State News

Across Massachusetts’ cities and towns, Latino and Black communities are experiencing higher rates of COVID-19 cases, and a recent study in Health Affairs identifies important factors that are independently associated with higher COVID-19 case rates in the state. The proportion of foreign-born, non-citizens was the strongest predictor of the burden of COVID-19 cases within a community, while household size and food service occupation were also strongly associated with the risk of developing COVID-19. Some factors, however, such as occupation in an essential service field, did not affect Black and Latino communities in a similar matter. The authors posit that other factors not examined in the study, such as structural inequities like disproportionately high incarceration rates, residence in areas with a higher concentration of multi-unit buildings and defacto neighborhood segregation, may contribute to the spread of COVID-19 in Black communities.

A new report from the Center for Community Solutions found prices for the same medical procedures varied widely among hospitals in Ohio, reports AboutHealthTransparency.org. The research found that not only did the price vary widely from hospital to hospital, but also, for each procedure the average cost in Ohio was much higher than the national average. The authors highlighted recommendations for controlling prices in Ohio, including one to create an independent oversight entity to set a cost benchmark.

Months after having an emergency appendectomy and a second surgery to remove a large blood clot that was likely a complication from the appendectomy, Shannon Harness is still fighting to negotiate and pay off his hospital bills. In this edition of Kaiser Health News’ Bill of the Month, we learned that as an uninsured patient Shannon was charged $80,232 for both surgeries, which is three to four times what an insurer would pay for the same surgeries. Paradoxically, uninsured patients have the highest medical bills because they don’t benefit from the discounted rates negotiated by insurers. After months of negotiation with the hospital, Shannon was able to lower the bill down to $22,304.17 and is working on a payment plan with the hospital.

A 2016 New Jersey law gave the state flexibility to share bid information submitted by all pharmacy benefit managers (PBMs) in order to incentivize them to submit lower offers in additional bidding rounds – known as a reverse auction. This approach was implemented in 2017 and is now projected to save $2.5 billion in drug spending for public employees between 2017 and 2022, according to NASHP. Several other states have followed New Jersey’s lead, with Maryland approving legislation to conduct reverse auctions for PBM procurement in 2020 and the New Hampshire State Senate passing similar legislation (however, the House suspended consideration of the bill in late June 2020).

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