A brief from the Colorado Health Institute looks at how telemedicine has boomed due to the COVID-19 crisis and whether Colorado will continue to use telemedicine at current levels once the COVID-19 pandemic has passed. The Colorado Health Institute identified five strategic policy areas that federal and state leaders have targeted to expand telemedicine, summarized with the acronym RAPID: reimbursement; access to services; professionals; information; and definitions. This brief also outlines key questions and research opportunities to guide policy discussions and offers profiles of how different providers have begun to use telehealth within the state.
Colorado lawmakers decided to table their public option plan because consumers, providers and other stakeholders haven’t been able to weigh in on the bill because of the COVID-19 pandemic, reports Modern Healthcare. The bill’s sponsors promised to resurrect the effort next year, arguing that the economic fallout from the outbreak demonstrates a need for more affordable health coverage plans in the state. The Colorado Hospital Association has denounced this public option plan, instead pushing its own plan for a statewide healthcare budget similar to policies in Oregon and Massachusetts.
A recent study of COVID-19 patients in Georgia (primarily metropolitan Atlanta) showed that 1 in 4 hospitalized patients had no recognized risk factors for severe COVID-19. Most patients identified as Black, and their clinical outcomes were similar to those of non-Black patients. In other words, though the frequency of invasive mechanical ventilation and fatality did not differ by race, Black patients were disproportionately represented among hospitalized patients, reflecting greater severity of COVID-19 among this population.
Georgia’s recent budget plans have been overturned by the overwhelming financial burden of the COVID-19 pandemic. The state’s Department of Behavioral Health and Developmental Disabilities outlined $172 million in budget reductions for the upcoming fiscal year. The budget cuts are alarming to patient advocates as the coronavirus crisis has sparked new mental health stresses. A Kaiser Family Foundation poll found that 56 percent of Americans reported that anxiety or stress related to the pandemic has led to at least one negative mental health outcome.
Patients of Hawaii providers exposed to peer comparisons in Hawaii experienced a 3 percentage-point increase in quality scores compared to a control group, according to a study in Health Affairs. This finding underscores the effectiveness of peer comparisons as a way to improve healthcare quality and supports Medicare’s decisions to provide comparative feedback as part of primary care and specialty payment reform programs.
As a state that runs its own health insurance marketplace, Idaho has tools at its disposal to help consumers enroll in comprehensive coverage, but has decided not to wield all of them, reports the CHIR blog. While Idaho has tried to lower enrollment barriers, it has also left large barriers in place. Rather than establishing a Special Enrollment Period (SEP), Idaho’s insurance department is encouraging uninsured consumers to enroll in short-term plans. These skimpy plans are unlikely to be sufficiently protective if residents contract COVID.
Most Illinois hospitals scored well in the Leapfrog Group’s latest report on patient safety, reports Illinois Radio Network. Forty-three percent of Illinois hospitals received an ‘A’ grade, which was significantly better than the national average– putting Illinois in the top 10 nationwide. According to the Leapfrog Group, hospitals with high marks tend to share certain traits, such as preventing medication errors by having the right technology in place or implementing strong staffing policies related to nursing and physicians staffing the ICU. The study considered 28 different factors when assigning grades, including policies, procedures and patient outcomes.
Indiana passed legislation requiring healthcare providers to give a “good faith” cost estimate to consumers five days before they deliver care, according to a Health Affairs blog that looked at how states are responding to the COVID crisis. The law also requires out-of-network providers delivering services in facilities that participate in health plan networks to accept the in-network negotiated rate unless consumers sign a statement consenting to the out-of-network charge.
The Louisiana Department of Health has released an interim report on its Reducing Maternal Morbidity Initiative, focused on reducing preventable maternal mortality and morbidity related to hemorrhage and hypertension, while also focusing on reducing racial disparities in these maternal outcomes. Preliminary outcomes indicated that severe maternal morbidity among women with hemorrhage and severe hypertension is decreasing in birthing facilities in the Perinatal Quality Collaborative.
Maine was one of two states to earn an 'A' grade from the Catalyst for Payment Reform (CPR) report card on healthcare price transparency, reports HealthLeaders Media. CPR and the Source on Healthcare Price and Competition, at the University of California Hastings College of Law, analyzed which states had advanced or implemented legislation promoting price transparency for healthcare consumers. The organizations focused on important components of price transparency laws, like whether the state mandates the creation of an APCD, makes healthcare price information available to consumers, and has a publicly accessible, mandated website.
The Governor of Maryland has vetoed a measure to fund the state's fledgling Prescription Drug Affordability Board, reports Maryland Matters. Senate Bill 669 and House Bill 1095 would set up a funding source for the panel, which was created in 2019 and began meeting for the first time in 2020. The board was established by lawmakers to identify ways to reduce the cost of prescription drugs. Though the funding was vetoed, the 2019 legislation that created the board guarantees it will receive state funds in the form of a loan on July 1. The board has until December 31 to identify a way to fund its operations and to repay the loan from the general fund starting next year.
Limited healthcare resources, high rates of preexisting conditions among residents and widespread poverty are among the factors that make Mississippi vulnerable, according to the Surgo Foundation's COVID-19 Vulnerability Index, reports the Clarion Ledger. The index is a measure of how at risk a community is when the virus hits. State rankings were based on factors like: resident socioeconomic status; household composition and disability; minority status and language; access to transportation; epidemiological factors; and healthcare system factors.
In response to healthcare outcome disparities surfaced by the COVID pandemic, Ohio legislators have launched a plan to address the gap, according to Rewind Columbus. These new strategies include: expanded access to testing through a partnership with the Ohio Association of Community Health Centers; a new position within the Department of Health dedicated to studying social determinants of health; an increase in the number of public health workers assigned to notifying residents of possible exposure to the virus; and interactive maps on the department's coronavirus web page displaying data on social determinants of health and their impact in the state's 88 counties. Currently, African Americans make up 14 percent of Ohio’s population, but represent 26 percent of the confirmed COVID-19 cases, 31 percent of hospitalizations from the disease and 17 percent of the deaths.
Health insurance companies in Oklahoma will be required to cover mental health and substance use disorders the same way they cover physical ailments under a new state law, reports The Oklahoman. Despite federal requirements passed in 2008, many states still struggle to provide equal coverage for mental health and substance use treatment. This inequality can come in the form of fewer in-network physicians or unequal reimbursement rates for behavioral health compared to physical health.
In Tennessee, anyone who wants a test can get one, and the state will pick up the tab. The guidance has evolved to “when in doubt, get a test,” and the state started paying for it in April, according to Kaiser Health News. Tennessee is doing more than double the minimum number of tests needed to control its outbreak, an NPR analysis states. Rather than private labs billing various health insurance plans, the state is picking up the tab at $100 per test.
From 2018 to 2020, Dallas-based DeLoney Law Group filed 81 percent of medical debt collection lawsuits in the state, totaling $14.8 million in judgments, according to a review of the Texas online court system by researchers from Johns Hopkins University. Patients interviewed by researchers stated that they were only given last-minute notifications about their hearings—a predatory litigation strategy, MedPage Today states. Though wage garnishment is prohibited by the Texas Debt Collection Act, debt collectors can still file a writ of execution or a writ of garnishment that allows them to go after any bank funds, property or income that is not a wage, according to the report. The hospitals that filed the most lawsuits were small, for-profit community hospitals.
Ambulatory care providers receiving fee-for-service payments are struggling to stay afloat after a sharp decline in non-emergency patient visits in response to COVID-19. Prospective, value-based payment arrangements, like Vermont’s All-Payer Accountable Care Organization (ACO) model, provide more flexibility and predictability to help providers, states, and health plans respond to changing patient needs. This interview from Center for Health Care Strategies describes how the state’s largest ACO, OneCare Vermont, is addressing COVID-19, including rapid ramp-up of telehealth capacity, and how payment reforms in the state supported the ACO’s rapid response.
Virginia will pilot a program with the City of Richmond to increase equitable access to personal protective equipment in underserved communities that may be most adversely impacted by the virus, according to the governor's office. Virginia’s Health Equity Leadership Task Force is working to leverage data to prioritize areas experiencing disproportionate impacts and is partnering with the City of Richmond to establish policies and programs to address inequities. The task force, created in March 2020, serves as the Commonwealth’s first-ever coalition during an emergency response to ensure a health equity lens is applied to all decision making within Virginia’s ongoing response.
Relative to hospital-based providers, office-based providers were earlier and quicker adopters of the biosimilar filgrastim, reports a study in the American Journal of Managed Care. Focusing on providers of Neupogen and biosimilar filgrastim, researchers compared trends in biosimilar uptake across provider’s place of service and their prescribing exclusivity. The study also found that across all places of service, providers predominantly prescribed one version of the treatment (either the biologic or the less expensive biosimilar), exclusively, for all their patients. Biosimilar uptake was more common among providers in office-based settings, those with larger practices, and those with a higher share of health maintenance organization patients, nonwhite patients and younger patients. As such, provider awareness and incentives could be important levers to strengthen U.S. biosimilar market penetration and competition.
If commercial payer reimbursement rates were set at Medicare levels, average hospital revenues would drop by 35 percent, according to Fierce Healthcare. Researchers of the study, published in Health Affairs, note, however, that there is significant variability between states in how such changes would impact revenue. For example, revenues would decrease by 40 percent in New Hampshire, as opposed to 21percent in Michigan. Additionally, average commercial prices for inpatient and outpatient facility services were about double Medicare fees, while commercial prices for professional services were about 60 percent higher. Though a uniform payment rate would lower administrative costs and increase efficiency, providers could face severe financial impacts. Therefore, the authors argue that efforts to more closely align payments must strive to avoid unintended consequences.
The ongoing COVID-19 public health crisis is causing an unprecedented shift in the way Americans view and access healthcare, reports the Alliance of Community Health Plans (ACHP). Citing concerns about COVID-19, 72 percent of U.S. consumers have dramatically changed their use of traditional healthcare services during the pandemic, with many delaying in-person care and embracing virtual options. More than 40 percent have delayed healthcare services and 38 percent intend to delay future care, treatment and procedures.
The National Academy for State Health Policy (NASHP) has created an interactive map showing states’ certificate-of-need (CON) programs. The map is based on a review of state statutes, administrative codes, websites, and other documents and was reviewed by nearly all states with CON programs. To learn more, read the National Academy for State Health Policy’s blog, 50-State Scan Shows Diversity of State Certificate-of-Need Laws or visit the Center for Health System Costs.
COVID relief fund grants vary dramatically per hospital bed based on a hospital’s payer mix. A Kaiser Family Foundation (KFF) brief examines the implications of the decision to allocate funding based on total net patient revenue. Researchers focused their analysis on hospitals with the highest and lowest shares of revenue from private payers, finding hospitals with the lowest share of private insurance revenue received less than half as much funding for each hospital bed compared to the hospitals with the greatest share of revenue from private insurance. Authors suggest an alternative methodology for distributing future funds could be based on patient volume or increasing grants for providers that are more reliant on public payors such as Medicaid would distribute funding more evenly and be less skewed by higher revenues from private insurers.
United States of Care has released a playbook to highlight particular partnerships, methods and policy choices that may be replicable in other communities now and in future waves of COVID-19. The case studies in California, Illinois and Washington describe approaches to address problems caused by social isolation; highlight effective partnerships to provide services for communities during the pandemic; identify actions to prepare communities for future waves of COVID-19; and offer opportunities to turn crisis efforts into standard practices for state leaders, policymakers and community partners.
Pricing was not aligned with actual benefits for dozens of cancer drugs, according to a STAT story detailing a study published in The Lancet Oncology. The author points to the rising prices for a variety of prescription drugs but focuses specifically on cancer drugs. Though higher prices may be justified by adding value for the patient, the author notes that there are many drugs that do not deliver the value promised. The researchers reviewed 65 cancer drugs approved by the Food and Drug Administration (FDA) between 2009 and 2017 and those approved by the European Medicines Agency, then calculated the monthly treatment costs for all five countries included in the study. They found that the median monthly treatment costs in the U.S. were nearly $13,200, compared with much lower costs in the four European countries with similar levels of wealth and standards of living. Researchers determined that the prices of cancer drugs should be better aligned with their clinical importance in order to improve access.
Though a comprehensive workplace wellness program had no significant effects on measured physical health outcomes, rates of medical diagnoses, or the use of healthcare services, the proportion of employees reporting that they have a primary care physician and improved beliefs about their own health increased, according to data from a randomized clinical trial (RCT) published in JAMA. These results complement recent RCT evidence that workplace wellness programs affect some self-reported outcomes but have limited effects on clinical or administrative outcomes.
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Though public health has accounted for most increases in life expectancy during the past two centuries, the public remains largely unaware of the public health system, according to a commentary discussing the importance of public health. Because public health operates mostly in the background, authors argue that it rarely gets the attention or funding it deserves until there’s a crisis, at which point, it may be too late. The author cites a brief from Trust for America’s Health, which shows that, after accounting for inflation, funding for the Centers for Disease Control and Prevention has decreased over the past decade.
A report from Health Affairs blog focuses on the difficulties consumers face while trying to decipher medical billing and insurance claims and the authors propose the consideration of federal legislation requiring all providers, whether in- or out-of-network, to bill through the insurer - the authors dub this proposal as consumer protection realignment (CPR). In this proposed realignment, plans would continue to negotiate rates with providers but would take on the responsibility and risk of billing patients for cost-sharing amounts and out-of-network payments, while providers would be required to return the resulting savings to plans in the form of lower charges for services. The authors believe CPR would support consumer choice but emphasize the need for research on how best to implement and enforce such a policy.
In recent months, the use of telehealth has significantly strengthened the healthcare system during the COVID-19 pandemic, highlighting the need for sustainable changes to our telehealth policies, according to a commentary published in MedPage Today. Though telehealth innovations have made strides, there are still potential barriers to patients once pandemic statutes expire. To ensure that patients will continue to have access to high quality telehealth services in the future, legislators must ensure that formerly restrictive statutes are permanently modified to embrace telehealth care.
Large hospital systems are receiving billions of dollar in emergency funding despite having deep financial reserves, according to an article published in the New York Times. The authors of the article call for a reallocation of federal funds to ensure that hospitals serving lower-income, higher-risk populations are receiving funds, while hospitals with large financial reserves do not receive unneeded financial assistance.
The pharmaceutical supply chain is opaque, inefficient and costly and intermediaries may be retaining 40 percent of the money spent on prescription drugs, according to a commentary discussing U.S. pharmaceutical drug spending. Additionally, a global pharmaceutical manufacturing supply chain that involves numerous intermediary firms can lead to safety and quality concerns. In order to safeguard the supply chain, the authors recommend manufacturing traceability and batch testing for all drugs.
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