State News

A U.S. District Court judge in the Eastern District of California upheld the state’s drug price transparency law, challenged by the Pharmaceutical Researchers and Manufacturers of America (PhRMA), reports NASHP. The law requires manufacturers to report and provide information about certain drug price increases and give 60-day advance notice of drug price increases if the list price is more than $40  and if the price increased more than 16 percent over the past two years. The ruling is a legal victory for states working to curb drug prices following the Supreme Court’s December 2020 decision to uphold an Arkansas law regulating pharmacy benefit managers.

Maryland’s global budget payment model reduced expenditures by more than $20 per month per beneficiary compared to a control group, according to a study Health Affairs. Maryland’s global budget payment model, originally piloted with eight rural hospitals, had no significant differences in service use or spending by Medicare beneficiaries. However, when the state expanded the model to all hospitals, Medicare expenditures decreased by more than $25 per month per beneficiary more than the control group during the first three years of the program, saving Medicare approximately $679 million. Maryland’s global budget payment model can serve as a model for other states considering value-based purchasing models.

A caregiver from Del City lost both her employment and medical coverage after a major stroke left her unable to work, leaving her completely without coverage when she later suffered a second stroke, according to the Oklahoma Policy Institute. Despite qualifying for a hospital program that provides medical assistance to uninsured individuals, the woman was unable to afford her medications. Her son, who suffers from diabetes, scaled back on his own medications to pay for his mothers’ and has suffered health consequences as a result. A patchwork of community-based programs has helped, but the services are time-limited and provide only a temporary solution. More permanent supports are needed to help Oklahoma residents afford needed care.

Rhode Island’s Office of the Health Insurance Commissioner’s affordability standards, created to moderate price growth by incorporating value-based purchasing arrangements in provider contracts are among Rhode Island’s efforts to promote value in healthcare, according to a study in Health Affairs. These efforts resulted in a large increase in commercial insurer spending on primary care services, an increase in the number of primary care providers, lower inpatient and outpatient fee-for-service spending and higher non-fee-for-service spending, primarily on primary care. Additionally, the state created an all-payer patient-centered medical home with payments tied to quality measures. However, quality and use did not change significantly after the implementation of these initiatives. Rhode Island’s laws can serve as a model for other states considering value-based payment models.

Prenatal care utilization and health outcomes for newborns have improved in Oregon in the three-year period following the state’s Medicaid expansion in 2014, according to two studies from Oregon State University featured in Health Affairs. Medicaid expansion was associated with a 2 percent increase in first trimester prenatal care utilization, a 23 percent reduction in preterm births and a 29 percent reduction in low birthweight among babies born to women covered by Medicaid.

A blog in Health Affairs highlights five challenges facing Vermont’s all-payer model (APM): incentivizing participation among providers; properly attributing patients to providers; paying for value; determining how financial risk should be distributed among providers; and overcoming the disadvantages of fee-for-service benchmarks. The all-payer model allows accountable care organizations in the state to receive payments from Medicare, Medicaid and commercial insurers and then align payments and quality measures for providers. While the APM offers theoretical advantages such as economies of scale, aligned incentives and potentially reduced administrative costs, without tax increases or public provision of services, operationalizing the model has been difficult.

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.

The Massachusetts Governor signed into law a wide-ranging bill that includes expanding access to telehealth after the COVID-19 public health emergency abates, reports Healthcare IT News. The new law mandates that insurers cover virtual behavioral health services at the same rate as in-person services, rate parity for primary care and chronic disease-management services for two years and rate parity across the board for 90 days past the end of the state of emergency. In addition, the law makes permanent measures to expand scope of practice for a wide range of providers, requires providers to notify patients in advance about whether a procedure is out of network and mandates insurance coverage for all COVID-19 related emergency, inpatient and cognitive rehab services.

Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts, according to State Health & Value Strategies. The state has been very intentional with language used to describe equity efforts, how key terms are defined and has placed an emphasis on engaging community partners to ensure that the community voice is apparent in state-level policy decisions. The state also developed a framework to demonstrate the importance of moving upstream to the understanding that racism, discrimination and bias impact the health outcomes of people who have been subjected to long-standing, even centuries-old oppression. The development of common definitions and adoption of a framework for understanding where work needs to focus has allowed for robust internal and external coordination and impact around how to work towards achieving health equity.