A woman in Indian Trail, North Carolina, went to an in-network hospital for surgery five times in 2020, thinking she was covered for anesthesia services, reports WBTV 3. When she received a bill from Novant Health Presbyterian Medical Center several months later, however, it claimed that she owed Providence Anesthesiology Associates $15,744.58 and her insurance, UnitedHealthcare, only covered $782.42. The patient found a statement on UnitedHealthcare's online portal showing that inpatient hospital stays include services for anesthesiologists; however, on it's website, the Center indicates that UnitedHealthcare terminated their contract in March 2020. This means that when the patient went in for surgery, no one told her she was no longer covered for anesthesia services, even though she went through a pre-approval process for each surgery.
Minnesota adults face high levels of healthcare affordability burdens, reports AboutHealthTransparency.org. A survey of more than 1,070 Minnesota adults, conducted by Altarum's Healthcare Value Hub from Oct. 30, 2020 to Nov. 27, 2020, found that more than half (51%) experienced healthcare affordability burdens in the past year. In addition, even more are worried about affording healthcare in the future and high numbers are worried about becoming ill from the coronavirus. The survey also revealed regional differences in how Minnesota adults experience healthcare affordability burdens. Fifty-seven percent of residents in the Southern region face these burdens, the highest in the state, and 51% of Southern region adults reported skipping a recommended medical test or treatment due to cost. Forty-one percent of Twin Cities Metro area residents, by comparison, reported doing the same.
Tennessee is set to become the first state to implement a Medicaid block-grant program after the Centers for Medicare and Medicaid Services (CMS) approved the state's waiver last week, according to Healthcare Finance. The block grant, called an “aggregate cap,” will create a fixed spending target based on historical enrollment and Medicaid cost data that increases at a “reasonable growth rate” over time. It will also give the state the option to exclude certain pharmaceutical drugs from the formulary. Numerous advocacy organizations, payers and providers oppose Medicaid block grants because they fear that underserved populations will lose access to healthcare by putting a cap on federal funds.
A majority of Virginians are unaware of the State Corporation Commission's Bureau of Insurance and believe the bureau does not provide consumers with enough information about how to contest health insurance coverage decisions, according to a survey by Mason-Dixon polling. Additionally, 92 percent indicated that they want easy-to-access information about insurance industry profits, medical expenditures, administrative costs and other metrics, reports State of Reform. A recent Altarum analysis found that though healthcare expenditures in Virginia are below the national average, private personal insurance healthcare spending is up 42.7 percent since 2008.
A new report from the Colorado Department of Health Care Policy & Financing found that specialty drugs represented less than two percent of drugs prescribed to patients in Colorado but accounted for almost 50 percent of total prescription drug expenditures, reports State Network. Additionally, the report on reducing prescription drug costs found that rebates paid to middlemen such as PBMs and insurance carriers are often retained as profits. Proposed solutions include creating an affordability board to study prescription drug prices, passing along rebates and savings to employers and consumers and increasing transparency in prices, profits and rebates.
D.C. Health announced changes to its COVID-19 vaccination distribution plan to ensure equitable distribution throughout the district, reports WJLA. Additional vaccination appointments will be made available to residents in wards that have a high proportion of BIPOC members and have been disproportionately impacted by the coronavirus. The plan to ensure equitable distribution comes after data from D.C. Health revealed that very few residents in wards that have had the most deaths from COVID-19 have been able to get a vaccine appointment, while residents in areas with the least deaths have been able to obtain the most appointments.
The Texas Health and Human Services Commission (HHSC) received federal approval for a 10-year extension through September 2030 for its Texas Healthcare Transformation and Quality Improvement Section 1115 demonstration waiver, according to The Texas Tribune. The federal funding agreement reimburses hospitals for the uncompensated care they provide to patients without health insurance. It also pays for innovative healthcare projects that serve low-income earners in Texas, often for mental health services.
The Pennsylvania Interagency Health Reform Council (IHRC) released recommendations to reduce costs, decrease disparities and improve healthcare delivery, reports the Pennsylvania Pressroom. The IHRC’s recommendations include creating a health value commission to institute healthcare cost benchmarking, developing regional accountable health councils to address health equity, integrating social services into healthcare delivery, making data dashboards public to drive quality improvement and leveraging state purchasing power. The IHRC will support legislative action related to these recommendations, continue to facilitate inter-agency coordination and track progress on the recommendations.
Oregon health officials and lawmakers are seeking the legislature's approval on formal report describing a cost-growth-capping program that would hold insurers and large and medium-sized medical practices to annual per-patient cost growth caps, require formal justification if they exceed the cap, and potentially fine them if they exceed the cap, according to The Lund Report. Oregon would be the fifth state to adopt a cost growth target program. The Sustainable Health Care Cost Growth Target Implementation Committee hopes to address the root causes of healthcare cost growth, however, there is worry that some providers and insurers, anxious to come in under the cap, may try to cut the quality or volume of care.
The U.S. Department of Health and Human Services announced that a collaboration of federal agencies will supply $6.5 million in funding over three years to evaluate the broadband capacity of healthcare providers and patients in the hopes of improving access to telehealth services, according to State of Reform. The initiative will focus on four states – Alaska, Texas, Michigan, and West Virginia – and is targeted specifically to rural areas. Funding for this effort will support the measurement of bandwidth and the quality of connectivity in target communities, and additional funding will be needed to address the needs identified.