State News Roundup - November 2020


Medicaid Expansion Would Save Alabama Mothers from Preventable Deaths
By Cover Alabama | Montgomery Advertiser | Nov. 19, 2020

In 2016, nearly 70 percent of Alabama’s pregnancy-related deaths were preventable, according to a report from the state's Department of Public Health and Maternal Mortality Review Committee. The committee recommended that Alabama improve maternal health by: expanding Medicaid coverage; increasing resources and services for women with mental health and substance use disorders; improving Medicaid reimbursement for providers; and encouraging broader education of mothers and families on maternal death risk factors. In this opinion piece in the Montgomery Advertiser, the author notes that Black women in the state die at three to four times the rate of white women from pregnancy-related complications, showing the importance of eliminating racial disparities in access to quality and affordable healthcare.


​​​​Arkansas' Crisis Stabilization Units Decreased Medical Utilization and Jail Involvement
By John Lyon | Arkansas Center for Health Improvement | Nov. 16, 2020

A significant portion of patients at a crisis stabilization unit (CSU) had decreased emergency department visits, inpatient or outpatient hospital stays or jail bookings in the six months following CSU intervention, according to a study from the Arkansas Center for Health Improvement. Using data from the state’s all-payer claims database, the study focused on one of the state’s four CSUs, an alternative to jails and emergency departments that provide mental health support for people in crisis who encounter law enforcement. There was an overall decrease in the number of patients who experienced a medical stay or jail involvement post-CSU, and those who did, experienced them less often than pre-CSU intervention. Total and per-member per-month costs for Medicaid increased in the post-CSU period, while costs for patients with commercial coverage decreased, possibly due to changes in utilization of costly medical services. The study also found that patients experienced a 27.5 percent decrease in total jail days in the post-CSU period.


 ​​​​How California Could Encourage Adoption of Alternative Payment Models
By Justin Yoo | California Health Care Foundation | Oct. 14, 2020

The California Health Care Foundation released an issue brief exploring California’s experimentation with alternative payment models (APMs) to address rising healthcare costs and improve quality of care, according to the State Health Access Data Assistance Center. The report outlines actions the state should consider to promote the adoption of APMs, including: requiring a certain percentage of spending in Medicaid and public employee benefit programs to flow through APMs; establishing measures to track progress toward APM adoption goals; assessing current APM adoption across all of the state’s healthcare markets; and collaborating with the Centers for Medicare & Medicaid Services to sponsor a specific APM.

Savvy Patient Fought for the Price She Was Quoted - and Didn't Give Up
By Anna Almendrala | Kaiser Health News | Oct. 27, 2020

A real estate agent and mother of two enlisted the help of the media to share her story when she received an unexpected medical bill that she was unwilling to pay, reports Kaiser Health News. She was charged twice for an outpatient procedure by a facility that offered her a discount on coinsurance that it was not authorized to provide, and her bill was sent to a collection agency. An investigation, prompted by a reporter’s call, verified the patient’s version of events, including a breakdown in the facility’s customer complaint process that should have prevented the bill from going to collections. While the issue was unintentional, it could have had serious financial consequences for a patient that lacked the time, resources or will to fight.


Rising Insulin Costs Force 40 Percent of Colorado Diabetics to Ration its Use
By Michael Booth | Colorado Sun | Nov. 17, 2020

More than 40 percent of surveyed Coloradans with diabetes said that high insulin costs forced them to ration their own use of the lifesaving drug at least once a year, reports the Colorado Sun. According to a new report from the state’s Attorney General, insulin costs for Colorado patients rose 262 percent in the past 10 years, which could be the result of a lack of competition among drug makers and distributors. These ‘lockstep’ price increases that have drawn lawsuits over alleged collusion. The report was ordered as part of a 2019 bill that caps copays for insulin at $100 a month and zeroes in on the fact that the insulin market is dominated by just three manufacturers and three pharmacy benefit managers. The report recommends steps that the state or federal government can make quickly to ease consumer burdens.

As HIV Infection Rates Rise in Colorado, Pharmacists Can Now Prescribe Preventive Medication
By Jennifer Brown | Colorado Sun | Nov. 18, 2020

Colorado has become one of the first states in the U.S. to allow pharmacists to prescribe HIV prevention drugs, as part of a public health effort to curb rising infection rates, reports the Colorado Sun. Pharmacies can now offer the daily preventive pill or an emergency version that can be taken within 72 hours of an exposure to the virus. While rural communities may have just two or three primary care doctors, they typically have about a dozen pharmacies, making this law a true expansion of access to the medication. This new HIV protocol also allows pharmacists to collect reimbursement from insurance companies for providing consultation to patients.


Federal Government Approves Georgia's State Relief and Empowerment Waiver
By The Centers for Medicare & Medicaid Services | Nov. 1, 2020

Georgia’s Section 1332 State Relief and Empowerment waiver has been approved, announced the Centers for Medicare & Medicaid Services (CMS). Beginning in plan year 2022, Georgia will implement a reinsurance program that is expected to reduce annual premiums for individuals by an average of 10 percent by covering some insurance costs once claims reach a certain amount. Beginning in plan year 2023, Georgia will transition the individual insurance market from a federally facilitated exchange to a private sector platform called the Georgia Access Model. The Georgia Access Model will serve as a one-stop shop that enables consumers to compare and enroll in plans offered by health insurance companies, web brokers and traditional agents and brokers. The state anticipates that the reinsurance program and the Georgia Access Model will increase health insurance affordability and enrollment.


Illinois Blues Putting $100 Million Behind Health Equity Effort
By Stephanie Goldberg | Modern Healthcare | Oct. 28, 2020

Blue Cross & Blue Shield of Illinois is piloting new programs to improve health outcomes for minorities and increase racial and ethnic diversity among medical professionals, reports Modern Healthcare. The COVID-19 pandemic has laid bare the inequities faced by people of color, which has led to the development of the Health Equity Hospital Quality Incentive Program. The program’s goal is to work closely with hospitals serving a large number of Blue Cross members in communities with people most at risk of contracting COVID-19 and, ultimately, reduce racial and ethnic disparities in care. The value-based, three-year pilot program will pay doctors more for achieving certain metrics, such as meeting maternal healthcare requirements and equitably implementing telehealth. So far, at least 10 hospitals and health systems have been invited to join. 

'Very Dire Situation' as Black Women in Illinois 6 Times More At-Risk for Death During Pregnancy and Hospitals Closing
By Alison Bowen | Chicago Tribune | Nov. 10, 2020

Illinois health officials are worried about increasing disparities in maternal health and mortality, with higher maternal deaths than the national average coupled with recent hospital closures, reports the Chicago Tribune. Black women across America are significantly more likely to die from pregnancy-related conditions, as well as deliver infants pre-term and lack access to prenatal care—25 percent of Black women in Chicago do not get adequate prenatal care, compared with 11 percent of white women. State health officials reviewing cases of pregnancy-related deaths have deemed about 72 percent of cases preventable. The Illinois Senate’s Public Health and Health and Human Services committees are looking into ways to shrink the maternal health disparities gap; at a recent hearing, advocates brought up opportunities to tackle these health disparities, including more implicit bias training and diversity in healthcare workers, covering doula services under Medicaid and expanding home visits and creating a birth center.

COVID-19 is Driving Telehealth's Growth. What Happens After the Pandemic?
By Vivian McCall | WBEZ | Nov. 17, 2020

Telehealth has grown rapidly in Illinois this year, in part thanks to an executive order by the state’s governor requiring insurance companies regulated by the state to cover telehealth appointments like in-person office visits, reports WBEZ. The state also expanded telehealth coverage for Medicaid and Medicare patients, and the federal government has loosened restrictions as well. However, if the pandemic ends (along with it, the governor’s order) with no legislative action, Illinois would revert to prior rules and healthcare providers would not be reimbursed for the same services at the same rates. Though experts are still unsure about the long-term impact on costs, telehealth has helped increase access without increasing patient costs for rural residents. Similarly, there is concern about lack of internet access among Black, Latinx and senior patients, which may cause them to miss out on telehealth access.


Federal Government Extends Indiana's Medicaid Expansion Alternative for 10 Years
By Shari Rudavsky | Indianapolis Star | Oct. 27, 2020

Indiana became the first state to receive a 10-year extension from the federal government for its alternative to traditional Medicaid expansion, the Healthy Indiana Plan, reports the Indianapolis Star. The plan provides benefits while at the same time requires beneficiaries to contribute in order to participate. Typically, states only receive a 2- or 3-year extension of their Medicaid expansion alternative health plan. The Healthy Indiana Plan currently insures more than 572,000 low-income Indiana residents, which is 100,000 more people than this time last year. The 10-year extension provides funding security for the next decade, while maintaining flexibility for Indiana to request federal approval to make improvements to the program down the line.


Distance to Care Contributes to Louisiana's High Maternal Mortality Rate
By Emily Woodruff | | Oct. 20, 2020

The lack of maternal care in many areas of Louisiana—forcing women to travel long distances for routine checkups, emergency visits and deliveries—likely contributes to one of the nation’s highest maternal mortality rates, reports The research from March of Dimes found that 35 out of 64 parishes have little to no access to maternal care, including Evangeline Parish, where there is just one OB/GYN for a population of more than 33,000 people. Due to scarcity of care, researchers estimate that one in four pregnant women in Louisiana may need to travel outside of their parish for the many services necessary to monitor a pregnancy: ultrasounds, blood tests, glucose screenings, specialist appointments and delivery. Traveling is not always possible for women who have transportation or time constraints. Women in these "maternity care deserts" had a threefold higher risk for death directly related to the pregnancy, such as severe bleeding or preeclampsia, a dangerous complication involving high blood pressure.


​​​​​​Telehealth Use in Maine Increases, but Remains Relatively Low
By Yconne C. Jonk et al. | Journal of Rural Health | Oct. 21, 2020

Telehealth improved access to behavioral health and speech language pathology services in Maine, through usage still remained low, according to a study in the Journal of Rural Health. Telehealth usage increased to 0.28 percent of Maine’s population in 2016, up from 0.02 percent in 2008, based on data from Maine’s all-payers claims database. Telehealth usage varied by area: speech language pathology was the most common type of service among rural residents, while psychiatric services were most common among urban residents. Medicaid was the primary payer for more than 70 percent of telehealth claims in both rural and urban areas of the state, driving the increase of telehealth claims over time. The study identified provider shortages, broadband, and Medicare and commercial coverage policies as barriers to telehealth access and implementation in rural areas.


​​​​​​Patients Want Healthcare Price Transparency, But Few Seek it Out 
By Jacqueline LaPointe | RevCycleIntelligence | Nov. 6, 2020

Most consumers living in Massachusetts, a state with some of the most comprehensive healthcare price transparency laws, have never thought to seek out pricing information, reports RevCycleIntelligence. About 54 percent of the 500 adults in Massachusetts surveyed by the Pioneer Institute said they never thought about trying to obtain price information about healthcare services. Additionally, the survey found that only one in five consumers had ever tried to find pricing information prior to obtaining a healthcare service. The survey also shows that 70 percent of adults who obtained insurance through employers or on the open market in June 2019 did not know that their health insurance carriers had a cost estimator tool. Not only is awareness a major barrier to healthcare price transparency, but consumers may be leaving money on the table.

Massachusetts Attorney General Calls for Equity in Healthcare
By Grady Culhane | | Nov. 17, 2020

Massachusetts’ Attorney General hosted a discussion summarizing a new report with recommendations on racial justice and equity in healthcare, reports The report highlights longstanding disparities, as well as the disproportionate effect that COVID-19 has had on Black, Hispanic and Latinx communities. The report calls for action in five domains: data to identify and address health disparities; equitable distribution of healthcare resources; telehealth as a tool for expanding equitable access to care; healthcare workforce diversity; and social determinants of health and root causes of health inequities.  

Small Doctor Practices Struggle with Telehealth
By Alex Kacik | Modern Healthcare | Nov. 18, 2020

Many Massachusetts physician groups are struggling to leverage telehealth as they continue to deal with lagging patient volumes, reports Modern Healthcare. Overall, there were more struggling small physician practices in Massachusetts than successful ones as of September and October, according to data released by the Massachusetts Health Policy Commission, as many providers found it difficult to use or clinically inadequate. Anecdotally, some providers are considering early retirement or joining larger practices.


How a Minneapolis Clinic is Narrowing Racial Gaps in Health
By Yuki Noguchi | NPR | Nov. 11, 2020

NorthPoint Health & Wellness Center has doubled the rates for childhood vaccinations and health screenings, resulting in prevention of disease and lower costs for treatment and care over its fifty-year history. The center is a community health and dental clinic and social services agency in Minneapolis that was founded to increase access to healthcare and social services in a community that is now 90 percent Black, Latinx or Asian, reports NPR. NorthPoint’s measures, including stocking a free-food shelf with healthy, culturally relevant food, has increased its reach in the diverse community—something many medical centers struggle with. NorthPoint is a community health clinic, not a hospital, so it does not face many of the commercial revenue pressures as many private hospitals and can focus on its mandate to improve public health through a lens of race in the community. This has allowed their community-oriented primary care approach to flourish and improve health outcomes and lower healthcare costs. 

New Course Highlights Importance of Cultural Competency in Medical Careers
By Abbey Machtig | Minnesota Daily | Nov. 11, 2020

A new course at the University of Minnesota is teaching undergraduate medical students cultural competency skills, reports the Minnesota Daily. The course focuses on teaching medical professionals about differences in cultural practices and how to communicate with patients who may have a history of medical mistreatment. Leaders in the program say they hope teaching these skills will lead to broader reform in the medical field. The instructor is seeking to make the class a regular offering.


Montana Audit Recommends Clarifying and Strengthening Hospitals' Community Benefit and Charity Care Requirements
By Allie Atkeson | NASHP | Nov. 30, 2020

A recent analysis of Montana’s 47 nonprofit hospitals’ community benefit spending—required in exchange for their tax-exempt status—found that the millions of dollars spent on community needs had no impact on residents’ health, reports NASHP. Montana’s Legislative Audit Division completed a report that calculated that the state’s nonprofit hospitals received more than $146 million in tax exemptions in 2016 and self-reported more than $257 million in community benefit spending—4 percent of which went to community health improvement, while 87 percent directly funded hospital services, raising concerns about efficiency. This finding is consistent with national research showing that only a small percentage of community benefit spending goes to community-based activities aimed at upstream drivers of health. The Division recommended the state enact laws defining reporting expectations for hospital community benefit spending and its impact on community health to ensure community benefit spending reflects state and community health goals.

North Carolina

North Carolina Health Department and Cherokee Indian Hospital Authority to Create First-in-Nation Indian Managed Care Authority
By North Carolina Department of Health and Human Services | Oct. 30, 2020

The North Carolina Department of Health and Human Services (NCDHHS) and the Cherokee Indian Hospital Authority (CIHA) have entered a contract to support the Eastern Band of Cherokee Indians (EBCI) address the health needs of American Indian/Alaska Native Medicaid beneficiaries through an Indian Managed Care entity, according to a press release by NCDHHS. This Indian Managed Care entity if the first of its kind in the nation and will establish a new delivery system, the EBCI Trial Option. The Option will manage the healthcare for North Carolina’s approximately 4,000 tribal Medicaid beneficiaries, with a strong focus on primary care, preventive health, chronic disease management and providing care management for high-need members.


​​​​​​Cancer and Rheumatoid Arthritis Drugs Continue to Be the Most Costly
By Oregon Division of Financial Regulation | Nov. 19, 2020

Cancer and rheumatoid arthritis brand-name drugs continue to be the most expensive for Oregon residents, according to new data from the Oregon Division of Financial Regulation. For the second year in a row, the brand-name drug Humira, commonly used to treat rheumatoid arthritis, was the costliest prescription drug reported by Oregon’s health insurance companies, as well as the most prescribed specialty drug. Glatiramer, used to treat multiple sclerosis, was the most expensive generic drug reported, costing insurance companies approximately $2,800 per prescription. To determine what insurers paid on average for each prescription and to identify the most expensive prescriptions, the program team examined claims data for drugs prescribed to 10 or more enrollees and compared the total dollars spent by insurers to the corresponding prescription counts for each drug.


Governor Announces Expanded Parity Protections
By Office of the Governor | Oct. 30, 2020

The Governor of Pennsylvania announced the passage of two laws meant to increase coverage for mental health services. These laws require health insurers to verify that they conducted analyses to ensure that their plans offer mental health and substance use disorder coverage that has similar cost sharing and in- and out-of-network coverage compared to physical health services. In addition, insurers must be able to make this documentation available to the state insurance department, policyholders and providers upon request. These laws will help strengthen and enforce mental health parity among insurance plans.

Rhode Island

Rhode Island Foundation Announces Plan to Eliminate Inequity Across the State
By Chris Barnett | Patch | Nov. 4, 2020

The Rhode Island Foundation is launching an $8.5 million plan over the next three years to both lead and strengthen diversity, equity, access and inclusion focused efforts in the community, with a primary focus on racial equity, reports Patch. The plan commits to improving health, economic and educational outcomes by focusing on system-wide reforms that stand to benefit those Rhode Islanders who have been left behind. The plan’s first step is to create the Rhode Island Foundation's Equity Leadership Initiative, which will identify and develop opportunities for BIPOC Rhode Islanders to help build a pipeline of future leaders in established positions of influence throughout the state.


Intermountain Healthcare and United Way of Salt Lake Partner to Address Social Determinants of Health
By Mallory Hackett | Healthcare Finance News | Nov. 19, 2020

Intermountain Healthcare, United Way of Salt Lake and several other healthcare stakeholders in Utah have collaborated to create scalable programs to address social determinants of health throughout Utah, reports Healthcare Finance News. The organizations will collaborate to improve the health and wellbeing of communities, improve coordination across health systems and reduce healthcare costs by addressing the upstream economic, education and social factors that impact people's health. This program builds on Intermountain Healthcare’s work to address social determinants of health in St. George and Ogden to create a state-wide network that addresses upstream factors of health.


Wisconsin DHS Continues Investment in Quality Healthcare for Rural Areas
By the Wisconsin Department of Health Services | Oct. 29, 2020

The Wisconsin Department of Health Services (DHS) has announced grants totaling more than $3.1 million to increase access to care and enhance quality in rural Wisconsin. According to a press release by DHS, the grants support education and training to assist rural hospitals and clinics in filling “high-need, high-demand” positions. The grants also seek to grow Wisconsin’s rural physician workforce by prioritizing individuals with Wisconsin ties for new resident positions.


​​​​​​​Hospitals Set Charges at Four Times Above Costs
By National Nurses United | November 2020

U.S. hospitals charge, on average, four times their total costs, a staggering markup that creates a significant burden for patients, according to a new study from National Nurses United. Nationwide, average hospital charge-to-cost ratios have more than doubled over 20 years. Additionally, of the 100 hospitals with the highest charges  relative to their costs, for-profit corporations own or operate 95 of them. For the 100 hospitals with the lowest charge-to-cost ratios, nearly two-thirds do not belong to systems.