New York state faces unique health challenges within its large and diverse population including large rural regions, the largest city in the United States, high levels of poverty and a large population of non-citizens. Despite these challenges, the state has been aggressive in implementing new health initiatives aimed at improving healthcare quality and reducing costs.
The state made history when it passed sweeping reforms to address surprise medical bills in 2014. The legislation includes an arbitration provision to address charges that seem wildly out-of-line with usual and customary charges.
New York has been progressive in pharmaceutical price transparency legislation, in 2015-2016 legislative season, developing bills that would require pharmaceutical companies to disclose costs relating to the drugs development.
New York State received a State Innovation Model Testing Award of $99.9 million dollar to improve its primary care model including behavioral health integration and interoperable electronic health records. New York is also focused on improving its regional population health by focusing on social determinants and health equity.
New York ranked 13 out of 47 states plus DC, with a score of 43.9 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.
The basic health program (BHP) in New York and Minnesota succeeded in helping low-income consumers access affordable care and reducing administrative complexity, but those results may not be replicable in other states, based on state-specific factors such as regulation and provider reimbursement, according to a report from the Urban Institute. While only two states implemented a BHP after the ACA was enacted, several states have recently begun considering their own programs: Oregon, Kentucky, Illinois, and West Virginia. However, the fiscal impact of a BHP can vary based on the coverage provided, Marketplace premiums, and provider reimbursement rates. One factor in New York’s success has been the state’s ban on age rating in the individual market. New York and Minnesota both reported stable markets with many insurers participating in their BHP, but it is difficult to predict how insurers in other states will react.
Recent legislation passed in New York aims to protect patients who have accumulated medical debt, reports the Office of Governor Hochul. The legislation amends the civil practice law and rules to prohibit healthcare providers from placing home liens on an individual’s primary residence or garnishing their wages to collect medical debt. This issue is particularly important to consumers, as more than 50,000 New Yorkers have been sued for medical debt over the past five years.
Advocates estimate that New York state could be overpaying by $1 billion for healthcare amid an increasing disparity in hospital costs, depending on where a person receives treatment, reports Spectrum News 1. As a result, some state lawmakers are working to find out just how much the state may be overpaying, due to the wildly fluctuating costs between hospitals and insurance plans. Specifically, lawmakers are asking for data to evaluate the cost of 1.2 million state workers enrolled in the New York State Health Insurance Program. The lawmakers addressed the Civil Service Department, trying to determine which hospital systems are overcharging for standard procedures.
New York state is doubling its spending to expand the physician workforce to include more people of color, bringing total efforts to $2.4 million, reports Spectrum News. The effort, first launched in 2017, has had moderate success, but just 12 percent of physicians are Black or Hispanic, despite compromising 30 percent of the state’s overall population. The COVID-19 pandemic further highlighted health inequities, which rallied support for this initiative. The program is meant to encourage students from diverse communities to pursue jobs in medicine, get accepted to and complete medical school in the state. Experts believe initiatives such as these will help provide trusted voices and more cultural understanding within the healthcare community, and, thus, improve equitable outcomes.
None of the 12 hospitals analyzed in New York City and Long Island were in full compliance with federal price transparency regulations, reports the Gothamist. A recent report from Patient Right Advocate reveals that just 14 percent of the 1,000 hospitals surveyed across the U.S. were in full compliance with the regulations. While many New York City hospitals complied with certain aspects of the new federal rule mandating hospital price transparency, many have left out certain key information. Some hospitals, like Mount Sinai, left out its discounted cash prices, but included a complete list of rates it had negotiated with health plans, while others missed the mark by a lot more. Numerous hospitals in New York City have not posted the rates that they charge insurers, while some included negotiated rates for just some insurers, but left others out.
A network of community health centers in upstate New York has started using a mobile medical unit to help remote patients access care, reports HealthLeaders Media. The Hudson Headwaters Health Network rolled out its first primary care van shortly before winter in 2021, with scheduled stops in three small communities, and has since added a fourth stop. The mobile unit addresses a growing problem in rural areas, where healthcare providers are scarce and health insurance rates are low. The network worked with each community to find a good location for the van, to allow visibility and easy access for patients, as well as Wi-Fi access. During the pandemic, the van has become an important resource, allowing access to testing and some vaccinations.
Chandak Ghosh rushed to the Mt. Sinai West emergency room in New York City in 2010 with severe back and stomach pains, according to We The Patients. He was diagnosed with kidney stones, given pain medication, and discharged. In the following days, Mr. Ghosh began to receive separate bills from numerous providers he had seen during his visit. Though he was fully insured, he was told he was responsible for payment until his insurance company paid, and that if he didn't pay by a certain date, the bills would be sent to collections agencies and could hurt his credit. By the time his insurance had fully paid (months later), Mr. Ghosh has received 27 different billing statements.
Individuals living in neighborhoods in Brooklyn with a high incidence of cancer experience significant barriers to care, according to a study published in Ethnicity & Disease. The study, conducted by researchers at New York-Presbyterian and Weill Cornell Medicine found that barriers include economic stability, education and community and social context (like stigma, bias and discrimination, eroding support systems and cultural misconceptions). To address the financial challenges related to cancer care, researchers point to changes that would reduce the need to take time off work, such as extended clinic hours, flexibility in scheduling and setting up interdisciplinary appointments so that patients can meet the entire health team at once. However, the researchers also point to advocating for policies that make high-quality healthcare more affordable, which would significantly help patients struggling with financial barriers to cancer care.
When he found himself suddenly without insurance, Cory Dowd signed up for what he thought was a regular insurance plan at a lower price than others offered, reports MPR News. However, he had actually signed up for a short-term limited duration plan, which he learned upon receiving the bill for his emergency appendectomy due to appendicitis. The initial hospital bill totalled more then $41,000, with the final hospital statement showing that insurance had paid just $1,682 and Dowd still owed $33,600. After contacting the hospital and insurance company multiple times, Dowd was finally informed that his outstanding hospital bill would be covered by his insurance company.
Omitting social determinants of health (SDOH) data from CMS’ Hospital Readmissions Reduction Program misallocated penalties attributable to SDOH to hospitals with the largest share of high-risk patients, according to a Health Affairs study. Researchers used 2012-2016 data from New York City to project the program’s penalties by augmenting CMS’ readmission model for heart attack, heart failure and pneumonia with SDOH scores created to measure geographic levels and individual-level social risk. They found that including these scores affects projected penalties for hospitals treating the highest proportion of patients with high SDOH scores. If CMS continues to omit this relevant patient and geographic data from this readmission model, penalties due to SDOH and social risk factors are misallocated to hospitals serving the largest share of these populations.
The United Hospital Fund published a report identifying the most effective ways to present meaningful and user-friendly pricing information to New York consumers, following a 2020 directive to create a consumer-friendly website, NYHealthcareCompare. Some recommendations include: using the “allowed amount,” as it best reflects the actual underlying price of healthcare services, using commercial claims data for the first iteration of the transparency website, and displaying pricing information for public insurance programs.
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.
New York’s Governor ordered state-run hospitals to stop suing patients over unpaid medical bills, and while most major private hospitals in the state voluntarily followed suit, one chain of hospitals has not, reports The New York Times. Northwell Health, the state’s largest health system, has sued more than 2,500 patients in 2020, despite the pandemic. The Northwell lawsuits each sought an average of $1,700 in unpaid bills, plus large interest payments; however, the system has sued for unpaid bills as small as $700. After this article was published, Northwell announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.
Uninsured New York City residents in all five boroughs can now enroll in a city program that gives them access to a physician and other health services, reports Patch. The program, NYC Care, expanded into Manhattan and Queens four months ahead of schedule. Regardless of immigration status or ability to pay, residents can enroll in the program and receive a card that helps them connect with guaranteed low or no-cost services. New Yorkers who are eligible for health insurance will be directed to the city’s public choice health plan, MetroPlus. About 30,000 New Yorkers have enrolled in the program since its launch last year and have used it for 85,000 provider visits and to fill 30,000 prescriptions.
New York has slashed health insurers’ requested rate hikes by an average of 85 percent, reports Syracuse.com. Health insurers had asked the state for an average increase of 11.7 percent for policies sold in the individual market. The state gave them an average increase of 1.8 percent, which the state Department of Financial Services said is the lowest increase for individual health plans in a decade. This decision comes in light of the fact that some insurers reported record profits for the first half of the year due to postponement of elective and non-emergency services, resulting in lower than expected claim payouts. The Department says these profits could be offset by higher than expected claim payouts in the second half of 2020 and in 2021.
New York is cracking down on healthcare providers who may be charging patient fees for personal protective equipment and other charges related to increased costs from the coronavirus, reports the Times Union. The state’s Department of Financial Services issued new guidance for health insurers to protect patients from being improperly charged with these equipment fees, with the governor citing the financial burdens this practice places on patients. The guidance notes that a participating provider should not charge patients fees or other charges in addition to the patient’s financial responsibility for covered services nor should insurers cover the charges. The state financial department has received complaints of healthcare providers, particularly dental providers, charging these patient fees, which are passed to patients’ insurers and go beyond the patient’s applicable cost-sharing. Among other things, state officials are asking insurers to immediately notify participating providers not to charge PPE fees and patients should be held harmless for these charges.
Insurance companies regulated by New York state have requested a premium increases averaging 11.5 percent due to the COVID-19 crisis, reports WSKG. Meanwhile, the number of claims submitted by patients during the Spring declined significantly, with elective surgeries across the state cancelled or postponed and people avoiding doctor’s offices and hospitals. Some insurance companies may have to issue rebates to premium holders. In past years, the state Department of Financial Services, which approves rate changes, hasn’t granted the increases that insurers have requested, but has granted premium hikes at lower rates.
Two health and housing consortia in New York City offer a model for better integrating the health and housing sectors, according to this article in Health Affairs. The Bronx Health and Housing Consortium is a collaborative network of healthcare, housing, social services and government organizations and agencies that seek to strengthen and integrate healthcare and housing systems at the policy, operational and individual patient/client levels. However, researchers note that structural changes are needed. Researchers believe this model could be replicable in not just large cities, but smaller and nonurban areas, as well.
The New York State Department of Health announced that 150,000 New Yorkers enrolled in healthcare through the state’s Marketplace in 2019, bringing the total enrollment to almost 5 million, according to News10. The Department of Health explains that the numbers are consistent with the state’s historically lowest uninsured rate of 4.7%. A more detailed report, including county data, for 2020 Marketplace enrollment is underway at the Department.
NYC Care, New York City’s answer to calls for universal healthcare, is now available in Brooklyn and Staten Island, according to amNY. The city expects to enroll 15,000 new NYC Care members in both boroughs over the next six months – since the launch in the Bronx in August 2017, 13,000 residents have enrolled in the program that offers free or low-cost health services. New members will be offered a primary care provider within two weeks of enrollment, have access to patient care overseen by NYC Health + Hospitals, have access to 24/7 customer assistance and a hotline for an on-call clinician to speak about patient needs, like prescription refills.
Telehealth giant, Teladoc Health, has announced plans to purchase InTouch Health, a telehealth company that serves the provider market, for $600 million, Crain's New York reports. Through the acquisition, Teladoc plans to create a virtual-care solution that spans provider-to-provider telehealth capabilities for inpatient care, as well as consumer-to-provider applications for outside hospitals. Teladoc has spent millions on acquisitions in recent years, reflecting consolidation that's affecting all of healthcare, including the telehealth sector.
To be launched in 2020, the New York Governor's Office announced the creation of a consumer-friendly healthcare price comparions website, reports Becker's Hospital Review. The website, NYHealthcareCompare, will provide cost, quality and volume data, broken down by hospital, as well as educational information about financial assistance options and surprise billing.
Using methodology developed by HHS’ Office of the National Coordinator, a New York eHealth Collaborative (NYec) analysis revealed that the use of the Statewide Health Information Network for New York is reducing unnecessary healthcare spending in the state by $160-$195 million annually. The analysis estimates that were the network to be fully leveraged across all current participants, the state could save almost $1 billion annually by avoiding duplicative testing, avoidable hospitalizations and readmissions and preventable ED visits if current participants alone were to continue using the system’s full capabilities.
Recently released data from the New York Department of Financial services has revealed that the state’s arbitration process, created through legislation in 2018, may substantially increase what New Yorkers pay for healthcare, according to a report by USC-Brookings Shaeffer Initiative for Health Policy. New York’s recent law uses what’s known as a “baseball-style” arbitration process, through which the arbiter must decide whether final payment should be the insurer’s initial allowed amount or the provider’s charges. Researchers’ main concern is the state’s guidance that arbiters should consider the 80th percentile of billed charges when determining the final payment amount, and the data reveal that arbitration decisions have averages 8 percent higher than the 80th percentile of charges. Therefore, researchers believe that high out-of-network reimbursement attainable through arbitration has likely increased emergency and ancillary physician leverage in negotiations with commercial insurers, leading to providers dropping out of networks to obtain higher payment, thereby extracting higher in-network payment rates, or some combination, which would increase premiums.
Hot spot maps identify key areas in New York City where Medicaid intervention and social determinants of health ( programming have the potential to help improve the health of individuals, according to a report from the United Hospital Fund. Several current initiatives offer promising strategies to tackle social determinants that could benefit from the use of these hot spot maps, including New York Medicaid’s reform initiative, the Delivery System Reform Incentive payment (DSRIP) program, the Healthy Homes value-based payment pilot and others.
The homeless population of New York City has long used the emergency department at higher rates than the non-homeless population, but new research indicated that this may be connected to first-time shelter use, according to the Wall Street Journal. Thirty-nine percent of adult homeless shelter users visited the emergency department for treatment or were hospitalized in the year before they entered a shelter. In fact, the number of hospital visits began to increase in the months leading up to shelter entry. The study, published in Health Affairs, also shows that in the year after leaving a shelter, 43.4 percent of first-time shelter users went to the emergency department or were hospitalized. These significant spikes in visits to the emergency department just before first-time shelter use and just after leaving a shelter indicate that these may be opportunities to connect individuals with interventions and social services to prevent individuals from becoming homeless.
New York is facing a shortage of healthcare workers because fewer people are choosing healthcare careers as the workforce ages and retires, according to the Observer-Dispatch. Additionally, demand has soared as the population ages and the increased turnover costs money, making it the biggest source of cost increases and including money on ads, recruitment and retention tools, lost productivity, and the cost of training employees.
New York’s 2013 mandate for protocolized sepsis care produced sepsis mortality rates significantly lower than those in four states without such regulations, according to FierceHealthcare. New research published in JAMA found that the unadjusted 30-day in-hospital mortality rates in New York dropped from 26.3 percent before the regulations were implemented to 22 percent afterwards. However, these results may not be guaranteed for other states, as New York had a specific environment in which to implement the regulations. First, mortality rates in New York were already higher than most other states, and secondly, this solution came during “a perfect storm,” with an engaged department of health, active hospital associations, willing partners and grassroots advocacy.
Healthcare spending in New York State is both higher and rising more sharply than the national average, reports NYS Health Foundation, with price growth being the primary driver of healthcare spending. A recent report examined healthcare spending, utilization, and prices for New Yorkers covered by employer-sponsored health insurance from 2013 to 2017, drawing data from the Health Care Cost Institute commercial claims database. The report found that per-person spending grew faster in New York during the five-year period than in almost all other states, though New Yorkers had lower average out-of-pocket costs compared to national spending. In addition, with few exceptions, price growth was the driving factor in healthcare spending across all categories of services examined.
A study that examined the network adequacy in New York State provides an overview of hospital network size and quality in the commercial, Medicaid, and NY State of Health markets, according to the New York State Health Foundation. The report found that some New York State regions offer residents access to primarily low-quality hospital networks, that differences exist in network size both within and across plan-product lines and there is a weak correlation between network quality and size. This project demonstrated that it is possible to measure health plan hospital network quality using publicly available sources.
New York City has the largest homeless population in the country, an issue the city has tackled through prevention, affordable housing and healthcare initiatives, according to this article in Harvard Business Review. The safety-net health system for the city, New York City Health + Hospitals, which serves more than one million people a year, is using data science to identify homeless patients and tailor their care and match them to the right hospital or community-based supports—ultimately including housing itself.
A new United Hospital Fund report reveals that New York accountable care organizations (ACOs) participating in CMS programs meant to reduce Medicare spending reduced spending by $11.5 million in 2017, after increasing spending by roughly $60 million in each of the two prior years. According to the United Hospital Fund, CMS still ended up about $40 million in the red after accounting for the ACOs that reported losses and distributing incentive payments to those that saved money. CMS started the Medicare Shared Savings Program six years ago to offer healthcare providers the opportunity to create an ACO that would be held accountable for the quality and cost of care of Medicare patients, in return for a share of any savings generated
Montefiore Health Systems worked with a startup, Valera Health, using a HIPAA-compliant app to better engage patients and give them more context about their care. According to MedCity News, Montefiore began working with Valera Health after receiving a grant from the CMS Innovation Center to develop a financially sustainable way to integrate behavioral care and primary care. Montefiore began using the Valera app during a pilot study that began in July 2016, which found that patients using the app missed fewer appointments, connected more frequently with their care teams than with phone calls, and experienced significant improvement in depression and anxiety scores, as well as remission rates.
In partnership with the Northeast Business Group on Health and their hospital rating site ExpectNY, Yelp recently announced that they will begin displaying maternity care measures on more than 50 hospital pages across New York City and Long Island where babies are delivered. According to AboutHealthTransparency.org, Yelp will display C-section Rates (NTSV), Breastfeeding Rates, Episiotomy Rates, and Vaginal Birth After C-section (VBAC) Rates on the Yelp pages for hospitals in these two cities that provide maternity care.
An analysis of New York's 2014 surprise medical bill law found that insurer, provider, and consumer stakeholders generally agree that the implementation of the law went smoothly, and that consumer complaints declines dramatically, according to a report from the Georgetown University Health Policy Institute, Center on Health Insurance Reforms. However, there continue to be significant gaps within the law concerning surprise balance bills due to patient misinformation about a provider's network status and use of out-of-network facilities during emergencies. The law protects consumers from charges for out-of-network services not paid by an insurance plan in cases of emergency or circumstances in which the patient did not have a reasonable choice between an in-network and out-of-network provider.
A new report from the United Hospital Fund, supported by the New York State Health Foundation, examined patient and family decision making around post-acute care, which includes service provided by home health agencies, inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The analysis found a robust evidence base around improving post-acute decision support and provided a number of policy recommendations and solutions to increase supports for patients and their families when making decisions about where to receive post-acute care.
The New York Health Act (NYHA), a single payer option for New York State residents, which is being considered by the legislature, is likely to increase use of health services as residents receive more coverage, according to an analysis of the legislation conducted by RAND and funded by the New York State Health Foundation. This single-payer option would cover all state residents, including undocumented immigrants, and seniors over 65 (assuming approval of waivers). Coverage would include medical benefits currently included in Medicare, Medicaid and Child Health Plus, as well as essential health benefits as included in the ACA, and more long-term care benefits may be included later. Key findings of the report indicate that overall healthcare spending under NYHA would decrease slightly (3 percent) by 2031, despite increased use of the system. Taxes would replace insurance premiums as the main source of healthcare financing and would need to increase by approximately 156%. However, depending on the design of the progressive tax schedule, most households in New York can expect to pay less, while the highest-income households could pay substantially more.
In response to extreme racial disparities in maternal death rates, New York City launched an initiative to reduce maternal deaths and complications among women of color, according to a news report from ProPublica. The city will improve their data collection on maternal deaths and complications, fund implicit bias awareness trainings for medical staff at private and public hospitals, and will launch an awareness campaign. Over the next three years, the city will spend $12.8 million on the initiative, to eliminate the black/white racial disparity in deaths related to pregnancy, and cutting the number of complications in half over the next five years. The city’s health department is targeting two dozen public and private hospitals, focusing on neighborhoods with the highest complications rates in the South Bronx, North and Central Brooklyn, and East and Central Harlem. Hospitals will study the data from cases that led to bad outcomes and hospital officials will run drills aimed to recognizing and preventing these outcomes. This initiative is an accountability measure and a positive first step towards addressing the concerns and needs of women of color and pregnant women.
There is increasing awareness that social determinants of health affect physical and mental health outcomes, especially in early childhood. Social determinants, particularly those that can lead to toxic stress, can stunt young children’s brains leading to long-term development challenges. A new study from the United Hospital Fund examining the effects of a learning collaborative called Partnerships for Early Childhood Development (PECD). PECD is a two-year grant that provided $700,000 to 11 New York City hospital-based primary care practices to build partnerships with 17 community-based practices. These clinical-community partnerships designed and implemented their own social determinants of health projects to screen families for social needs. Over 5,500 families were screened and at least 1,900 families were determined to have one or more social needs. In the first year of the project, referral rates to community based practices were high, but follow up was low due to various barriers the teams encountered in tracking referrals, sharing information and other social hurdles that kept the families from seeking services. Strengthening the referral approach and closing this feedback loop is the focus for the upcoming second year of the grant.
Many online healthcare transparency tools are new and vary widely in the information they contain and how it is displayed. New York state is continuing to invest in resources to ensure that residents have access to timely and meaningful information they need to make decisions about their health, including the state’s all-payer claims database, as described by a new report that contains a national inventory of transparency tools to guide state policy. In addition, a new online database evaluates national tools in four categories: physicians, hospitals, prescription drug pricing and health insurance purchasing. The inventory, which examines more than 230 healthcare transparency tools across the US, offers best practices and recommendations to help consumers make value-based healthcare decisions. The online platform includes tools containing quality information for physicians and physician groups, though price features are lacking.
Improving access to healthy foods and access to safe places for physical activity is the focus of the Building Healthy Communities initiative from the NYS Health Foundation. This report examines the strategies to develop the initiative, set goals and assess the progress and impact in six targeted neighborhoods. Lessons learned and next steps for additional neighborhood transformation is also included in the report.
The integration of podiatric services could enhance chronic care management, improve health outcomes, reduce healthcare costs and ultimately benefit the shift toward value-based care, according to an article in HealthITAnalytics. A study was conducted on podiatric interventions and their effect on diabetes, obesity, back pain and fall prevention care. These conditions have a significant impact on New York residents: approximately two million New Yorkers have diabetes, 25 percent of whom develop foot ulcers. Researchers found that for diabetic patients with foot ulcers, podiatric services had the potential to reduce approximately 13,500 inpatient admissions annually and could save nearly $510 million in diabetes costs. In obese patients, podiatric treatment could reduce subsequent inpatient admissions by approximately 19 percent and save almost $1.1 billion in healthcare costs.
A new calculator can help New Yorkers choose a health plan on the state exchange based on the state of their health, according to an article in the Times Telegram. The NYPlanCosts Calculator is a first-of-its-kind calculator to help people determine their likely out-of-pocket costs under different health plans based on which of 10 health conditions apply to them. Those include: bipolar disorder, breast cancer, diabetes, pregnancy and childbirth, heart disease, hepatitis C, HIV, multiple sclerosis, rheumatoid arthritis and schizophrenia. The calculator is based on the idea that premium prices shouldn’t be the only factor that decides which plan people choose because out-of-pocket costs beyond the premium can vary greatly.
Although quality measurement and public reporting have grown dramatically over the last two decades, the information that New Yorkers want and need in order to make informed health care choices is severely lacking, leaving them without the tools to make better decisions. To better understand what quality information is currently available, what information consumers want, and the gaps between the two, UHF’s Quality Institute engaged in a 15-month inquiry supported by the New York State Health Foundation. Empowering New Yorkers with Quality Measures that Matter to Them also synthesizes research on quality measurement and reporting, interviews with a broad range of health care experts, and advice from a 17-member advisory group. It identifies the types of information consumers most want and the barriers to overcome to help New Yorkers become empowered health care consumers.
To truly know if patients are feeling better after a surgery, hospitals can't rely only on routine quality metrics. That's where collecting data on patient-reported outcome measures can help. According to an article in Modern Healthcare, all patients at New York’s Hospital for Special Surgery began post-operatively asking patients 10 questions from the Patient-Reported Outcomes Measurement Information System, or PROMIS, a survey about the patient's quality of life and ability to function. Questions are related to the patient's social support system as well as pain intensity and sleep behavior. Those responses are logged into the patient's electronic health record. This allows doctors to understand how the patient's quality of life changed before and after the procedure.
In Africa and India, the idea of using healthcare workers was born of necessity. They simply didn’t have the money or resources to do it any other way. Unlike sub-Saharan Africa, Upper Manhattan is rich in hospitals, medical schools and pricey specialists. But it’s poor in effective community-based primary care, particularly the kind of care that can reach into kitchens and living rooms of patients, according to a news story in Politico. City Health Works is a promising approach that differs from a lot of other health coaching or community groups. It was co-designed with clinicians in its community, from places like Mount Sinai Hospital, who are open to a team-based approach and who understand that peer workers can sometimes reach where a physician cannot.
NYSHealth produced 2017 data report that highlights key cost drivers and trends and shows how New York compares nationally and with other states. New York's health care spending overall and per capita are among the highest in the nation. Health care expenditures were the second highest in the country, totaling $193 billion in 2014, up from $165 billion in 2009.
Fair Health, a Midtown nonprofit that says it has the largest medical-claims database in the country, is unveiling a health care cost-transparency website for New Yorkers called youcanplanforthis.org, according to Crain’s New York Business. The site is launching ahead of the state’s all-payer database, a potentially similar resource that has been in development for six years. Perhaps the most useful feature is the ability to compare costs by provider for some common procedures, including those associated with obstetrical care and orthopedics. However, users will have to go elsewhere for quality ratings. Fair Health’s database includes access to more than 24 billion billed claims for medical and dental procedures.
A new report by the Medicare Rights Center discusses the role of consumers and consumer advocates in implementing health system transformation models in New York state. The Medicare Rights Center enlisted the expertise of a panel of individuals and asked them to analyze the current state of health system transformation in New York, focusing specifically on three challenges a changing health system creates for advocacy organizations: the need to understand new risks, the need to educate consumers and others about new realities, and the need to engage consumers in designing, implementing, and monitoring new models.
The state Department of Financial Services said it would allow insurers selling plans to individuals to raise rates by 14.6% on average in 2018; insurers had asked for a 17.7% increase. According to a report by Modern Healthcare, the department said rising drug costs, especially specialty drug spending, were the greatest driver of price increases. The impact of premium increases will vary based on buyers' income levels: Nearly 60% of customers who bought a plan on the marketplace last year were eligible for subsidies. The department noted that individuals purchasing the cheapest silver-level plan, the most common choice, would pay 5% less next year than in 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.
New York State's overall and per capita healthcare spending is among the highest of all the states, according to a Public Agenda survey. New York was one of 43 states that received an "F" grade for their price transparency laws from Catalyst for Payment Reform in 2016. The state is planning to create an online platform to disseminate price and quality information to its residence based on an all-payer claims database.
Some hospitals are 1.5 to 2.7 times more expensive than the lowest-priced hospitals within the same region of New York State, according to Modern Healthcare. The study, funded by the NYS Health Foundation, also found that a hospital’s market leverage—its bargaining power when negotiating with insurers—is a key factor in the prices a hospital can command. Hospitals with high prices do not necessarily have higher quality scores and those with lower prices do not necessarily have lower quality score.
Three hospitals in the Mount Sinai Health System have agreed to pay nearly $3 million to settle a possible suit alleging that they held onto Medicare and Medicaid overpayments, according to Modern Healthcare. The alleged overpayments originated in 2009-2010 when the hospitals were part of Continuum Health Partners. A whistleblower email and a comptroller audit alerted the health system to the potential overpayment, but the health system did not return all the money until well beyond the government’s allowed time frame.
The New York State health department has released a plan that will expand and improve access to primary care medical homes across the state, according to a United Hospital Fund Press Release. The plan hopes to guide New York in adopting a delivery model that improves quality and value of care. The adoption of this model is also in line with New York City’s Take Care New York 2020 goals.
According to Crain’s New York Business, the State Health Information Network has nearly half the population of New York State signed up to have their health records shared among most of the state’s healthcare centers. The project, which began in 2006, is expected to accrue savings of more than triple the annual $70 million dollar operating cost.
A study in the May edition of Health Affairs evaluated the power of market concentration in correlation with rising costs in the New York and California markets. The study found that increased hospital and medical group concentration exhibited an increase in premiums in both states. The results showed a difference in health plan concentration exhibiting a positive correlation in premium growth in New York but a negative association in California.
A new report released by the de Blasio administration outlines strategies to strengthen the city’s 11-hospital system and stabilize the hospitals’ finances, according to Crain’s New York Business. New York City Health and its hospitals have lagged behind its peers in high quality care and revenue. De Blasio hopes that with this plan the city can avoid potential layoffs and hospital closures that have plagued NYC in the past.
A new United Hospital Fund report examines the performance of New York’s accountable care organizations in the second year of the federal Medicare Shared Savings Program, finding that they lag the national experience on cost savings but outperform it on quality results.
Consumers are not proficient users of healthcare information and would benefit from increased access to quality and cost data for healthcare decision making, according to a report from the New York Academy of Medicine. However, efforts to provide such information to consumers should recognize the need to ensure individuals have the knowledge, motivation, and sense of empowerment to effectively utilize such data.
New York hospital mergers could result in price increases greater than 20 percent and increased market concentration with little improvement in quality, according to a Manhattan Institute report. In addition, the study found that lower mortality rates were present in systems with less concentrated markets.
Medical bills for out-of-network providers can surprise consumers with thousands of dollars in costs they didn’t plan for and sometimes cannot afford. A significant share of people who had problems paying medical bills say that the issue was charges for providers they did not know were out of network. New York state has a solution to this problem that bears watching, according to a Wall Street Journal blog post by Drew Altman.
This Huffington Post article by James Knickman of the New York State Health Foundation evaluates the results of a new groundbreaking study on hospital spending and price variations and what it means for New York. The study finds that many parts of the state have low hospital spending compared to national averages, but other parts have much higher spending, prices vary widely within a community, and prices are higher when there is less competition from other hospitals in the same community.
A new guide from the United Hospital Fund distills information about the State’s value-based payment roadmap for several critical audiences, including healthcare providers, health plans, policymakers, and other Medicaid stakeholders. Navigating the New York State Value-Based Payment Roadmap frames the State’s plans to transform the way it finances healthcare services, moving from volume- to value-based payments—a payment transition broadly recognized as essential for delivery system reform.
This NYSHealth-funded report, prepared by the APCD Council, examines the issues related to the development of regulations and policies for an all-payer database (APD) in New York State. It also offers recommendations for State policymakers on the choices before them and seeks to preserve an expansive vision for the APDand the extent of its powers. The report captures lessons learned from other states that have developed, or are developing, similar systems and highlights the perspectives of key stakeholders in New York.
The Federal Trade Commission (FTC) submitted comments on the New York Senate Bill 2647 and Assembly Bill 2888. The FTC claims this legislation would allow for the collaboration of providers beyond the reasonable standard established by antitrust laws. These collaborations may result in reduced competition and higher costs for consumers.
Catalyst for Payment Reform and the New York State Health Foundation released the Scorecard on New York Payment Reform.
New York state announced the approval of a $100 million State Innovations Model Testing Grant from the Centers for Medicare and Medicaid Innovation. The funding will go towards New York’s Health Innovation Plan, a strategy to increase transparency, implement payment reform that encourages service quality over quantity, and to support the state’s Health Prevention Agenda by promoting access to primary care and community based resources.
According to an article by Capital New York, many New York health insurance companies asked for double digit rate increases for 2015, but the state dramatically reduced most requests. This follows on the heels of a tamping down on 2014 rate requests. As highlighted by a Kaiser Family Foundation study on 2014-2015 premium changes, these rate reductions have prevented significant price increases for New York consumers.
The State Health Commissioner announced the launch of the redesigned NYS Health Profiles Website. This tool allows consumers to explore and compare quality measurements of area hospitals, home care organizations, nursing homes and physicians.
New York announced the CMS approval of a Medicaid waiver to fund the Delivery System Reform Incentive Payment (DSRIP) program. This Medicaid waiver restructures the Medicaid program using the state’s Medicaid Redesign Team’s recommendation and $8 billion in reinvestments to reward milestones in system transformation, clinical management and population health. Although planning began in 2014, key delivery reforms will launch in 2015 creating 25 Performing Provider Systems (PPSs)—networks of providers who will be held accountable for health outcomes—that aim to reduce avoidable hospital use by 25 percent within the first five years.
The Emergency Medical Services and Surprise Bills Law was passed to require disclosure and restrictions on the amounts consumers can be charged for surprise medical bills. The measure aims to address the issue of surprise medical bills, as described in this New York Times article, and will go into effect on March 31, 2015. Addressing the issue of surprise medical bills is of interest in many states and this Consumers Union case study of New York’s work can be used by other state advocates to achieve similar legislation. [More information and resources on surprise medical bills can be found here.]
The New York State Health Foundation’s Healthcare Costs and Spending in New York State report provides a wide variety of graphics depicting New York healthcare costs and spending. According to the report, New York is the second largest state spender on health expenditures at $163 billion every year. New Yorkers have experienced significant increases in premiums over the last ten years to accommodate the increased spending, with private insurance spending increasing faster than public. This, however, does not mean public spending is under control. In 2009, New York ranked third among states in per-enrollee Medicaid spending.
The New York State Department of Health 2013 Managed Long-Term Care Report reviews the 38 pre-existing NYS- certified managed long-term care plans. These plans target the chronically ill and disabled and receive a monthly risk-adjusted capitated payment to cover health and social services, including home care, personal care, transportation and skilled nursing facilities. Since the implementation of MLTC plans in 2004, enrollment has steadily increased and now covers more than 120,000 New Yorkers, 90 percent of whom reside in New York City. Enrollee satisfaction rated high, with 84 percent of respondents rating their health plan as good or excellent, although the report includes an underwhelming 27 percent response rate.
The New York State Health Innovation Plan outlines health goals for 2013-2017 that includes continued adoption of best practices and outcomes, achieving high standards for quality and consumer experience, generating upwards of $5 billion in savings from prevention interventions, limiting unit price increases, and reducing unnecessary care. To reach these goals, New York aimed to utilize strategies coined the five pillars: access, care management, increasing transparency, value-based insurance design and community health, with an additional focus on investment in the workforce, health information technologies and metrics for quality, patient satisfaction and cost-effectiveness.
A New York Times article covered the huge markups included in hospital bills compared to the actual costs they incur, as seen in the Hospital Inpatient Cost Transparency Data. The data also shows the large discrepancy between providers on costs and charges. A second New York Times article highlighted important takeaways from the newly publicized data.
The state’s Medicaid Redesign Team announced $14 million was saved in the 2011-12 fiscal year. The savings came without reducing benefits, while implementing a global spending cap and expanding coverage to include 140,000 additional low-income people.
The state’s Medicaid Redesign Team completed a Multi -Year Action Plan with several recommendations to improve health outcomes and curb the cost trend that include expanding access to supportive housing, expanding provider scope of practice, targeting trouble areas, such as Brooklyn, and implementing a system of performance measurement.