hospitals are on the Brink of Closure

By Alex Kacik | Modern Healthcare | Feb. 20, 2019

A new analysis of CMS data reveales that 21 percent of rural hospitals are at high risk of closing, reports Modern Healthcare. That equates to 430 hospitals across 43 states that employ about 150,000 people and generate about $21.2 billion in total revenue a year. States with the highest proportion of rural hospitals in financial distress include Alabama, Alaska, Arkansas, Georgia, Maine and Mississippi. Experts recommend increasing flexibility for rural hospitals to tailor service offerings to community needs and the use of telehealth as promising solutions.

As Value-Based Efforts Lag, Push for Price Regulation Gains Momentum

By Harris Meyer | Modern Healthcare | Feb. 23, 2019

Policymakers on both sides of the aisle are finding momentum and common ground in targeting price increases with price-setting proposals, reports Modern Healthcare. According to the CMS Office of the Actuary, nearly half of the projected 5.5 percent average annual healthcare spending growth will be due to price increases, with only a third coming from increased service utilization and intensity of services caused by the aging baby boomer generation. Advocates of price-setting proposals are hopeful bipartisan legislation that would cap out-of-network physician prices at a percentage of Medicare rates might pass this Congress. States are also highlighted as potential avenues for new cost control legislation, including public plans and Medicaid buy-in programs, rate caps as conditions for hospital mergers, and the establishment of all-payer claims databases.

Cost Caps and Coverage for All: How to Make Healthcare Universally Affordable

By David Kendall, Gabe Horwitz and Jim Kessler | Third Way | Feb. 19, 2019

A report released by Third Way proposes a path to universal coverage by building on existing programs such as Medicare, Medicaid and The Affordable Care Act. The plan is based on two main parts: cost caps for out-of-pocket expenses based on income and insurance coverage for every American. Universal coverage is achieved through automatic enrollment for those who qualify for free coverage, a one-click application for those who qualify for subsidized coverage, automatic catastrophic insurance for those who remain uninsured, and an expanded Medicare program for 55 to 64 year-olds. The proposal is financed by reducing complexity for patients, realigning incentives to produce better value for patients, protecting consumers against high prices, and pointed tax increases on the nation’s wealthy.

The Difference Between a ‘Public Option’ and ‘Medicare for All’? Let’s Define Our Terms

By Margot Sanger-Katz | The New York Times | Feb. 19, 2019

In response to increased national discussion around healthcare, the New York Times published a glossary to define and categorize some of the many existing proposals to expand coverage and control costs in the U.S. Terms include Medicare for all, single-payer healthcare, and universal coverage. The article also links to many current proposals from potential presidential candidates and legislation currently filed in the House and Senate.  

Visit the Hub website for background on drug costs, reducing low-value care, increasing high-value care, rural healthcare and more!