Healthy Alaskans released a 2020 scorecard analyzing the state’s performance when it comes to improving residents’ health, according to State of Reform. The scorecard shows that Alaska met its target or improved on 12 of its 25 health goals, including reducing its cancer mortality rate, increasing the percent of adolescents who haven’t used tobacco in the past 30 days and reducing the rate of “unique substantiated child maltreatment.” The state made little progress on other measures, like suicide mortality rates, mental health indicators and obesity rates. At the same time, the state released an updated health improvement plan, Healthy Alaskans 2030, which establishes health priorities and objectives for the decade to come.
Health Current, Arizona’s statewide health information exchange, announced the implementation of a new “closed loop” referral platform to help users gain a greater understanding of social determinants of health (SDOH) and enhance data exchange, according to EHR Intelligence. The system aims to streamline the SDOH screening and referral process by better connecting healthcare and community service providers, increasing access to social services and verifying that recommended social services were received. The effort closely aligns with the Arizona Medicaid program’s Whole Person Care Initiative, which focuses on SDOH such as housing, employment, criminal justice, transportation and home and community-based services interventions.
The California Health Care Foundation released its 2021 Health Policy Survey detailing California residents’ experiences with the healthcare system in the past year and the health policy agenda they believe state policymakers should support. Top priorities included making sure state and county public health departments have the resources they need to control the spread of COVID-19 and making sure there are enough healthcare providers across the state. Fifty one percent of respondents said they delayed, skipped or cut back on care because of cost in the last 12 months. Of those individuals, 41 percent said that rationing their care worsened their health condition. Additionally, nearly half of Californians said that it is harder for Black and Latino people to get the care they need compared to white people. Of those who believe it is harder, at least three in four think the federal government, health insurance plans, state government and individual healthcare providers are doing too little to address racial and ethnic inequality in the healthcare system.
Colorado is now soliciting vendors to implement the state’s Canadian Drug Importation Program, reports CBS Denver, and anticipates awarding vendor contracts later this year. The program is designed to give Coloradans access to Canada’s lower-prices drugs and was made possible through a change in federal policy enacted in November 2020, which allows FDA-authorized programs to import certain prescription drugs from Canada. A recent report from the Colorado Department of Health Care Policy & Financing posits that the average savings on importable drugs could be more than 60 percent, but savings for some drugs was greater than 90 percent.
Colorado launched pop-up vaccination sites in underserved areas in an attempt to eliminate the racial and economic disparities in COVID vaccine distribution, reports the Colorado Sun. The goal of the program is to reach underserved communities where they are and reduce barriers to vaccination, such as online vaccination appointment portals and inoculation sites that are far away. So far, Colorado has operated 18 of these health equity clinics, administering thousands of doses to Black and Hispanic Coloradoans who have much lower vaccination rates than their white counterparts. The Governor also says the state needs to build vaccine trust among these communities by developing ambassadors and leading by example.
Connecticut’s governor unveiled two proposals aimed at reducing the cost of healthcare, including an annual tax on insurance carriers to fund additional insurance subsidies and a plan to limit yearly increases in prescription drug costs, reports The CT Mirror. The fee on insurers would generate approximately $50 million annually to subsidize the cost of insurance for people purchasing coverage through the state’s exchange, but could also be used for other causes, including raising the Medicaid eligibility level or a reinsurance program. The Governor also proposed to limit yearly hikes in prescription drug prices to the rate of inflation plus 2 percent. Drug manufacturers exceeding that amount would be fined and revenue from the penalties would be used to subsidize health coverage.
The D.C. Council created the Council Office of Racial Equity (CORE), which will assess proposed legislation for its impact on racial equity, reports DCist. CORE will primarily use Racial Equity Impact Statements to evaluate how a piece of legislation could hurt or benefit groups of people who have traditionally been underserved and discriminated against and provide a list of possible effects or racial and social inequities..
Mayor Bowser declared gun violence to be a public health emergency in the city and announced a new “whole-government” approach to address it, reports The Washington Post. The District of Columbia has seen an increase in gun-related homicides, which disproportionately affects Black men—one of the many health inequities that Black people in D.C. experience. The city is establishing a “gun violence prevention emergency operations center” that will be staffed with people from education, job training, mental health counseling and housing fields. The Center aims to address root causes of gun violence, such as poverty, lack of education, and poor physical and mental healthcare, among other upstream factors of health.
Both primary healthcare need and demand in D.C. increased from 2015 to 2018, with Black and Latino populations experiencing greater need and demand than white and Asian populations, according to a report from the D.C. Policy Center. Healthcare need is measured as the number of annual primary care visits an individual is predicted to have based on their age, sex, and health status, and healthcare demand is the predicted number of annual primary care visits while accounting for barriers, such as cost, education and language. The report notes that there are higher shares of elderly residents among Black Washingtonians and higher shares of children among Latino Washingtonians—age groups that typically need more primary care visits. However, the report also finds that there is a larger gap between healthcare need and demand. Barriers to healthcare—including language, cost and education—are likely to be higher for Black and Latino populations. The authors suggest that the greater amount of primary healthcare need among Black and Latino populations could be a factor causing the inequitable COVID-19 outcomes that these groups are experiencing.
AARP has partnered with Illinois racial justice groups to launch a “disrupt disparities” effort across the state, reports State of Reform. The multi-year effort will address the disproportionate number of older Black, Latino and Asian American seniors who have died of COVID-19 in Illinois and will work with state legislators to address this and other issues. Another crucial equity issue facing Illinoisans is access to broadband internet. According to AARP, more than a third of Black and Latino seniors in the state do not have internet access at home, leaving this vulnerable group more disconnected. Economic security is another issue AARP hopes to address, explaining that helping seniors pay off their debts will allow seniors of color to be more economically secure.
Maine’s largest healthcare system, MaineHealth, received a $12.8 million dollar grant from the National Institutes of Health to study ways to reduce disparities in quality of care between rural and urban areas, reports the Portland Press Herald. The grant will be used to fund several studies, including research on the use of telehealth and rural health outcomes, that aim to reduce rural health disparities in acute care settings. The funds will be used to develop a statewide network to address barriers in rural health, such as limited resources, access and expertise.
The Maryland House of Delegates has overridden the Governor’s 2020 veto of a Prescription Drug Affordability Board, enabling plans for the Board to proceed, reports STAT+. In January, the Senate also overrode the veto, which the Governor had issued over concerns that the move would raise taxes and fees at a time when the COVID-19 pandemic had already hurt citizens. The Board is designed to function like rate-setting boards that regulate what public utilities can charge residents, with supporters arguing that the board can save consumers money by lowering prescription drug costs. What sets the PDAB apart from other state efforts to rein in costs is that it can, if determined to be in the best interest of the state, make a recommendation to the Maryland General Assembly to pursue upper payment limits to make drugs affordable. If the Board makes this determination, it will first develop a plan of action for review and approval by the Legislative Policy Committee. Maine has also enacted a law creating a board. Although rather than setting upper payment limits for medicines, the board established a spending target for public payers and seeks to leverage public purchasing power to meet its target.
The Michigan Coronavirus Racial Disparities Task Force reduced COVID-19-related cases and mortality among Black residents and may serve as a model for other states, according to a case study from the National Governors Association. The authors identified some of the task force’s best practices, including: establishing clear objectives with specific metrics; ensuring cross-sectoral collaboration and diversity within the task force; and enabling leadership and state leaders who are committed to work and provide the right mix of expertise to minimize staff fatigue and stress. Michigan’s Task Force and Governor also contributed to reductions in health inequities by: distributing six million free masks; declaring racism a public health crisis; requiring implicit bias training for all state employees; and improving the quality of data reporting on racial disparities.
Medicaid plays an essential role in reducing health disparities and Minnesota has been a leader in longstanding public reporting of health disparities for the state and Medicaid program, including social risk factors, according to a report from AcademyHealth and the Disability Policy Consortium. The report, created in response to the disproportionate impact of COVID-19 on Black, Latino, Native American, Asian and other people of color, people with disabilities, and people living in poverty, explains how state Medicaid programs can respond to health disparities. Minnesota has continued to develop reporting measures on health disparities, particularly within the Medicaid population, to inform their Medicaid value-based payment model for the Integrated Health Partnership Initiative, which is required to propose a health equity measure tied to interventions intended to reduce health disparities. The report provides more information to support state Medicaid programs measure and address health disparities, emphasizes the importance of an intersectional approach to disparity measurement, and urges state Medicaid programs to invest in data and analysis to measure health disparities.
The Governor of New Jersey signed an Executive Order directing the Office of Health Care Affordability and Transparency to convene an Interagency Health Care Affordability Workgroup to identify opportunities within the administration and across the public and private sectors to advance healthcare affordability, accessibility and transparency. The Executive Order also directs the Department of Banking and Insurance to develop plans to implement both healthcare cost growth benchmarks and affordability standards to ensure increased oversight and accountability. Additionally, the Order establishes the Health Care Affordability Advisory Board, comprised of healthcare industry stakeholders, consumer advocates, and policy leaders, to guide the development and implementation of the cost growth benchmarks.
As part of the Nurture NJ Maternal and Infant Health Strategic Plan, New Jersey’s Medicaid program is adopting several new initiatives to improve maternal and infant health within the state, the Governor’s office reports. New Jersey’s Medicaid program will expand coverage to include doula care; will no longer pay for non-medical early elective deliveries; and will require obstetrical providers, nurse midwives or other licensed healthcare professionals to complete a perinatal risk assessment form during a beneficiary’s first prenatal visit to help identify trends in risk factors. These initiatives also contribute to the Strategic Plan’s aims of combating the state’s maternal and infant health mortality crisis by reducing racial disparities in these areas.
In response to inequitable vaccine rollout in New Jersey, state officials have created a ‘vulnerable populations plan,’ which calls for partnerships with community centers and places of worship to create vaccine clinics focused on specific communities, reports NJ Spotlight News. These partnerships are expected to bring dedicated vaccines to racially diverse and vulnerable communities hardest hit by the pandemic. The partnerships will operate temporarily, with each seeking to vaccinate some 3,000 people over two weeks and then reopening several weeks later to provide second doses of the vaccine.
Medicaid expansion in 2014 in New York State was associated with a statistically significant reduction in severe maternal morbidity in low-income women during delivery hospitalizations compared with high-income women, according to a study in Anesthesia & Analgesia. Excess maternal morbidity and mortality is a grave public health concern in the U.S., particularly since there are extreme income and racial disparities. Researchers looked at more than two million delivery hospitalizations and note that the proportion of Medicaid births increased a relative 12.1 percent from the pre-expansion period.
Oregon’s healthcare workforce does not match the diversity of the state, according to the Oregon Health Authority’s (OHA) biennial Oregon Health Care Workforce Needs Assessment report, which shows that the Hispanic/Latino, African American/Black, and American Indian/Alaska Native providers are underrepresented in most licensed healthcare professions. OHA also released its evaluation of the Health Care Provider Incentive Program, which is designed to increase racial and ethnic diversity in the healthcare workforce.
The Oregon Health Authority has officially launched the Community Benefit Minimum Spending Floor program—a regulatory system intended to ensure that Oregon’s nonprofit hospitals don’t cut their spending on charity care, according to The Lund Report. Other states, especially those that expanded Medicaid, have taken similar steps to ensure that nonprofit hospital systems devote an adequate portion of their spending to community-benefit programs. The Oregon Health Authority’s definition of community benefit not only includes charity care to uninsured or indigent people, but also community health programs, employee education, certain kinds of research and the difference between what a hospital says it costs to care for a Medicaid-covered patient and the amount that the state pays as reimbursement.
Lehigh County could have saved roughly $1.4 million for prescription drugs in 2019, reports Stat+. The Office of the Controller’s report found that rebates negotiated by pharmacy benefit managers were frequently pocketed by the insurance company as profit, rather than credited to the county. In addition, the office identified 200 prescription drugs that were available at lower prices from competitors. The office recommended pursuing comparative prescription drug pricing for the 200 drugs and receiving the full value of prescription drug and medical claim rebates from the insurance company to save the county money.
Although the State Health Department directed providers months ago to report COVID-19 vaccine race and ethnicity data, 36 percent of race and 40.9 percent of ethnicity data are missing, according to the Pittsburgh Post-Gazette. Many providers, including Pennsylvania’s largest health system, are still not collecting and reporting this data. Based on available data, Black people make up 3 percent of the state’s population but only 0.4 percent of vaccine recipients, while Latino people make up 8 percent of the population but 3 percent of vaccine recipients. Incomplete race and ethnicity data make it difficult to comprehensively track and address disparities in vaccine distribution.
Half of Pennsylvania residents struggled with healthcare costs in the past year and nearly two thirds were worried about affording healthcare in the future, reports The Philadelphia Inquirer. In addition, Altarum Healthcare Value Hub’s 2020 Consumer Healthcare Experience State Survey (CHESS) found that to reduce healthcare costs, 20 percent of Pennsylvania adults skipped going to the doctor, a procedure or a recommended test and 22 percent skipped medication doses, cut pills in half or avoided filling a prescription. The COVID-19 pandemic has only exacerbated concerns about healthcare costs, with 60 percent of Pennsylvania residents worried about being able to afford COVID-19 treatment if they need it.
Rhode Island’s strategy to implement a cost growth benchmark, in tandem with engaging healthcare leaders and stakeholders, is a model for other states, according to a report from the Milbank Memorial Fund. Rhode Island implemented measures to work alongside the cost growth benchmark in order to address not only cost growth, but cost drivers, to control rising healthcare costs in the state. The state’s private-public partnership emphasizes the shared commitment to reducing healthcare costs and can be used as a model in other states exploring cost-containment strategies.
Rhode Island’s use of insurance rate review can serve as a model for other states looking to reduce healthcare costs, report NASHP. Rhode Island’s affordability standards prevent insurers’ negotiated rates with hospitals from increasing more than the rate of inflation, plus one percent. This has reduced quarterly enrollee spending by an average of $55 from 2010 to 2016 and lowered patient cost-sharing without impacting quality metrics or healthcare utilization. The affordability standards also included provisions to increase spending on primary care, promote a patient-centered medical home model, support the state’s health information exchange and work toward comprehensive payment reform in order for insurers’ premium rates to be approved. Rhode Island’s affordability standards can be used as a model for other states looking to constrain hospital costs.