Alabama will receive more than $4.6 million in federal funding to increase the state’s health workforce in rural and underserved communities, reports the Birmingham Business Journal. The funding from HHS is part of a nationwide effort to improve the quality distribution and diversity of health professionals serving in communities across the country. Workforce development has been a significant concern in Alabama’s healthcare sector for many years, but that’s particularly true in rural areas.
Practice-level participation in innovative care models led to a $30 per member per quarter decrease in spending for three Arkansas Blue Cross and Blue Shield value-based primary care programs, according to a Milbank Memorial Fund issue brief. The brief examined changes in healthcare spending and utilization (years 2011 through 2018) associated with practice-level participation in one of the three Arkansas Blue Cross and Blue Shield value-based primary care programs. Estimated savings suggests a 2:1 return on investment, indicating that each dollar spent on care management fees among this commercially insured adult population resulted in a $2 savings in beneficiary spending. Reductions in acute inpatient stays and emergency department use likely account for the program savings. Savings were greater for participating practices in later years for each of the programs, suggesting that return on investment may increase over time.
The Colorado Center for Improving Value in Health Care has expanded Shop for Care, a transparency tool that allows consumers to compare price and quality information for select services and procedures at Colorado healthcare facilities, according to AboutHealthTransparency.org. The newly improved tool includes updated 2018 prices for imaging services like X-rays, CT scans and MRIs, as well as episode prices for 11 new hospital and outpatient procedures including hysterectomies, colorectal resections and more. The tool shows that price and quality vary significantly across Colorado, and higher prices do not necessarily signal better patient experience or outcomes.
Colorado has four new health insurance laws focused on improving access and affordability for state residents, reports Summit Daily. The first law creates the Health Insurance Affordability Enterprise, which extends Colorado’s reinsurance program for five years and expands coverage to those who were initially left out. The law also aims to provide more access to insurance for low-income people who receive federal subsidies, as the program caused those individuals to spend more on health insurance than they had before. The second law deals with reimbursement for telehealth services and requires that insurance carriers cover telehealth visits for behavioral, mental and physical healthcare. The state has also simplified the health insurance enrollment process by enabling people to enroll while filing their taxes and allowing working adults with disabilities over the age of 65 to participate in the Medicaid buy-in program.
A new Georgia law protects patients from surprise medical bills in an emergency or when they receive care at an in-network healthcare facility but are treated by an out-of-network provider (such as an anesthesiologist), according to Community Catalyst. Patients will pay no more than they would have if the care had been received in-network, and providers cannot bill a patient for any additional amount, Arnold Ventures reports. However, Georgia’s bill extends only to state-regulated health insurance plans and certain public plans (such as the state employee health plan).
The Idaho Governor signed an executive order making more than 150 emergency rules enacted since March to address the coronavirus pandemic permanent, reports mHealth Intelligence. Idaho healthcare providers now have permanent access to a wide range of telehealth tools to improve access to care and outcomes. The measures include allowing more freedom of online platforms for providers to use to connect with patients, allowing licensed out-of-state providers to treat Idaho patients and giving physician assistants more responsibilities in care management.
Illinois has renewed the Hospital Assessment Program and enacted the Health Care Affordability Act, according to WISC/WRSP. The Hospital Assessment Program has provided $450 million in additional funding for hospitals since the last assessment in 2016, with priority going to hospitals that serve large numbers of Medicaid patients. The Health Care Affordability Act eliminates and loosens requirements for Medicaid access and helps families enroll in and maintain coverage through the Children's Health Insurance Program and the ALL KIDS Act.
Through a unique partnership between Iowa Medicaid and public health agencies, Iowa’s I-Smile program addresses the disproportionate impact of dental disease on low-income individuals, reports the National Academy for State Health Policy (NASHP). I-Smile, and its related I-Smile @ School for children and I-Smile Silver for adults, help promote preventive oral health services and reduce barriers to dental care across the state. I-Smile primarily targets the 47 percent of Iowa children ages 0-12 who are enrolled in Medicaid to provide dental care and disease detection early in life and limit costly, preventable dental procedures. Additionally, given the link between mothers’ oral health and their infants’, I-Smile also serves pregnant women.
Like many states, Kansas has experimented with a variety of strategies to expand its workforce capacity to care for patients with COVID, a blog by the Kansas Health Institute describes. Kansas’ efforts have included: expanding scope of practice for advanced practice registered nurses and physician assistants; expediting the process for inactive or retired physicians to receive licensure to assist with COVID; and allowing early graduations from state medical schools so senior medical students can enter the workforce.
Dental therapists are now able to obtain licenses to practice in Maine, reports the Pew Charitable Trusts. Dental therapists are midlevel providers who can perform preventative care and basic restorative procedures and can help address barriers to accessing oral health services. They have been used as effective tools in increasing access to care in rural areas and for patients on public insurance as well as improving oral health outcomes in other states. The Maine Board of Dental Practice’s ruling establishes education and licensure requirements so that schools can create training programs and enables dental therapists in other states to relocate and practice in Maine.
A 2019 report by Blue Cross Blue Shield of Massachusetts Foundation revealed that the state struggled to provide adequate access to behavioral health services despite having a high density of primary care practitioners and psychiatrists, an innovative Medicaid coverage and delivery system and a high rate of insured residents. The report noted opportunities to expand telehealth to improve access to these services. The Foundation’s latest report explores this telehealth potential, proposing a framework for an optimal telebehavioral health system of care, highlighting barriers to adoption for providers and consumers and identifying opportunities to promote and expand access across the state.
The Massachusetts Board of Registration in Medicine has approved its first permanent telehealth policy, having previously approved the same policy on an interim basis in March 2020, reports JD Supra. The policy provides that a ‘face-to-face encounter’ is not a pre-requisite for a telehealth visit and that the same standard of care applies in both in-person and telehealth encounters. This permanent policy change is one of the first state actions to make permanent some of the temporary measures that were put in place to facilitate telemedicine use during the COVID-19 pandemic.
The Michigan Department of Health and Human Services (MDHHS) is launching the We Treat Hep C Initiative to bring down the cost of hepatitis C medication for the state’s Medicaid program and the Michigan Department of Corrections, according to Upper Michigan Source. The agency will seek proposals from Direct-Acting Antivirals (DAA) manufacturers to provide a significant discount to these programs. In return for this discount, the product will be the preferred DAA for Medicaid and MDOC, with minimal prior authorization requirements.
PhRMA, the drug industry lobbying association, sued the state of Minnesota over a newly enacted law meant to prevent people who cannot afford their insulin from rationing it, reports STAT News. The Alec Smith Emergency Insulin Act allows Minnesotans who would otherwise forgo their insulin to immediately pick up a 30-day supply of the drug from a pharmacy for $35, while drug makers would be forced to provide the insulin for free or face hefty fines. PhRMA is seeking a permanent injunction that would prevent the law from going into effect.
A $2.5 million grant for American Indian and Alaska Native students in the Montana State University College of Nursing will be used for Montana Advantage Nursing Scholarships, reports MSU News Service. These scholarships aim to increase American Indian and Alaska Native enrollment and graduation rates by reducing financial barriers. The ultimate goal is to achieve health equity for these populations by increasing the number and quality of American Indian and Alaska Native nurses and primary care providers who are educated to deliver culturally sensitive healthcare services to their communities in remote and rural settings, as well as urban areas. The grant, from the Health Resources and Services Administration of the U.S. Department of Health and Human Services, will be distributed over five years.
As part of the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative, Nebraska’s Medicaid agency and Department of Health and Human Services worked together to promote the judicious use of antibiotics in outpatient settings with the goal of reducing inappropriate antibiotic prescribing. The program has delivered Stewardship Across Nebraska presentations to over 100 providers in rural areas, enrolled over 30 urgent care providers in stewardship education activities through targeted outreach, and hosted a statewide Antimicrobial Stewardship Summit that provided antimicrobial education to 270 health care professionals including over 130 nurses, 80 pharmacists, and 30 providers, reports a Center for Health Care Strategies brief. Under the initiative, Nebraska’s Medicaid and public health agencies partnered to improve outpatient antibiotic prescribing by sharing and analyzing data to target education and outreach to providers in outpatient clinics and urgent care settings. Specific activities include analyzing outpatient prescribing data and geographic hot spots and distributing educational and promotional materials.
The Seacoast Area Mobile Market (SAMM) is New Hampshire’s first mobile farmer’s market and also supports local vendors, reports New Hampshire Magazine. The SAMM supports local farmers while also reducing the great distances many underserved residents face to access nutritious food by busing fresh local produce into communities that do not have access to farmers markets or may be food insecure. SAMM enables customers to use SNAP dollars at the market and SNAP recipients are able to use the two-for-one deal on fresh fruits and vegetables as part of the statewide Granite State Market Match program.
Following a handful of other states, New Hampshire has passed a law to set up prescription drug importation programs with Canada, reports Healio News. The omnibus bill also puts a $30 price cap on monthly insulin copays for those with state-regulated commercial health insurance. Proponents of the measure believe it will create transparency in drug pricing and help New Hampshire residents get access to lower-cost prescription drugs, namely insulin.
New Hampshire has enacted a new law that greatly expands how care providers in the state can use telehealth, reports mHealth Intelligence. The new law amends the state’s definition of telemedicine to include new modalities, like audio-only phones, and requires Medicaid and private payers to reimburse for telehealth services at the same level as in-person care. The law makes several telehealth expansions passed by emergency measures due to the COVID-19 crisis, such as reimbursement parity and the ability for providers and patients to collaborate on care via telephone, permanent.
Despite state and federal requirements that health plans must cover a wide range of costs related to COVID-19 testing and care, New Jersey hospitals say they aren’t being properly paid, reports NJ Spotlight. Thirty acute care facilities in the state reported that more than 1,000 claims related to COVID-19 patients were denied by various health insurance companies between March and the end of June, according to the New Jersey Hospital Association. In half of the cases, the company questioned the medical necessity of the treatment. One hospital alone reported nearly 1,500 denials related to testing services, regardless of the requirements that these services be covered.
New Jersey teachers will participate in a reformed health benefits system that supporters say is designed to save taxpayers hundreds of millions of dollars, reduce the cost for educators and protect the quality of their healthcare, reports NJ Spotlight. The new law seeks to reduce taxpayer costs for teacher benefits by at least $300 million by reducing the number of health plans options and shifting from an employee-contribution system tied to premium price to one linked to earnings. Teachers will have access to three plans in which premium costs are tied to salary.
Insurance companies regulated by New York state have requested a premium increases averaging 11.5 percent due to the COVID-19 crisis, reports WSKG. Meanwhile, the number of claims submitted by patients during the Spring declined significantly, with elective surgeries across the state cancelled or postponed and people avoiding doctor’s offices and hospitals. Some insurance companies may have to issue rebates to premium holders. In past years, the state Department of Financial Services, which approves rate changes, hasn’t granted the increases that insurers have requested, but has granted premium hikes at lower rates.
An analysis performed by the Oregon Health Authority and the Oregon Health Leadership Council showed that 40 percent of evaluated services were found to be low-value and constituted more than $500 million in spending, according to a new report. Researchers reported that Medicare had the highest rate of low-value services per 1,000 members at 595.5, which is approximately 170 percent higher than the rate for the commercially insured population. The report examines 47 measures and includes actionable opportunities to address the rise in healthcare costs and improve the effectiveness of care that is delivered to patients in Oregon.
A 2013 payment reform implemented by Oregon’s Medicaid program was associated with a 42.4 percent relative reduction in traditional primary care services—driven primarily by decreased use of imaging services, according to Health Affairs. The payment reform changed the Medicaid program’s reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. The authors stated that Oregon’s initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.
Compared with Baltimore (an untaxed control city), Philadelphia experienced significantly larger declines in the amount of sugar-sweetened beverages sold in small independent stores after implementing a 1.5 cent per ounce tax, according to a study published in Health Affairs. The study also found that 120 percent of the Philadelphia beverage tax was passed on to purchasers of taxed beverages via price increases at small independent stores one year after the tax was implemented. Researchers concluded that excise taxes may be an effective policy tool for decreasing the purchase of sweetened drinks in small independent stores, particularly among populations at higher risk for sugar-sweetened beverage consumption.
Complaints made to the State of Texas about surprise medical bills are down more than 95 percent since a new law took effect this past January, according to News 4 San Antonio. However, authors note that only 20 percent of Texans are protected by the surprise medical bill law because it applies to insurance regulated by the state. Under the new law, medical providers and insurance companies can go to arbitration to settle price disputes.
Telehealth visits during March grew significantly from the previous year and approximately half of all telehealth visits were for mental health services, according to a preliminary report on COVID-19 healthcare trends from the Utah Department of Health. Using APCD data, the report shows that medication “days supplied” was 12.3 percent above average in March 2020, with a significant increase for anti-depressant and anti-anxiety medications. The report also noted a sharp decline in the number of child and adolescent immunizations provided in March 2020 as compared to 2019 trends.
A new Virginia law protects patients and their families from receiving surprise medical bills by setting up a good faith arbitration process for resolving billing disputes between insurers and providers, according to WHSV. The law prohibits balance billing for out-of-network emergency services and certain non-emergency services at in-network facilities.
Integrating health and social services is increasingly important, particularly as patients with complex needs cope with the COVID-19 pandemic. A case study by the Commonwealth Fund describes how a nonprofit in Snohomish County, Washington, partnered with a Medicare Advantage plan to provide care coordination and social services – like home-delivered meals and medically related transportation – as a cost-saving intervention for the plan’s high-need, high-cost members. The process offers insights about how to integrate health and social services in a financially sustainable way.
Nearly half of Wisconsin residents in a federal survey say that they have put off medical care because of the COVID-19 pandemic, reports the Wisconsin Examiner. In addition, more than one in five are concerned about someone in their household losing a job or having their hours cut, according to the U.S. Census Bureau’s weekly survey. The impacts of the COVID-19 crisis have impacted not just access to healthcare, but also housing and employment security.
More than half of U.S. adults with a health savings account (HSA) had not contributed money into it in the last 12 months, according to a study in JAMA Network Open. The cross-sectional national survey of adults aged 18 to 64 years enrolled in a high-deductible health plan also revealed that approximately 1 in 3 participants did not have an HSA. Those who obtained insurance through an exchange were more likely to lack an HSA than those with insurance through an employer. Of those who did not contribute to their HSA, 44.9 percent stated they did not perceive a need for healthcare services, while 40 percent already had sufficient savings to cover healthcare expenses. However, other reasons for not contributing included not considering it (36.8%) and being unable to afford saving for healthcare (31.9%).
Changes in the way one health insurer pays for medical services can spill over onto patients covered by other insurers by changing provider behavior, according to a study released in Proceedings of the National Academy of Sciences of the United States (PNAS). Researchers studied the Medicare Comprehensive Care for Joint Replacement program to see how payment reform directly affected not only the targeted patients in the traditional Medicare program, but also the impacts on those in the Medicare Advantage program. For nontargeted Medicare Advantage patients, researchers estimate that the payment reform reduces discharges to post-acute care facilities by a statistically significant 12 percent, which is similar to the average direct effect on traditional Medicare patients.
Healthcare organizations integrating wraparound services, risk prediction models and public health nurses into care models improved patient outcomes, cost effectiveness and better alignment of care services, according to a study from Systems for Action, conducted by Indiana University-Purdue University Indianapolis (IUPUI). Co-locating wraparound services that address social determinants of health reduced healthcare utilization and costs. Risk prediction models, most useful when utilizing broad sources of information, helped ensure patients were referred to needed services. Integrating public health nurses into case conferences fostered collaboration, learning and attempts at policy changes. These tools can be used to improve healthcare quality and performance.
The cost for an out-of-network test for COVID-19 can range from $20 to $850, according to an analysis from the Kaiser Family Foundation. The median amount for a test was $127 and about half of hospitals priced their tests between $100 and $199. This is a stark contrast from Medicare’s reimbursement rate, either $51 or $100, depending on the type of test. There is also a wide variation in the price of antibody tests, ranging from $35 to $300. While federal regulations require health coverage of COVID-19 testing, it cannot regulate the price, resulting in a large variation. The CARES Act also required hospitals to share their cash price for COVID-19 testing during the public health emergency period, however, the analysis found that about a quarter of the hospitals assessed did not make this information publicly available, limiting the price transparency initiative.
Among adults who lost work or work-related income, approximately half reported an unmet need for medical care either due to cost or concerns about exposure to the virus according to a report from the Urban Institute. Additionally, of those adults, more than half of those with lower incomes, with uninsured family members, in families with chronic health conditions and parents living with children under 19 were in families that avoided healthcare due to cost or concerns about virus exposure. The economic decline due to the pandemic threatens to exacerbate existing healthcare inequities and it is argued that policies are needed that make healthcare affordable and safe to ensure that families get needed care.
Payment models based on pharmacy invoice surveys did not affect overall Medicaid drug spending, according to an analysis in Health Affairs. While list prices for pharmaceutical drugs have increased, several states have turned to using the National Average Drug Acquisition Cost, a voluntary survey of outpatient pharmacies’ drug invoices, to set payment rates in an effort to reduce spending on prescription drugs. However, the payment model change did not change total outpatient drug spending, in part, the authors argue, because dispensing fees substantially increased and the new model relies heavily on dispensing fees for reimbursements.
Several state insurance regulators are increasing efforts to protect patients from surprise bills for coronavirus tests, according to a news report in Politico. Washington is banning labs from billing insured patients and other states, such as Tennessee, Georgia, Oklahoma and North Dakota, are capping costs or narrowly defining what insurers should pay for tests. Concerns about price gouging and surprise billing abound, however, relying completely on private insurance to cover the testing costs could result in higher premiums and healthcare costs.
Replacing wasteful drugs on formularies with alternative, lower cost, drugs that have the same benefits can reduce spending without sacrificing value, according to a report from the National Academy for State Health Policy (NASHP). Several purchasers have developed waste-free formularies and have experienced significant costs savings. Health plans can change pharmacy benefit manager contracts to adjust how they are reimbursed; realigning payment incentives with those of the health plan can discourage placement of wasteful drugs on formularies. The report references the Johns Hopkins’ report, Removing Waste from Drug Formularies, that assists plans in identifying potential savings from removing wasteful drugs from their formularies.
The Lown Institute has launched a new ranking system that evaluates charity care spending, the amount of low-value services that hospitals provide and their patient demographics as compared to the community, reports Modern Healthcare. The system uses three weighted categories, made up of 42 metrics, to evaluate performance: patient outcomes, civic leadership and value of care. Hospitals in Fort Worth, TX, Houston, TX, Brooklyn, NY, and Jupiter, FL earned the highest scores in the rankings. This ranking system is intended for healthcare executives and policymakers to judge competitors and potential partners, not for patients to shop around for services.
The U.S. has let pharmaceutical manufacturers set prices and accumulate monopoly power—something that could lead to high retail costs for COVID-19 vaccines, according to an analysis in Kaiser Health News. We do not have a simple, direct mechanism for regulators or legislators to control drug pricing, unlike many other countries. Britain has paid AstraZeneca one-fifth the cost per dose that the U.S. has to secure doses of its vaccine candidate in the fall. While public scrutiny may affect companies’ pricing during the emergency period, they could charge higher rates for years thereafter, costing us dearly when other countries will pay much less.
HHS payment cuts to hospitals’ off-site outpatient departments are legal, according to a ruling by the U.S. Court of Appeals for the District of Columbia Circuit, reported by Modern Healthcare. The decision stated that volume-control measures do not have to be budget-neutral and that HHS has the authority to make pay cuts to control unnecessary increases in the volume of covered outpatient services. The ruling reversed a lower court’s decision that the payments were unlawful.
The pandemic has caused many physician pay and benefit cuts and could result in larger changes to physician compensation, reports Modern Healthcare. Some health systems are considering adopting new, more quality-based compensation models rather than volume-dependent models. The long-term impacts of the pandemic could force health systems to move to a value-based compensation system in order to maintain financial viability.