State News

A 2019 analysis by the Washington Health Alliance found a 10 percent decrease in wasteful spending in the state’s commercially insured population and a 24 percent decrease in wasteful spending in the Medicaid population from 2014-2017, reports State of Reform. Despite significant progress, wasteful spending continues to be an issue, as 51 percent of the 9.5 million services examined were deemed “low-value” and likely representing unnecessary spending. 

Few Massachusetts consumers know how to get price information before a procedure, despite the state’s 5-year old transparency provisions, according to a Becker’s Hospital Review analysis of a poll by the Pioneer Institute and DAPA Research. Indeed, seventy percent of respondents said they want to know the price of a medical service before obtaining it, though thirty-two percent of respondents said they don’t know whether their insurance company has a website or cost estimator tool that would allow them to compare out-of-pocket costs. Researchers believe this shows that though the public wants transparency in their healthcare prices, easy access is not yet a reality.

D.C.’s Medicaid program is the first in the country to receive approval for a demonstration project that will use federal Medicaid money to pay for patients with severe mental illness to be treated in large residential psychiatric institutions and treatment centers, according to Modern Healthcare. Medicaid currently prohibits payments to institutions with more than 16 beds, which behavioral health advocates claim has contributed to the high unmet need for the treatment of both mental health and substance use disorders.

Researchers looking into North Carolina’s Medicaid program released a case study detailing the poor health outcomes and high-cost Medicaid beneficiaries in Graham County, North Carolina, and paired these stories with policy recommendations to reorient the Medicaid program around patient needs, according to a Health Affairs blog post. Graham County has seen a gradual decay of outpatient care delivery infrastructure, and patients suffer from a lack of providers and lack of transportation, often forcing them to use emergency medical services as primary care or for transportation. Policy recommendations include investing in telehealth, deploying the existing workforce more efficiently, and empowering local officials by providing them with adequate funding for the increased responsibilities they shoulder.  

Florida has launched the Florida Health Price Finder website, which gives residents the ability to search for prices on non-emergency medical procedures in the state, according to ABC News. Some healthcare advocates are critical because the website only provides average numbers from a few years ago, which may be out of date. Moreover, the tool does not take Medicare and negotiated rates into account. The Florida Hospital Association has also called the validity of the data into question. 

According to a new report by Mental Health America, South Carolina ranks 44th overall in the nation for mental health problems and access to proper care, explains the Charleston City Paper. In the past five years, South Carolina has dropped 11 places in the ranking.  

California regulators rejected a proposed merger between Adventist Health System/West and St. Joseph Health System, citing concerns that the transaction could increase healthcare costs and limit access to healthcare services, according to Modern Healthcare. Consumer advocates support the decision, despite the systems’ claims that the merger would boost access to quality care for vulnerable and underserved populations throughout Northern California.

Oklahoma ranks in the top ten for states with the highest rates of surprise medical bills, reports Oklahoma Watch. A study by the Peterson Center on Healthcare and the Kaiser Family Foundation found that one in five emergency room visits in Oklahoma resulted in at least one out-of-network charge for patients with employer-sponsored health plans in 2017. Despite several legislative attempts, Oklahoma remains one of 25 states without laws protecting patients against out-of-network surprise bills as of 2019.  

Oklahoma ranks in the top ten for states with the highest rates of surprise medical bills, reports Oklahoma Watch. A study by the Peterson Center on Healthcare and the Kaiser Family Foundation found that one in five emergency room visits in Oklahoma resulted in at least one out-of-network charge for patients with employer-sponsored health plans in 2017. Despite several legislative attempts, Oklahoma remains one of 25 states without laws protecting patients against out-of-network surprise bills as of 2019.