State News

Virginia has been approved to proceed with a state-based health insurance exchange, according to the Office of the Governor of Virginia. Approval from the Centers for Medicare & Medicaid Services allows Virginia to take over some functions of its current federal exchange beginning with open enrollment this November and puts the Commonwealth on a path to full control by 2023. This move will enable the state to implement policies to better address costs and provide more targeted outreach and enrollment services to Virginians.

Blue Cross Blue Shield of Rhode Island will provide coverage for telehealth services for primary care, behavioral care and specialist care with no cost-sharing for commercial members, reports the Providence Journal. The insurer is also waiving cost-sharing for COVID-19 testing and treatment. In addition, the insurer will be providing $11 million in premium relief to its small-group and fully insured customers, following earlier premium relief in June.

Mental health drugs now account for a fourth of all pharmacy spending by private insurance and about a third of pharmacy spending by public payers, such as Medicaid. Spending is expected to increase 60 percent over the coming decades, according to a CMS prediction cited by the Clarion Ledger. This will have a large impact in Mississippi, where approximately 77,000 Medicaid beneficiaries had behavioral health diagnoses (a number that includes children but not infants) in state fiscal year 2019. Restricting access to needed medications can be detrimental in the long run— “69 percent of patients with medication access problems had adverse events compared to 40 percent for patients with no access problems,” according to Joyce West, director of the American Psychiatric Research Network. 

State regulators are expected to start combing through the finances of thousands of Oregon medical practices with a goal of capping per-patient spending growth at 3.4 percent, according to the Lund Report. The state’s Sustainable Health Care Cost Growth Target Implementation Committee has been working to craft a workable plan to slow the increase in healthcare spending. The committee is using a collaborative approach to cap rates, but committee members and Oregon Health Authority staff have not yet decided which entities will be subject to agency scrutiny and enforcement. Hospitals and major practices will likely be on the list, but the inclusion of large specialty clinics and small medical practices is still up for debate.

School-based health clinics have begun to use telemedicine, videos and an app to connect with and treat students, reports Fox 9. The clinics, which regularly help thousands of kids each year with many services, from physicals to mental health support, have had to adapt during the pandemic. Minnesota Community Care, which runs 10 clinics in St. Paul Public High Schools, adapted out of concern about meeting unmet student medical needs with students out of school

Three out of four Kentuckians (77 percent) are worried about affording healthcare, according to a survey conducted by the Healthcare Value Hub in collaboration with the ThriveKY campaign. Kentucky adults reported numerous affordability problems. Almost a third of respondents delayed going to the doctor and 1 in 5 rationed medicine in the past year due to cost. Additionally, dissatisfaction with the current healthcare system is both statewide and bipartisan. The majority of respondents (71 percent) agreed or strongly agreed that the healthcare system needs to change, and 69 percent of respondents identified healthcare as the priority issue the government should focus on. Respondents endorsed a number of strategies to lower healthcare costs, but the clear front-runner, at 91 percent, was to “expand health insurance options so that everyone can afford quality coverage.”

The federal Health Resources & Services Administration (HRSA) has ranked Wisconsin the third best state in the nation for the quality and performance efforts of its Critical Access Hospitals, reports Aspirus. HRSA’s measures are from its Medicare Beneficiary Quality Improvement Project, which includes more than 1,350 hospitals across 45 states. The program is intended to reduce hospital closures in rural areas, promote a process for improving rural healthcare and focus on community needs

North Carolina’s largest insurer says that its push to reform its payment system through value-based care has already saved more than $153 million in its first year of operation, reports the Triangle Business Journal. Blue Cross Blue Shield of North Carolina launched its value-based care plan, Blue Premier, in January 2019, alongside five of the state’s largest hospital systems, replacing the traditional “fee-for-service" model and reimbursing providers on quality of care rather than quantity of services provided. The company says it has generated an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on healthcare. In addition, Blue Premier physicians increased screenings for colorectal cancer by 3,041 members and controlled blood pressure for 13,412 more members than in 2018, showing health benefits alongside cost savings.

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.