A new report from the University of Alabama’s Education Policy Center found that physical access to healthcare is a luxury that Black Belt communities don’t enjoy, reports the Alabama Political Reporter. The Education Policy Center defines the Black Belt of Alabama as comprising of 24 counties. Of those, 17 have fewer than the statewide average of 3.9 hospital beds per 1,000 people, according to the report. Indeed, four of the Black Belt counties have no hospitals, with some hospitals over an hour away. Even before the COVID-19 pandemic, access to healthcare for rural residents was tenuous. Researchers note that hospitals in states that chose to expand Medicaid were 84 percent less likely to close, because the increased coverage for poorer rural residents encouraged care access and boosted revenue for hospitals that care for high numbers of uninsured residents.
Arkansas Health & Wellness and Arkansas Total Care will be deploying FirstNet to rural healthcare providers and federally qualified health centers (FQHCs) in Arkansas to expand access to telehealth services, according to the companies' press release. FirstNet is a high-speed broadband communications platform built for America's first responders and the extended public safety community. This program will help rural providers and FQHCs integrate virtual care into their workflows and will better enable providers to serve patients in rural areas.
Arizona’s Medicaid agency announced that it will no longer pursue a planned Whole Person Care Initiative to address social determinants of health in its December 2020 1115 waiver renewal request, according to State of Reform. Due to the COVID-19 public health emergency and budget limitations, the agency will instead focus on a series of smaller-scale, cost-effective initiatives within the parameters of the existing Medicaid program. One initiative is a partnership with Health Current, Arizona’s Health Information Exchange, to source a new "closed-loop referral system” that providers can use to identify social risk factors and manage referrals to community-based agencies to address health-related social needs. In the future, the agency plans to continue to seek opportunities to address social risk factors and explore new strategies to expand initiatives outside of 1115 waiver authority.
California’s governor signed legislation meant to bring down the cost of prescription drugs for taxpayers, employers and consumers, according to a press release from the governor’s office. The first-in-the-nation law tasks the California Health and Human Services Agency (CHHS) with developing manufacturing partnerships to produce or distribute generic prescription drugs, thereby increasing competition in markets that have driven up prices for consumers and helping address critical drug shortages. CHHS will focus on manufacturing drugs that could produce the biggest cost savings and will submit a report to the legislature analyzing how its efforts have impacted competition, access and costs for those drugs.
California will join 28 states that allow nurse practitioners to practice independently, in an effort to address workforce shortages creating barriers to care, according to the Sacramento Bee. The new law will allow nurse practitioners to open their own practices after a three-year period of operating under a doctor’s supervision, beginning in 2023. The state’s Board of Registered Nursing will establish a commission to oversee implementation and practice requirements, including nurse practitioners’ obligation to notify patients that they are not physicians.
A new report commissioned by the California Future Health Workforce Commission assesses financial support offered to Californians training to become non-physician providers and the data collected on these efforts to help overcome barriers to meeting workforce needs across the state. Recommendations include expanding state-level opportunities for financing educational debt for primary care non-physician providers and making primary care more appealing to offset trends toward specialization.
Citing challenges to addiction treatment access in Colorado, a new state program has transformed six RVs into mobile clinics to reach isolated communities, reports Kaiser Health News. As brick-and-mortar addiction clinics have closed or stopped taking new patients due to COVID-19, these mobile clinics have become more crucial to rural residents seeking addiction care. Each RV has a nurse, a counselor and a peer specialist who has personal experience with addiction. And because broadband access is often limited in rural areas, these RVs provide a telehealth bridge to medical providers in cities, so that rural residents can be prescribed medicine to fight addiction and overdose.
Fees levied on insurers and patients for health services provided in hospital-owned facilities in Connecticut totaled $437.2 million last year, reaching their highest level since the state began tracking the charges in 2015, according to the Harford Business Journal. The increased revenue generated from the fees was partially driven by an 11.4 percent increase in the number of patient visits subject to a facility fee, with digestive-system and cardiovascular procedures generating more fee revenue than other service categories across the state. The average facility fee was $147 for visits billed to Medicaid, $213 for visits billed to Medicare and $426 for visits billed to commercial insurers. It is not clear what portion of the facility fees commercially insured patients ended up paying, compared to their insurer.
Georgia’s new Medicaid Section 1115 demonstration program, “Pathways to Coverage,” has been approved, the Centers for Medicare & Medicaid Services (CMS) announced. This program will allow working-age Georgia residents (ages 19-64) who are otherwise ineligible for Medicaid to opt into Medicaid coverage by participating in qualifying activities, such as working 80 hours a month. The program applies to individuals with incomes less than or equal to 100% of the federal poverty level (FPL). The state expects over 30,000 Georgia residents will receive Medicaid coverage during the first year of this demonstration program.
Of the ten counties nationally with the highest death rates from COVID-19, five are in Georgia, reports Georgia Health News. Hancock County is first on the list, with a COVID-19 death rate of 45.7 per 10,000 residents and a population where 3 in 4 residents are people of color. These counties are located in rural areas and have high levels of poverty and chronic disease, high uninsured rates, more older residents and large proportions of racial and ethnic minority groups. They also have a long history of systemic racism, which has served as a pre-existing condition for high COVID-19 death rates. Morehouse School of Medicine, an Atlanta school, is using a $40 million federal grant to implement an initiative to fight COVID-19 in minority rural communities.
Starting in December 2020, low-income immigrants age 65 and older in Illinois will be eligible for Medicaid-like coverage, regardless of immigration status, reports the Chicago Tribune. Initially, between 400 and 2,000 people are expected to sign up for the program, which was part of the state budget passed earlier this year. An unpublished study by Rush University Medical Center shows the 75 to 85 age group without legal immigration status should increase elevenfold in the next 10 years. Currently, undocumented older adults are being served by a patchwork of organizations that are having to make exceptions to find solutions to help patients that would otherwise go without needed services. Advocates hope this program will provide preventive care benefits and provide a safety net that is currently inaccessible to this population.
An analysis of employer claims data by RAND found significant variation in the prices private health plans pay for inpatient and outpatient services at Kansas hospitals, both compared to Medicare and across hospitals, reports KCUR. Prices at the University of Kansas Hospital and Overland Park Regional Medical Center were among the highest in the country, while prices at Lawrence Memorial Hospital were lower than those observed across the state and nationally. Additionally, private health plans paid more than twice the Medicare rate for hospital care in 2018. Unwarranted variation in healthcare prices, combined with a lack of transparency, makes it difficult for employers to make educated decisions when shopping for health plans to cover their employees.
With no protections in place, Kansans remain among the most vulnerable in the country to surprise medical bills, reports KCUR. Studies cited in an issue brief by the Kansas Health Institute found that Kansas had the second highest rate of out-of-network charges for inpatient hospital care in 2016. Ultimately, one in four Kansas patients received out-of-network services through an in-network hospital. Another study analyzing claims from 40 states found that Kansas ranked fifth for out-of-network charges billed to emergency room patients. Despite ample evidence, the state has yet to take action to address surprise medical bills. A 2020 proposal to establish partial protections failed in the legislature, in addition to a proposal to require doctors and hospitals to give patients better cost estimates prior to care.
Louisiana legislators passed several health-specific pieces of legislation during the latest special session, according to The Advocate. The legislature passed 71 bills in total, including: requiring the Department of Health to submit documentation to the CMS to receive financial relief for providers that provide care to people with developmental disabilities; directing the Louisiana Board of Pharmacy to study and make recommendations relative to pharmacists' ability to test, screen and treat certain health conditions; and authorizing a study of the decline in health insurance coverage among children in the state.
The transition from hospital fee-for-service to a population-based revenue system in Maryland is proceeding successfully, according to a Health Affairs Blog. The state’s Medicare savings performance in 2019 was the best since hospital global budgets were implemented in 2014. COVID-19 has provided an unforeseen stress test, which the state responded to with swift collaboration and communication with the Centers for Medicare and Medicaid Innovation, hospitals and other stakeholders, to ensure they could fulfill the promise of guaranteed level of revenue without dramatically increasing prices for payers, employers and consumers. COVID-19 has shown the weaknesses of the fee-for-service payment model, while Maryland’s Total Cost of Care model has allowed hospitals to fare relatively well during the pandemic.
Since August, the rates of COVID cases and deaths per million people for Black residents were the same or lower than those for white residents, according to data provided by Michigan’s health department, Modern Healthcare reports. The racial disparity of coronavirus' impact was prevalent in the early days of the pandemic, with Black residents representing 29.4 percent of cases and 40.7 percent of deaths, despite making up just 15 percent of Michigan's population. State officials credit the work of the Coronavirus Task Force on Racial Disparities for implementing programs like the Rapid Response Grant program, which awarded 31 grants from federal CARES Act funding worth $20 million to help provide underserved communities with food and housing assistance and access to COVID-19 and flu testing.
Residents in North Carolina face serious hurdles to accessing dental care, reports the Carolina Public Press. In 2019, residents in 98 of the state’s 100 counties lived in a region designated by the federal government as a Dental Health Professional Shortage Area. Even if residents can find a provider, cost may still be a barrier. Many low-income residents may not have dental insurance and those who qualify for “medically necessary” dental care through Medicaid may have difficulty finding providers who take Medicaid.
The State Treasurer of North Carolina, who manages the state employees’ health plan, has spent years trying to persuade hospitals to accept lower payments, but has struggled to discover the existing rates the plan pays each hospital and enact policies, reports Kaiser Health News. In North Carolina, hospital inpatient prices for private insurers, which typically drive health premiums, rose by 10 percent from 2014 to 2018. In an effort to help the state control healthcare costs, the Treasurer proposed to base prices on a percentage of Medicare rates, a form of reference pricing, giving hospitals 175 percent of what Medicare reimbursed for inpatient services and 225 percent for outpatient services—a move that would resulted in payment cuts to most hospitals. In response, the North Carolina Healthcare Association warned customers that if no agreement could be reached with the state plan, the hospitals would be considered out-of-network providers. In many states, hospital associations are political powerhouses, with lobbyists and influence from being the largest employer in many legislative districts.
The Ohio Department of Medicaid seeks to update its managed care setup with a focus on population health, meeting the needs of children with complex needs and reducing administrative hurdles for patients and healthcare providers, according to Health Policy Institute of Ohio. The state has invited privately operated managed care organizations to submit applications. These changes are the result of comments provided by beneficiaries, physicians, hospitals and other healthcare providers. Many highlighted concerns with the current system that forced families with children in need of intensive and costly services to relinquish custody for their children to be eligible for Medicaid. Under the plan, Ohio Rise, some youth would qualify for modified eligibility requirements, allowing them to receive assistance while remaining in their family’s custody.
The Governor of Pennsylvania signed an executive order to set up new councils in an effort to control healthcare costs, improve access to medical care and address treatment disparities, reports the Pittsburg Post-Gazette. The Governor also plans to create five Regional Accountable Health Councils to develop ways to reduce disparities in the healthcare system and promote the purchase of healthcare services based on the highest value to the consumer. The Governor will also work with the state legislature to create a Health Value Commission, charged with keeping healthcare payers and providers accountable for spending growth and ensuring the long-term affordability and sustainability of the healthcare system by setting spending benchmarks.
The Latino Impact Plan examines inequities and barriers within the Rhode Island Latinx community across three issue areas: economic equity, health and education, with an additional emphasis on the impact of the pandemic, according to a press release from the Latino Policy Institute. The plan surfaces healthcare access and insurance coverage disparities and highlights how holistic care serves a critical role in communities. The report made several recommendations to address inequities, including healthcare coverage for all children and inclusive statewide communications and engagement.
Fewer infants died in South Carolina last year, but data published by the state’s Department of Health and Environmental Control shows that all improvement was observed exclusively among white babies, reports the Post and Courier. This data highlights the widening and significant racial gap between white and Black infant deaths. In 2019, Black infants born in South Carolina were nearly three times as likely as white babies to die before their first birthday. Infant mortality has long been considered an important metric in evaluating broader public health. A variety of factors contribute to these statistics, including a mother’s preexisting conditions, access to prenatal care and more.
UVA Health continues to rely on thousands of property liens to collect old bills, in contrast to VCU Health, another huge, state-owned medical system that pledged to remove all property liens, according to Kaiser Health News. Property liens are the hidden icebergs of patient medical debt, legal experts say, lying unseen, often for decades, before they surface to claim hard-won family savings or inheritance proceeds. Earlier this year, UVA Health temporarily suspended patient lawsuits and wage garnishments, increased discounts for the uninsured and broadened financial assistance after a 2019 Kaiser Health News examination found that the health system had sued patients 36,000 times over six years for more than $100 million–an amount far higher than what insurers would have paid.
The Washington State Health Care Authority, governor’s office, state medical association and insurance companies signed a memorandum of understanding committing to improve primary care and develop a new payment model in Washington state, according to a press release. The goals of the initiative are to: increase primary care expenditures while decreasing total health spending; align payment and incentives across payers; align quality metrics across both payers and providers; promote and incentivize integrated, whole-person and team-based primary care, physical and behavioral healthcare and preventive services; improve provider capacity and access; and work with interested public and private employers to spread and scale the model throughout the state.
Wyoming’s governor has created a task force to come up with legislative policy solutions to tackle the state’s high healthcare costs, according to the Star Tribune. The group is made up of a diverse and broad set of healthcare, state and legislative officials and has established four priorities: evaluate current healthcare services in Wyoming; determining the service priorities that are needed for the state and assessing accessibility of service priorities within specific geographic areas; determining what factors are driving high healthcare costs; and formulating solutions to provide equitable, affordable access to high-risk populations. A variety of policy solutions are on the table—including an examination of what a single-payer system would look like in Wyoming.
CORHIO and Health Current, the state health information exchanges (HIEs) for Colorado and Arizona, respectively, will partner to form a new data exchange to serve providers and patients in their region, reports Healthcare IT News. Together, the two HIEs manage data for around 1,320 healthcare organizations in the two states and hope to build a more effective model for community-driven and broadly deployed healthcare interoperability. This partnership is part of a larger trend, with the federal Office of the National Coordinator for Health IT showing support for state and regional health information exchanges and recognizing them as key conveners and coordinators during the COVID-19 pandemic.
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