State News

Starting in early 2020, Idaho will launch a new value-based payment model that will compensate federally qualified health centers (FQHCs) and other providers based on how much they improve the cost and quality of care delivered to Medicaid enrollees, reports NASHP. Idaho Medicaid plans to sign contracts to implement the model in January, with implementation beginning July 1, 2020. Both FQHCs and other types of providers have expressed interest in participating in this value-based model.

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. 

Residents of Mississippi spent nearly 17 percent of their annual wages on health insurance in 2018—the highest in the nation, according to a report from the Commonwealth Fund. Spending on premiums and deductibles outpaced wage growth in every state, with the average spending for a single person’s coverage reaching $749, states the Clarion Ledger. Mississippi’s median family income is among the lowest in the country and the percent of income residents contribute to insurance costs grew by nearly 6 percentage points since 2008. Moreover, Mississippians pay a larger share of the premium for their employer-sponsored coverage.

The governor of Vermont submitted a concept paper to the federal government outlining the state’s approach to implementing the first-in-the-nation drug importation law, according to NASHP. Unlike an earlier submission from Florida that proposes a wholesale importation plan to benefit public programs, Vermont’s plan includes all commercial health plans and is designed to benefit all state residents, not just those on public programs. Vermont proposes to assure consumer savings through a number of vehicles, including lowering premiums and deductibles, and reducing or eliminating copays on imported drugs.

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.