State News

Horizon Blue Cross Blue Shield of New Jersey and Atlantic Health System have seen early success in their payer-provider shared accountability program in which they tie payments for services directly to outcomes in achieving quality and cost goals, reports New Jersey Business Magazine. The program represents a step away from traditional “fee for service” models and have has resulted in more than a 9 percent reduction in unnecessary hospitalizations and a 5 percent reduction in the total cost of care for patients and members in its first program year. The program used prior cost trends to jointly set a total cost of care target for certain members, and the reimbursement is adjusted annually based on performance as compared to cost targets, quality of care and patient outcomes.

The Centers for Medicare and Medicaid Services issued a warning after Vermont failed to meet performance targets for the state’s all-payer model, reports the VTDigger. The experiment—which combines money from Medicare, Medicaid and commercial insurance to fund healthcare services on a per-patient basis, rather than a fee for services rendered—aims to incentivize preventive care and to lower the growth of healthcare spending, neither of which has been realized in the three years since the program began. OneCare Vermont, a for-profit hospital and provider group that manages the all-payer system, has also failed to meet enrollment targets. If the state is unable to provide a satisfactory response within 90 days, the federal government will draw up a corrective action plan. Vermont’s Agency of Human Services has asked state healthcare leaders to develop a “complete plan for rebooting the all-payer model” within 45 days.

Black people in Georgia are dying from COVID-19 by as much as 3-4 times the rate for white people across all age groups, according to a new analysis in the Augusta Chronicle. The disproportionate impact of COVID-19 on Black people likely stems from systemic inequities in employment, education and access to healthcare, as well as the higher prevalence of chronic diseases among minorities.

RAND Corporation’s recent study shows that hospitals in Georgia charged private companies nearly three times the amount they were paid by the Medicare program for the exact same services, reports Georgia Health News. The gap between reimbursement from Medicare and private insurers has widened between 2016 and 2018. Lower reimbursements from Medicare and Medicaid has likely caused hospitals to “cost shift” and charge privately insured patients a higher rate for the same services.

New Mexico has launched a new partnership between the state Attorney General, Auditor, Ombudsman, and Department of Health and Adult Protective Services to increase accountability and the standard of care for individuals in nursing homes and long-term care facilities, according to a press release from the Office of the Governor. The partnering organizations will review data and investigate complaints about fraud and abuse, as well as charge civil penalties and prosecute as needed. These efforts are intended to strengthen financial transparency and protection of the elderly.

The Washington Health Alliance released its second Community Checkup report in 2020 on the quality of healthcare in Washington state. In addition to other features, the report includes a new Quality Composite Score that combines up to 29 Community Checkup measures to make it easier to compare the quality of healthcare being delivered across the state and by different provider groups. While the composite score provides a more streamlined and nuanced understanding of care quality on primary care measures endorsed by Alliance members, it does not provide an understanding of other important factors, such as cost, patient experience, and care disparities. As the work of the Alliance continues, the Quality Composite Score may evolve to incorporate and measure these important aspects of healthcare.

The Oregon Health Authority released the 2019 CCO Metrics Report, which shares the results of Oregon’s pay-for-performance quality incentive program for its coordinated care organizations (CCOs). This report shows CCO performance across three categories of measures: CCO incentive metrics, state quality metrics and CMS core metrics. For example, in 2019, nine of 15 CCOs improved on the use of emergency departments among members with mental illness. However, asthma as a cause of hospital stay increased almost 12 percent at the statewide level in 2019. 

The Maryland Health Department has convened an inter-agency task force aimed at reducing the COVID-19 positivity rate in Hispanic communities, reports WTOP and Maryland Matters. The Hispanic Outreach Task Force will look to provide support to Baltimore City to connect underserved Hispanic communities to social services, prevention tactics, isolation housing, educational materials and contact tracing. The task force will also experiment with an intervention program that would provide financial assistance, medical care, isolation, food and other services for families who have tested positive.

Beginning in 2021, pregnant Black and Pacific Islander women in San Francisco will get a $1,000 monthly supplement during and up to six months after their pregnancy in a first-of-its-kind initiative meant to help improve health outcomes for both mom and baby, according to ABC News. The initiative aims to reduce disparities in premature births and maternal deaths among Black and Pacific Islander mothers (compared to white mothers), resulting from a lack of access to quality healthcare, income inequality issues and systemic racism. The supplements will be paid for through private donations and some public funding and will come without any restrictions on how the women spend the money.