State News

Prisma Health Greenville Memorial Hospital will be the first hospital in South Carolina to offer home recovery care, designed to keep patients out of the hospital by bringing key elements of inpatient care directly to their homes, according to GSA Business Report. Home recovery care is often beneficial for individuals suffering from non-life threatening, acute medical conditions, and may lower stress and reduce recovery time. So far, eligible patients using the model at other health systems have accepted the option at a 90 percent rate – the care model has resulted in a 44 percent reduction in readmission rates when compared to hospital care delivered in a traditional acute setting.

In an effort to make healthcare more affordable, Blue Cross Blue Shield and Sanitas Medical Center will offer a full-service clinic to provide primary care, urgent care, lab and diagnostic imaging services, care coordination and wellness and disease management programs in one location, according to Chron. They hope the primary-care driven, value-based model will reduce costs by providing affordable access to preventable care, thereby preventing the need for more serious treatment down the line. The key, the organizations believe, is working together to improve healthcare as a whole.

Blue Cross and Blue Shield of North Carolina and Cambia Health Solutions will drop their plans to combine, following the resignation of the North Carolina insurer's chief executive, Patrick Conway, according to the Wall Street Journal. These insurers had initially planned to combine and generate $16 billion in annual revenue, covering over six million people through Blue Cross Blue Shield plans - the new entity was to be lead by Conway. 

For the first time since Colorado opened its health insurance exchange, people will see a drop in coverage prices, according to the Canon City Daily Record. Coverage costs across the state will drop by an average of 20.2 percent. In western Colorado, which has some of the highest health insurance premiums in the U.S., a family of four will save an average of $10,000 per year, according to the Colorado Division of Insurance. The main reason for the price cut is the state’s new reinsurance program, which uses $260 million in state and federal funding to cover some of the most expensive medical costs for those who purchase plans through the marketplace.
 

The Wisconsin Office of the Commissioner of Insurance reports that people in Wisconsin who purchase health insurance on the ACA exchange will have more choices in 2020, according to the Milwaukee Journal Sentinel. The number of insurers selling health plans will increase to five, up from three in 2017. Officials believe that the increased competition on the exchange will keep price increases in check and could even lead to price decreases for the following year. 

Thousands of former patients at Deaconess and Valley hospitals will have medical debts erased as part of a major legal settlement with Community Health Systems (CHS), a struggling for-profit hospital chain, according to The Spokesman-Review. The settlement comes more than two years after the Empire Health Foundation sued CHS, alleging the company failed to provide the levels of charity care that it had promised when buying the hospitals from Empire Health Services in 2008. CHS also agreed to pay the foundation $20 million to create a political lobbying arm, the Empire Health Community Advocacy Fund. 

With enrollment for Minnesota’s health plans set to begin, many are watching to see the effects of insurers’ recent announcements of insulin out-of-pocket caps, according to the Star Tribune. Those who purchase coverage through MNsure or from Medica and UCare will have their out-of-pocket spending on each insulin prescription capped at $25 per month, regardless of annual deductibles. When asked, insurance companies have explained that an amendment in the state’s recent omnibus healthcare spending law makes it illegal for Minnesota insurers to profit from selling insulin. Consumers who use insulin note that it is an important necessity for them, but that other medical necessities are still expensive, like insulin pumps and glucose monitors.

The Michigan Department of Health has proposed removing pharmacy benefit managers (PBMs) from overseeing prescription drug claims and negotiating prices for the state’s Medicaid program in a hope to save Medicaid dollars, according to Modern Healthcare. The department expects the proposal will save the state about $40 million, streamline administrative processes and ensure uniform drug coverage for Medicaid enrollees. Other states have stopped outsourcing prescription drug services to PBMs after studies found that PBM prices often exceed Medicaid fee-for-service drug prices. While PBMs defend their practices by stating that they address high drug prices by negotiating payment rates from pharmaceutical companies by leveraging formularies and utilization management tools; critics assert that PBMs have an incentive to prioritize high-priced drugs over more cost-effective alternatives.

Nexus Montgomery, a collaboration between six competing Maryland hospitals, has created a cross-continuum of care partnership that includes skilled nursing facilities, according to Home Health Care News. The goal of this pilot is to leverage non-medical home care to help consumers live safely and independently in their homes. As hospitals are subject to financial penalties for high readmission rates, especially within Maryland’s global budget system, pilots such as this one may help keep people healthier and out of the hospital.