Research Roundup - May 2017

Arizona

How Arizona Medicaid Accelerated the Integration of Physical and Behavioral Health Services

By Deborah Bachrach, et al. | The Commonwealth Fund | May 2017

The siloed nature of medical and behavioral services has caused agencies to have different--sometimes misaligned--policy goals, priorities and strategies that can impair the delivery of quality patient care. Researchers have looked into Arizona's attempt to consolidate physical and behavioral health services within its Medicaid agency and have found consolidation enabled more strategic purchasing and streamlined regulatory processes, along with enhanced communication among sectors, according to The Commonwealth Fund.  

California

Reducing Needless Medical Tests that May Harm and Cost Consumers

By Chad Terhune | California Healthline | May 19, 2017

Experts estimate that at least $200 billion is wasted annually on excessive testing and treatment. Overly aggressive care can lead to mistakes that are estimated to cause up to 30,000 deaths each year, according to California Healthline. In California, low-value care has led to three insurers in the state to band together and promote care that is safer and more cost effective. Progress has been slow, but Sharp Rees-Stealy Medical Group has cut unnecessary lab tests by more than 10 percent and has succeeded in educating both doctors and patients in overuse.  

California Considering Measure to Increase Spending on Medi-Cal's Homeless Population

By Pauline Bartolone | California Healthline | May 3, 2017

Lawmakers in California are considering an additional $90 million in state housing spending over five years to subsidize rent for homeless Medi-Cal patients, according to California Healthline. Research shows the homeless population are frequent users of emergency departments and sheltering them can reduce spending on public health and other social services.   

Iowa

Iowa’s Medicaid Expansion Promoted Healthy Behaviors but was Challenging to Implement

By Natoshia Askelson, et al. | Health Affairs | May 8, 2017

Iowa’s Medicaid expansion was designed to offer incentives for enrollees to complete healthy activities in return for a waiving monthly premiums. Healthy activity completion rates did not exceed 17 percent, according to research published in Health Affairs. Results indicated that lack of awareness contributed to low takeup rates. These results suggest that the federal and state government should devise more effective and innovative ways to incentivize healthy behaviors.   

Louisiana

Louisiana Proposes Tapping a Federal Law to Slash Hepatitis C Drug Prices

By Sarah Jane Tribble | Kaiser Health News | May 4, 2017

Public outcry over high-priced Hepatitis C drugs has prompted Louisiana officials to propose using an obscure federal law to get medicines at a lower cost, according to Kaiser Health News.  Hepatitis C treatment in Louisiana would cost the state a staggering $764 million for the 35,000 uninsured and Medicaid enrollees with Hepatitis C. Under existing federal law, the Trump administration could sidestep patents and contract with a generic supplier to offer a lower-priced version of the expensive antiviral drugs. The government would have to pay the drugmaker only  “reasonable compensation” and prove that using the product benefits the U.S. government.  

Maine

Sufficient Money Makes Maine’s High-Risk Pool Successful

By Patty Wight | Kaiser Health News | May 17, 2017

High-risk pools have been touted as a strategy to hold down premiums for those outside the high-risk pool. A number of states have attempted high-risk pools with mixed results. Maine has been more successful than most due to a key ingredient--sufficient funding--according to Kaiser Health News. 

Massachusetts

Commonwealth Care Alliance Shows Promise in Managing Complex Patients

By Priyanka Dayal McCluskey | The Boston Globe | May 10, 2017

Massachusetts began the Commonwealth Care Alliance four years ago with the goal to manage care for some of the poorest and sickest people in the state. The Boston-based program has begun to show success in treating this complex population and reducing costs, according to the Boston Globe.Hospital admissions for members enrolled in the program for at least 18 months have dropped by 22 percent.  

New York

Strategic Assessment of New York State’s Regional Population Health Investments

New York State Health Foundation | May 2017

The NYS Health Foundation released a report analyzing New York’s current funding for total population health. The report evaluates the state’s Prevention Agenda goals, examining which entities receive funding grants and how the state can gain more value for its spending by better coordinating its investments in population health.

Oregon

Low-Cost Behavioral Nudges Increase Medicaid Take-up Among Eligible Residents in Oregon

By Bill Wright, et al. | Health Affairs | May 2017

A study using randomized controlled design to evaluate the effectiveness of improved communication and behaviorally informed “nudges” designed to increase Medicaid take-up among eligible populations showed that even low-cost interventions resulted in increased enrollment, according to Health Affairs. The effects were stronger among populations who had already expressed interest in health insurance but weaker among groups that had not. Using low-cost mass outreach efforts has the potential to decrease the rate of uninsured by increasing insurance coverage among vulnerable populations.  

Tennessee

Rising Hospital Costs and Shrinking Payments are Threatening Tennessee’s Hospitals

By Holly Fletcher | The Tennessean | May 7, 2017

The expense of providing Tennessee residents with care is increasingly outweighing the revenue coming in, according to The Tennessean. Hospitals use gross charges--the money they charge for services before applying discounts for insurance contracts and Medicare payments, among others--as an indicator of the revenue they need to function. Gross charges in Tennessee grew 49 percent annually from 2010 to 2015, but in the same period contracted discounts, charity care and bad debt collectively grew by 61 percent annually. Policymakers need to pay attention to the growing financial constraints that many hospitals in rural areas across the country are facing.   

Vermont

State Legislation Boosts Potential for Remote Medicine

By Mike Faher | VT Digger | May 17, 2017

State lawmakers have passed legislation aimed at expanding the use of telemedicine technology in the state, according to the VT Digger. The bill requires insurers to cover telemedicine services--defined as healthcare services delivered through live, interactive audio and video--at the same levels as in-person services.

Recent Reports

What’s New in State Drug Pricing Legislation?

By NASHP Staff | NASHP | May 1, 2017

Eighty legislative bills pertaining to drug pricing were introduced in 2017, according to a report from NASHP. While there is a high level of interest in drug pricing among state legislators, only Maryland, Montana, New Mexico, New York, and Utah have passed drug pricing legislation.  These legislative milestones are important steps in the journey to control rising drug prices.

Doctors Should Question the Value of Most Heavily Promoted Drugs

By Tyler Greenway and Joseph Ross | BMJ | May 2017

Researchers from Yale argue that physicians should be wary of the industry’s top marketed drugs. The top promoted drugs are less likely than top selling and top prescribed drugs to be effective, safe, affordable, novel, and to represent a genuine advance in treating disease, according to a study in BMJ.  The researchers suggest that more efforts are needed to better evaluate the value of drugs and clinicians should take steps to limit their exposure to industry promotion and engage with evidence based recommendations about medication choices.   

The Effect of Price Transparency in Electronic Health Record on Clinician Behavior

By Mina Sedrak, et al. | JAMA | April 21, 2017

Many health systems are considering using price transparency to influence clinician ordering behavior. Evidence thus far has been limited to single-site evaluations of shorter duration. In a new study, researchers have found that displaying Medicare allowable fees for inpatient laboratory tests did not lead to a significant change in overall clinician ordering behavior or associated fees, according to this study in JAMA. Findings suggest that price transparency alone may not lead to significant changes in clinician behavior and future interventions need to be better targeted or combined with other approaches.  

Tiered-Provider Networks May Reduce Overall Medical Spending

By Anna Sinaiko, et al. | The Commonwealth Fund | May 10, 2017

Tiered-provider networks are increasingly used in employer and other private health plans to steer patients to doctors and hospitals that provide higher-quality care at lower cost. An analysis of tiered-provider network plans sold by Blue Cross Blue Shield of Massachusetts were linked to 5-percent lower spending, according to The Commonwealth Fund.  Results indicate that tiered-provider networks may be an effective tool for reducing overall medical spending.  

The Role of Care Management Within a Pioneer ACO

By Juhn Hsu, et al. | Health Affairs | May 2017

Using data from 2009-2014, researchers have examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department visits and hospitalizations and on Medicare spending. Participation in the care management program was associated with substantially reduced hospitalization rates and emergency department visits, as well as lower Medicare spending, according to a study in Health Affairs. Targeting high-risk beneficiaries and shifting care away from the ED are viable mechanisms for altering spending within ACOs.

Maximizing Investment in Community Benefit

By Rose Purrelli Swensen | Health Resources in Action | April 2017

Nonprofit healthcare providers are required to demonstrate community benefit activities that promote health.  A brief released by Health Resources in Action describes an innovative approach--the SIP-LINE process--that engages hospital leadership and key experts to align the vision of community benefit with the larger institution and community needs. The SIP-LINE approach offers the opportunity for participants to examine the breadth and depth of community needs and available resources, identify common ground with the hospital system, and select approaches that will deliver results.

Telemedicine Use in Rural Areas is Growing but Varies Among States

By Ateev Mehotra, et al. | Health Affairs | May 2017

Telemedicine use is increasing and many state legislatures are considering ways to increase access to the service. A new report analyzing Medicare fee-for-service claims for telemedicine use on mental health care found that the number of telemental health visits grew an average of 45 percent annually, according to a study in Health Affairs.  Researchers found that there was wide variation across states and those states with a telemedicine parity law and a pro-telemental health regulatory environment had higher rates of telemental health use that those that did not.  

Prescription Drug Prices Rose More than 8 Percent Last Year

Truveris NDI | May 10, 2017

Prescription drug prices rose by 8.8 percent last year, marking the fourth consecutive year of overall price hikes. This amounts to an annual average price increase of almost 10 percent during the past three years, according to data from Truveris NDI. Brand name drugs increased 12.9 percent and generics increased only 0.3 percent.  

Commentary/News

Free-standing Emergency Departments Offer Costly Convenience

By Carolyn Johnson | The Washington Post | May 7, 2017

Free-standing EDs are facilities where people can receive acute care any time of day.  Thirty-two states have more than 400 free-standing EDs, but many are prompting complaints due to the hospital-size bills, according to the Washington Post. Without a hospital affiliation, they cannot bill Medicare or Medicaid, instead seeking to attract patients with more lucrative private insurance.  

Attorneys General Investigating Lilly on Insulin Product Pricing

By Alex Kacik | Modern Healthcare | May 1, 2017

The state Attorneys General of Washington and New Mexico are investigating Eli Lilly over the pricing of its insulin products, according to Modern Healthcare. In January, a class-action lawsuit was filed that accused Lilly, along with Sanofi and Novo Nordisk, of conspiring to drive up the cost of insulin.