State News

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.

New Hampshire highly regarded NH HealthCost transparency tool does not always discuss facility fees, which are increasingly common, according to the New Hampshire Union Leader. These fees are applied by medical offices, urgent care centers and clinics affiliated with hospitals to better spread costs across the network to boost revenue, but they’re poorly disclosed and carry a high cost compared to the services provided. Though some insurance companies are working to reimburse more for facilities fees, customers can still be caught off guard. Consumers want more easy-to-use transparency tools. 

Legislation aimed at overhauling Massachusetts’ healthcare system was introduced this month, according to the Boston Globe. Among other things, the legislation would require an increase in spending by hospitals and insurers of 30 percent over three years for primary care and behavioral health, without increasing overall spending. This move to reshape the delivery of services reflects the concern that less than 15 percent of total medical expenses are spent on primary care and behavioral health combined. In addition, this legislation would streamline the behavioral health provider credentialing process. Also of note, this legislation would seek to create more extensive state oversight of drugs that cost over $50,000 per person per year, even if bought through the private market.

A report from Massachusetts’ Attorney General finds that alternative payment models did not shift care to lower cost providers, as frequent plan-switching by patients and the administrative complexity of the arrangements limited the effectiveness of the models, according to RevCycleIntelligence.

Recently released data from the New York Department of Financial services has revealed that the state’s arbitration process, created through legislation in 2018, may substantially increase what New Yorkers pay for healthcare, according to a report by USC-Brookings Shaeffer Initiative for Health Policy. New York’s recent law uses what’s known as a “baseball-style” arbitration process, through which the arbiter must decide whether final payment should be the insurer’s initial allowed amount or the provider’s charges. Researchers’ main concern is the state’s guidance that arbiters should consider the 80th percentile of billed charges when determining the final payment amount, and the data reveal that arbitration decisions have averages 8 percent higher than the 80th percentile of charges. Therefore, researchers believe that high out-of-network reimbursement attainable through arbitration has likely increased emergency and ancillary physician leverage in negotiations with commercial insurers, leading to providers dropping out of networks to obtain higher payment, thereby extracting higher in-network payment rates, or some combination, which would increase premiums.

The Oklahoma Health Care Authority announced the statewide expansion of a pilot program to improve the health of Medicaid members with chronic conditions by optimizing their medication. A secure data platform analyzes social, medical and behavioral data to identify health needs, barriers to care and dangerous gaps in care. The platform then uses artificial intelligence to generate personalized treatment plans according to clinical best practices, which it sends to patients’ providers. Plan implementation is monitored to ensure that patients remain on track.

Hot spot maps identify key areas in New York City where Medicaid intervention and social determinants of health ( programming have the potential to help improve the health of individuals, according to a report from the United Hospital Fund. Several current initiatives offer promising strategies to tackle social determinants that could benefit from the use of these hot spot maps, including New York Medicaid’s reform initiative, the Delivery System Reform Incentive payment (DSRIP) program, the Healthy Homes value-based payment pilot and others.