By Diane Wagner | Rome News-Tribune | March 10, 2017
Lt. Gov. Casey Cagle has tasked state Sen. Chuck Hufstetler, R-Rome, and four others to come up with a plan to bolster the state’s healthcare safety net system in light of federal intent to change the Affordable Care Act, according to Rome News-Tribune. Hufstetler views this as an opportunity to establish a program that could be used as a national model, where preventative care is key to success in improving health or reducing costs.
By Betsy Russell | Idaho Statesman | March 20, 2017
Legislation that would invest $10 million in tobacco settlement funds in coordinated primary care for about 15,000 of the most chronically ill people in Idaho’s health coverage gap, failed in the Senate on a 13-22 vote, according to the Idaho Statesman. An estimated 78,000 Idahoans are at or below the federal poverty line, but don’t qualify for Medicaid or subsidized health insurance. The bill also sought to steer people from emergency departments into coordinated care programs.
By Marie-Claude Lavoie et al. | American Journal of Preventive Medicine | March 23, 2017
The 2011 Maryland alcohol sales tax increase led to a significant reduction in the rate of all alcohol-related crashes, especially among drivers aged 15–34, according to the American Journal of Preventive Medicine. Increasing alcohol taxes is an important but often neglected intervention to reduce alcohol-impaired driving.
By Dori Cross, et al. | Health Affairs | March 2017
Primary care practices with a greater proportion of high-need patients -- those with multiple physical, mental or behavioral health conditions -- perform better on a range of measures, including, cost and utilization, according to this Health Affairs study. Small practices (those with one or two physicians) also had lower overall spending, but not less utilization, compared to large practices. These findings suggest the opportunity exists to experiment with care sites that specialize in complex care to drive better value for high-need patients.
Fox 9 | April 3, 2017
Gov. Mark Dayton refused to sign a $542 million reinsurance bill, but allowed it to become law, according to Fox 9. The bill subsidizes health insurance companies in the individual market, helping to defray costly claims. Lawmakers who supported the bill hope that the savings will be passed to consumers in the form of reduced premiums. The Governor’s reservations about the source of funding for the insurance subsidies and failure to include a MinnesotaCare buy-in option on the individual market led to his decision against signing the bill. However, in a letter to the House Speaker, Dayton has pledged to allow the bill to become law by failing to act upon it within three days, as required by law.
By Susan Livio | NJ.com | March 22, 2017
New Jersey hospitals saved $641 million by preventing more than 77,000 adverse events during the past five years, according to NJ.com. The savings were noted in a report by the New Jersey Hospital Association which received $10.3 million through the Affordable Care Act to fund training initiatives to prevent hospital acquired infections, bed sores and other adverse events.
By North Carolina Institute of Medicine | March 2017
A yearly report that measures 22 socioeconomic factors affecting the health of North Carolina children has given the state mixed reviews. The state scored well on insurance coverage indicators, insuring a record-high 96 percent of kids. The state scored lowest on measurements for economic security, with nearly 53 percent of children under age 5 living in poor or near-poor homes. The report shows there are deep racial and ethnic disparities in North Carolina and child poverty remains a critical public health issue within the state.
By John McConnell, e. al. | Health Affairs | March 2017
In 2012, Oregon moved the majority of its Medicaid enrollees into coordinated care organizations, leading to a 7 percent reduction in expenditures, according to this Health Affairs study. The savings were primarily attributed to reductions in the use of inpatient services. The transition also led to reductions in avoidable emergency department visits, some measures of appropriateness of care and, more concerning, to a reduction in primary care visits.
By Nick Malawskey | PA Penn Live | March 22, 2017
Healthcare system mergers and consolidation have led to a number of mega systems, some of which now reach across vast geographic areas, according to PA Penn Live. The Pennsylvania Healthcare Cost Containment Council has produced an interactive map that provides viewers a breakdown of the systems with the highest market share in some counties.
By Sky Canaves | Laredo Morning Times | March 13, 2017
Amid the flurry of last-minute bills submitted before the end of the current legislative session are a number that target healthcare pricing practices and aim to create more transparency around costs, according to the Laredo Morning Times. The legislation targets freestanding emergency rooms that have proliferated in Texas since 2009, many of which are out-of-network for most insurance plans, and improving the availability of information about healthcare costs in an effort to bring charges down and create a more transparent market for medical services.
By Mary Reed, et al. | Health Affairs | March 2017
Innovative insurance plans that pair value-based insurance designs (VBID) with high-deductible health plans found that the low-cost access to high-value treatments offset reductions in medication adherence associated with having a deductible plan, according to this Health Affairs study. The value-based plan appeared particularly beneficial for patients who started with low levels of medication adherence. Patients with additional clinical complexity or patients with lower socioeconomic status, however, did not show adherence improvements and might not be taking advantage of value-based insurance design provisions.
By Christopher Whaley, et al. | Health Affairs | March 2017
Reference pricing induces consumers to select lower-price alternatives in all forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers, according to this article in Health Affairs. The impact on consumer cost sharing is mixed, with some studies finding higher copayments and some lower. Over time, reference pricing may increase pressure for price competition and lead to further cost-reducing innovations in healthcare products and processes.
By Steven Pizer, Michael Davies and Julia Prentice | AJMC | March 10, 2017
Longer waits for the scheduling of consults were found to be significantly associated with decreased patient satisfaction, according to AJMC. Because patients often report high levels of powerlessness and uncertainty while waiting for consultations, these wait times are an important patient-centered access metric for accountable care organizations (ACOs) to consider. ACOs should have systems in place to streamline the specialist consult referral process and increase care coordination.
By Kaylyn Swankoski et al. | AMJC | March 15, 2017
An evaluation of the first two years of CMS’s Comprehensive Primary Care (CPC) initiative found that patient experience ratings of care were slightly better for CPC than for comparison practices, according to this AMJC study. There were small, statistically significant, favorable effects for two of six measures: getting timely appointments, care, and information; providers support patients in taking care of their own health; and providers discuss medication decisions.
By Elizabeth Whitman | Modern Healthcare | March 20, 2017
CMS has delayed the expansion of a bundled payment pilot, Comprehensive Care for Joint Replacement, and the implementation of its bundled payment initiatives for cardiac care from July 1 to Oct. 1, 2017, according to Modern Healthcare. It also delayed several other bundled payment programs. CMS is reportedly weighing pushing back implementation of all bundled payment initiatives even further, until 2018.
By David Radley, Douglas McCarthy and Susan Hayes | The Commonwealth Fund | March 16, 2017
If every state achieved the performance of top-ranked states, their residents and the country as a whole would realize dramatic gains in healthcare access, quality, efficiency and health outcomes, according to the Commonwealth Fund. The 2017 scorecard demonstrates progress in nearly all states between 2013 and 2015. The biggest gains were in health insurance coverage and the ability to access care when needed, with Medicaid expansion states experiencing the most improvement. Wide variations in performance across states persisted, as did disparities experienced by vulnerable populations within states.
By Bob Herman | Modern Healthcare | March 21, 2016
Anthem sued Express Scripts for more than $15 billion after the PBM did not share enough drug savings with Anthem, which led to “an obscene profit windfall” for Express Scripts, according to Modern Healthcare. Anthem CEO Joseph Swedish said his company was overpaying $3 billion annually for prescription drugs through the contract. Anthem's legal strike may spur other health insurance companies to re-evaluate their contracts with pharmacy benefits managers to see if they are getting shortchanged on drug savings. It could also allow Anthem and others to consider integrating drug benefits under their own corporate umbrellas.
By Nancy Yu, Zachary Helms and Peter Bach | Health Affairs Blog | March 7, 2017
The premiums pharmaceutical companies earn from charging substantially higher prices for medications in the U.S. compared to other Western countries generates substantially more revenues than the companies spend globally on research and development, according to this Health Affairs Blog. This finding counters the claim that the higher prices paid by U.S. patients are necessary to fund research and development. The analysis does not address whether prices in European countries or in the U.S. are appropriate.
By Sarah Jane Tribble and Sydney Lupkin | Kaiser Health News | Jan. 17, 2017
Lucrative financial incentives created by the Orphan Drug Act succeeded in encouraging more than 200 companies to bring nearly 450 “orphan drugs” to market since the law was enacted in 1983. However, drug companies are now manipulating the same legislation to maximize profits and to protect niche markets, according to Kaiser Health News. More than 70 orphan drugs were drugs first approved by the Food and Drug Administration for mass market use. These medicines were later approved as orphans, providing their manufacturers millions of dollars in government incentives plus seven years of exclusive rights to treat that rare disease.
Pew Charitable Trusts | March 16, 2017
High-income countries use a variety of payment policies to manage the cost of pharmaceuticals that the U.S. could benefit from, according to Pew Charitable Trusts. Evidence suggests that the six policies -- external benchmarking, internal benchmarking, value-based benchmarking, restrictions on off-label prescribing, payer-seller agreements, and coverage denial of unaffordable drugs -- can, and do, support health systems in efforts to manage costs.