State News

As part of its 2012 Medicaid waiver, Oregon created 16 coordinated care organizations (CCOs) to manage care for Medicaid recipients with the ability to use “flexible services” to reduce the need for medical services--defined as low-cost, health-related services not covered by the state’s Medicaid program. A recent study in the Journal of Health Politics, Policy and Law looked at the use of these services and the challenges providers faced. A key finding was the need to provide managed care organizations (MCOs), such as CCOs, with detailed definitions and guidance up-front on health-related services they are expected to coordinate and pay for. While flexibility to pay for a variety of services may help MCOs respond to their patients’ unique health-related needs, many CCO informants described clarification and certainty provided by new rules as helpful. 

Maryland Medicare beneficiaries had 2.8 percent slower growth in total expenditures, relative to a comparison group, largely driven by a 4.1 percent slower growth in total hospital expenditures, reports Healthcare Innovation. The report, prepared by RTI International, examines the first five years of Maryland’s All-Payer annual, global hospital budget Model and finds that slower growth in emergency department expenditures (30.6 percent) and other hospital expenditures (17.2 percent) drove total Medicare hospital savings in Maryland. It's important to note that the model reduced both total expenditures and total hospital expenditures, indicating that costs were not shifted to other parts of the healthcare system outside of the global budgets.

Arizona made an innovative change in its scope-of-practice rules, enabling hospitals to more easily use dental hygienists to help prevent ventilator-assisted pneumonia – the leading cause of death from nosocomial infections in critically ill patients, according to NASHP. Nurses often provide oral-hygiene care to ventilator-dependent hospital patients, but some hospitals prefer to use dental hygienists because of their expertise. However, state scope-of-practice laws typically ban dental hygienists from providing care without the supervision of a dentist, which hospitals may not employ. Arizona’s law reduces barriers to practice by allowing dental hygienists working in hospital settings to practice under the supervision of a licensed physician, who must available for consultation but does not need to be physically present when the care is administered.

Premiums and deductibles in 2018 were 10 percent or more of the median income for workers in 42 states, including Ohio, according to a Commonwealth Fund report. In Ohio, the average premium contribution and deductible made up 11.1 percent of median household income, compared with 6.9 percent in 2008. Rising deductibles could make employees more likely to delay or skip care or, to not take prescription medications, an analysis from the Health Policy Institute of Ohio stated. 

In 2018, Texas had about 54 primary care physicians per 100,000 people—one of the lowest ratios in the country, far below the national ratio of 76 per 100,000. More than a quarter of Texans live in an underserved county, according to the Texas Observer. As a result, Texans often have to travel for hours to get care, which ultimately leads to poorer outcomes and higher mortality. 

A recent report from the University of Colorado Denver revealed that there are 71 census tracts in Colorado where a high rate of housing insecurity and mental health needs overlap, according to The Colorado Independent. The interactive map included in the report will be used by officials and lawmakers to more efficiently target services and funding. These preliminary findings support a 2019 study by the Robert Wood Johnson Foundation that found households that struggle with greater housing cost burdens also see poorer health outcomes. Experts hope this map will allow policymakers to locate the best areas to provide additional support to produce better outcomes.

Sutter Health and a group of physicians will pay the federal government $46 million to settle allegations that they violated the Stark law by billing Medicare for services provided by professionals with whom the entities had improper financial relationships, reports Modern Healthcare. This is the second federal settlement by Sutter this year – In April, Sutter and several of its affiliated medical foundations agreed to pay $30 million to resolve allegations that the foundations submitted inaccurate information about the health status of Medicare Advantage enrollees, resulting in plans and providers being overpaid.

The Hospital-Acquired Condition Reduction Program did not improve patient safety in Michigan beyond existing trends, according to an independent evaluation published in Health Affairs. While rates of all hospital-acquired conditions declined from 133 per 1,000 discharges in the pre-program period to 122 in the post-program period, greater improvements were observed for non-targeted measures.  

Maryland legislators announced that the Health Education and Advocacy Unit within the Consumer Protection Division of the Office of the Attorney General closed 1,974 cases in Fiscal Year 2019 and assisted consumers in saving or recovering almost $2.5 million. The Annual Report on the Health Insurance Carrier Appeals and Grievances Process estimates that when consumers seek assistance from the Health Education and Advocacy Unit, carrier denials are overturned or modified over 50 percent of the time.