Research Roundup - July 2018

California

California Governor Signs Bill Implementing APCD

By Marjie High | State of Reform | July 17, 2018

California’s recently passed health spending bill includes a number of provisions, including a one-time grant of $60 million to fund a state-wide all-payer claims database, reports State of Reform. According to an earlier post, the California Health Care Payments Database will collect information relating to the utilization, pricing and social determinants of health with the purpose of using “the information to inform policymakers in making decisions regarding how to reduce healthcare costs while improving quality and reducing disparities.” The Health and Human Services Secretary will use the database to compile annual reports to the California Legislature, which will (1) compare prices by payer and providers, (2) make recommendations to contain healthcare costs, reduce health disparities and improve the quality of healthcare and (3) offer strategies to increase transparency of healthcare costs.  

California Drug Pricing Transparency Law Hailed as Success

By Marjie High | State of Reform | July 11, 2018

Supporters of California’s recently enacted drug pricing transparency law (SB 17) are calling it a success after several manufactures notified California health plans that they are rescinding previously announced price increases, according to State of Reform. The law requires drug manufacturers to notify purchasers at least 60 days in advance if they plan to increase a drug price by more than 16 percent in a two-year period. To date, prescription drug price transparency laws have been enacted in Oregon and Vermont and are pending in several other states. Despite supporters’ claims of success, it remains to be seen if transparency reporting requirements will have a long-term effect on rising drug prices.

Hawaii

AlohaCare Announces $5 Million Community Innovation Investment Program

By Kylie Walsh | State of Reform | July 3, 2018

AlohaCare has announced a new Community Innovation Investment Program, which will allocate $5 million to community-based programs that promote health and wellness, address social determinants of health and innovate healthcare delivery and payment systems, according to State of Reform. As part of the program, AlohaCare, the third largest health plan in the state, will partner with primary care providers to test innovative pilot projects that work to achieve the Quadruple Aim of better outcomes, lower costs and improved patient and provider experiences.

Maryland

Maryland Governor Signs Federal All-Payer Health Contract

By Brian White | Associated Press | July 9, 2018

Maryland signed a contract with the federal government to enact the state’s unique all-payer healthcare model, according the Associated Press. This five-year contract with the Centers for Medicare and Medicaid Services is designed to create incentives to improve care while saving money, to provide greater coordinated care, expanded patient-care delivery and chronic disease management. The model emphasizes quality over quantity, expecting to total $1 billion in savings over the next five years. If successful, this holistic-approach plan could be replicated around the country to help address the financial strain on Medicare.

Oregon

CCOs Make the Grade - But Do Patients Benefit?

By Courtney Sherwood | The Lund Report | June 27, 2018

Oregon’s Medicaid coordinated care organizations (CCOs) got a shining report card on June 26 – but it’s not clear how many of the metrics they’re being graded on are making the state’s healthcare system better, according to The Lund Report. The Oregon Health Authority will pay out $178.3 million to providers for meeting performance goals, but experts are divided on whether the annual report card reflects the overall goal of keeping prices in check and improving the health of patients. While some metrics, like vaccination rates, correlate to better member health, some believe that other metrics, like the share of child-bearing-age women using contraception, need to be amended.

Ohio

DeWine Tells Ohio’s Pharmacy Middlemen He’s Ready to Sue Them

By Catherine Candisky | The Columbus Dispatch | July 23, 2018

Ohio Attorney General Mike DeWine is ramping up his investigation into the costly practices of pharmacy middlemen, hiring outside counsel to assist with a probe he expects to lead to litigation against companies managing drug benefits for Medicaid and other tax-funded health insurance programs. According to The Columbus Dispatch, DeWine stated that “today, I am putting PBMs [pharmacy benefit managers] on notice that their conduct is being heavily scrutinized, and any action that can be taken and proven in court will be filed to protect Ohio taxpayers and the millions of Ohioans who rely on the pharmacy benefits provided.” The announcement was applauded by the Ohio Pharmacists Association but criticized by political opponents who characterized the move as an empty gesture designed to shore up votes before the election.

Texas

Many Texans are Skipping Needed Healthcare Because of the Cost

By Liz Hamel, Bryan Wu, Mollyann Brodie | Kaiser Family Foundation | July 2018

More than half (55 percent) of Texas residents say it is difficult for them and their family to afford healthcare, and roughly six in ten say someone in their household has postponed or skipped medical care in the past year because of the cost. According to new survey data from the Kaiser Family Foundation, problems with healthcare affordability are much more commonly reported among Texans with lower incomes, those with health problems and the uninsured. In addition to general difficulty affording care, about four in ten Texans (38 percent) say they or someone in their household had problems paying medical bills in the past 12 months. 

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

Recent Reports 

Growth in Spending on Privately Insured Drives Much of U.S. Health Spending Growth in 2017 and Early 2018

By Corwin Rhyan | Altarum Center for Value in Health Care | July 2018

Growth in spending on privately insured patients drove much of the health spending increase in 2017 and 2018, according to a new report from Altarum. The report, which looks at trends in spending, prices, enrollment and utilization by payer, found that spending and price growth among the privately insured population exceeded Medicare and Medicaid despite very low growth in enrollment in the past year. Since 2014, private spending growth has been driven mostly by higher prices and increased utilization. Per-enrollee, private payer spending has grown 45.9 percent since 2009, which is three times the rate of Medicare and Medicaid per-enrollee spending. However, total health spending for Medicaid grew 72.6 percent, the fastest among all sources of healthcare spending, during the same time period. 

Consumer Behaviors Among Individuals Enrolled in High-Deductible Health Plans in the U.S.

By Jeffrey Kullgren, et al. | JAMA Internal Medicine | March 2018

Consumers with high-deductible health plans (HDHPs) often find themselves needing care but foregoing it because they cannot afford it--or receiving care but not being able to pay for it. Consumers with HDHPs are encouraged to seek out price and quality information, save money for future services and discuss costs with providers. This study in JAMA Internal Medicine found that less than half of consumers were saving for future services (40%), and a small minority of consumers sought out price information (14%), quality ratings (14%), discussed costs with their provider (25%) or tried to negotiate a better price for a service (6%).

Value-Based Insurance Design Improves Medication Adherence Without an Increase in Total Healthcare Spending

By Rajender Agarwal, Ashutosh Gupta and Mark Fendrick | Health Affairs | July 2018

An updated systematic review evaluating the effects of consumer cost sharing on medication adherence found that decreased cost sharing with value-based insurance design was associated with improved medication adherence. There was no demonstrated effect on total healthcare spending, indicating that increased spending on drugs was offset by decreased spending elsewhere. Limited evidence suggested improvement in clinical outcomes and quality, which are areas recommended for further review. 

Driving Healthcare Transparency with Actionable Resources: Interactive Tool and Assessment Report

By Human Services Research Institute and NYS Health Foundation| July 2018

Many online healthcare transparency tools are new and vary widely in the information they contain and how it is displayed. New York state is continuing to invest in resources to ensure that residents have access to timely and meaningful information they need to make decisions about their health, including the state’s all-payer claims database, as described by a new report that contains a national inventory of transparency tools to guide state policy. In addition, a new online database evaluates national tools in four categories: physicians, hospitals, prescription drug pricing and health insurance purchasing. The inventory, which examines more than 230 healthcare transparency tools across the US, offers best practices and recommendations to help consumers make value-based healthcare decisions. The online platform includes tools containing quality information for physicians and physician groups, though price features are lacking. 

A Health Equity and Value Framework for Action: Delivery and Payment Transformation Policy Options to Reduce Health Disparities

By Sinsi Hernández-Cancio, et al. | Families USA| July 2018

Families USA’s Health Equity Task Force for Delivery and Payment Transformation has laid out a rubric for assessing the potential impact of new initiatives on equity. The task force’s first publication is intended for health equity and health system transformation leaders to assist in policy development and prioritization that best serves their communities and constituencies. According to a Families USA report summary, the publication reviews key issues that payment and delivery reform must take into account to advance health equity and improve the health of those currently experiencing disparities, including, but not limited to, inequities based on race, ethnicity, sex, sexual orientation, English proficiency, immigration status, income, and geographic location. In addition, the transformed healthcare system must be supported by a payment system designed to reward the provision of high-quality, equitable care to all. 

Delivering Quality Health Services – A Global Imperative for Universal Health Coverage

By World Health Organization | July 2018

The World Health Organization reports that low-quality healthcare is driving up costs and contributing to disease. The Delivering Quality Health Services report identifies some of the most common problems in hospitals, including: medication errors, inaccurate diagnosis, unnecessary treatments and hospital-caused infections regardless of the socio-economic status of the country. The authors note that these problems contribute to the rising costs of healthcare in all countries.

Lowering Hospitals’ Medicare Costs Proves Difficult

By Karen Joynt Maddox, et al. | New England Journal of Medicine | July 19, 2018

The Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. Recent studies have shown reductions in Medicare payments for some services, such as joint replacement, but little is known about the effect of BPCI on medical conditions. This study evaluated the five most commonly selected medical conditions in BPCI: congestive heart failure, pneumonia, chronic obstructive pulmonary disease, sepsis and acute myocardial infarction. The researchers found that BPCI was not associated with significantly lower Medicare payments, length of hospital stay, emergency deparemtn use, hospital readmissions or mortality. The researchers noted that in order to bend the cost curve we need more than just incentives at the hospital level. We need to think about factors outside the hospitals that may be influencing people’s health and develop a more holistic approach to coordinate care for more complicated patients.

Emergency Care in Rural Areas Improved with Telemedicine

By Nicholas Mohr, et al. | Telemedicine and E-Health | Jan. 2, 2018

Emergency department-based telemedicine has been implemented in many rural hospitals to provide specialty care and expertise to patients with critical time-sensitive conditions. A study published in Telemedicine and E-health found that door-to-provider time was six minutes shorter for patients who first used a telemedicine visit. In 41.7 percent of the telemedicine encounters, a telemedicine provider was the first to see the patient, on average 14.7 minutes earlier than local providers. However, ED length of stay was 40.2 minutes longer for all telemedicine patients. According to the researchers there is clearly more work to be done on the clinical impact of timely rural emergency department care. 

Study Finds EHR Implementation Still Taking Too Much Time, Causing Serious Errors

By Rose Meltzer | Fierce Healthcare | July 23, 2018

Physicians have been complaining about the administrative burden of EHRs for a long time, and a new study quantifies these concerns and shows how these platforms can complicate simple tasks. The study, published in JAMA, suggests there is wide variability in usability and safety among EHRs. Some tasks were quick and error free, but others took up to two minutes to complete and were filled with errors. For example, half of one group of the studied physicians wrote an incorrect dose to prescribe a steroid. The consequences of these errors range from wasteful, unnecessary testing, to potentially fatal, like an inadequate or toxic course of treatment. More checks and balances are needed to ensure EHRs are used safely, but providers need to be proactive to prevent errors and harm from happening as well.

EHRs Associated with Lower Hospital Mortality After Systems Have Time to Mature

By Sunny C. Lin, Ashish K. Jha and Julia Adler-Milstein | Health Affairs | July 2018

A study published in Health Affairs to look at the relationship between electronic health record (EHR) adoption and thirty-day mortality rates for the period 2008-13 found that each new EHR function adopted was associated with a 0.21 percent reduction in mortality rate per year. As hospitals add EHR functions over time, new capabilities could separately contribute to improved performance—for example by supporting clinicians’ ability to prescribe appropriate medications and avoid potentially dangerous drug interactions and other medical errors. Thirty-day mortality rates also showed that average EHR adopters performed significantly better than nonadopters, with 0.67 percent reduction in deaths. Mortality reduction from EHR adoption was significantly greater for smaller hospitals.

Where the Magic Happens: A Guide to Grassroots Organizing for Consumer-Driven Delivery Reform

By Community Catalyst | June 2018

Community Catalyst has released a guide that synthesizes successful work the Center for Consumer Engagement in Health Innovation has done with state advocates across the country in raising consumer voices in health system reform initiatives. Featured examples show how the Center’s state-based partners are building power among marginalized populations as consumers become more involved in delivery reform issues. The guide also answers questions about which populations to reach out to, what key points to listen for, how to talk to consumers about complex issues, what organizing tactics to use and how to participate in and influence delivery system reform initiatives.

Visit the Hub website for background on healthcare cost drivers, rural healthcare, transparency initiatives, high-deductible health plans and more! 

Commentary/News

Hospitals Roll Out Online Price Estimators as CMS Presses for Transparency

By Harris Meyer | Modern Healthcare | June 2018

Over the past two years, a growing number of hospitals have begun offering online price estimates directly to consumers for common, less complex services, according to Modern Healthcare. The recent push stems from mounting pressure from regulators and consumers to be transparent about costs, especially given increasing public anger about unexpected large medical bills. Still, there are limitations to the types of services for which consumers are able to shop for the best price. Additionally, price-estimator tools currently do not offer information on quality of care, outcomes or patient satisfaction, further limiting the usefulness of the tools. 

Some Patients Fight Back Against Surprise Medical Bills

By Meg Bryant | Healthcare Dive | July 2018

A Texas Supreme Court decision giving uninsured patients suing hospitals access to data about how much insurance companies pay for similar procedures may make it easier for them to negotiate under similar circumstances. According to an article in Healthcare Dive, Texas law prevents hospitals from charging uninsured patients a “reasonable and regular rate,” but hospitals were previously unwilling to provide necessary data in lawsuits. A few factors are contributing to the problem: health plans are narrowing their provider networks and raising deductibles. States also lag in price transparency and consumer protections. An Altarum report from November gave just two states — Maine and New Hampshire — an A on healthcare price transparency. New payment and delivery models, such as bundled payments, may make it easier for patients to anticipate medical costs. 

States Expand Telemedicine to Allow Prescribing of Controlled Substances

By Rachel Arndt | Modern Healthcare | July 2018

An increasing number of states have allowed the use of telemedicine to prescribe medications according to a story in Modern Healthcare. Eight states, including Connecticut, have now allowed providers to prescribe controlled substances for mental health disorders via telemedicine. While there are still several limitations, the new legislation is a recognition that telemedicine can play a role in improving access to healthcare services. 

A Hospital’s Human Touch: Why Taking Care in Discharging a Patient Matters

By Judith Graham | Kaiser Health News | July 2018

Patients and caregivers want to feel prepared to look after themselves or loved ones when they leave the hospital, and they want to know that their needs will be attended to until they stabilize or recover, according to a study published in the Annals of Family Medicine. A Kaiser Health News article describes the importance of open communication between providers and patients during serious health episodes and care transitions, highlighting Project ACHIEVE, a $15 million study investigating the effectiveness of interventions designed to improve care transitions. The project involves asking patients, especially older adults, undergoing care transitions about their experiences. A preliminary research report found that common problems include haphazard, uncoordinated approaches and a lack of teamwork and leadership. A survey of 9,000 patients and 3,000 caregivers will be published this fall. 

Urgent Care Clinics are Prescribing Too Many Unnecessary Antibiotics

By Lena H. Sun | The Washington Post | July 16, 2018

An analysis published in JAMA found that nearly half of patients who went to urgent care clinics seeking treatment for a flu, cold or other conditions that do not require antibiotics received a prescription for one anyway. According to The Washington Post, patients who get unnecessary antibiotics are at risk for severe side effects, even with just one dose of the medicine. Overuse of antibiotics also accelerates the emergence of drug resistant bacteria, or “superbugs,” causing medical harm. Another study also found that in the United States, nearly one-third of antibiotics — or about 47 million prescriptions dispensed every year — in doctor’s offices, emergency departments and hospital-based clinics are not needed and not effective. The Urgent Care Association is working with others in the industry, the CDC and George Washington University’s Antibiotic Resistance Action Center on ways to ensure proper antibiotic prescribing. However, patient expectations remain a challenge. 

Cost of Individual Health Insurance Depends More than Ever on Where You Live

By Donna Rosato | Consumer Reports | July 2018

An analysis published by Consumer Reports shows how healthcare premiums can vary by state. Through its interactive map, consumers are able view their state’s current average monthly premium, projected annual increases and state legislative developments regarding insurance providers. Additionally, the article touches on federal-level changes initiated by the Trump administration that may be contributing to increasing premiums and how legislation can affect states independently.

Health Insurers are Vacuuming Up Details About You—And it Could Raise Your Rates

By Marshall Allen | ProPublica| July 2018

Without any public scrutiny, insurers and data brokers are predicting your health costs based on data about things like race, marital status, how much TV you watch, whether you pay your bills on time or even buy plus-size clothing. According to an article in ProPublica, this data may help determine how much consumers pay for insurance. Patient advocates and privacy scholars say the insurance industry’s data gathering runs counter to its touted, and federally required, allegiance to patients’ medical privacy. At an annual America’s Health Insurance Plans conference, Optum, a company owned by UnitedHealth Group, defended the practice by saying it uses the information to link patients’ medical outcomes and costs to details like their level of education, net worth, family structure and race. Though some insurance companies are already using socioeconomic data to help patients get appropriate care, patient advocates are skeptical health insurers have altruistic motives for gathering people’s personal information.