State News

Healthcare Rising Arizona – an advocacy organization backed by a California-based labor union – filed a 2020 ballot initiative that aims to improve Arizonans’ health and hospital care, according to Chamber Business News. The initiative will address four main areas: patient billing, by requiring providers to offer refunds if patients are overcharged; infection control, by holding private hospitals to national safety standards; new wage mandates for hospital workers, with annual wage increases for four years; and pre-existing conditions. Healthcare Rising Arizona says the initiative is designed to reduce deaths and lower costs, allowing hospitals to focus on improving patient care. Healthcare organizations argue that it would increase patient costs; mandate an increase in health care workers’ salaries regardless of performance; and claim responsibility for improvements already being made by the federal government, the state and local healthcare providers.

Sunflower, a subsidiary of Centene, will be required to issue more than $25 million in health insurance rebates to nearly 19,000 Kansans who purchased Ambetter individual health plans, reports KCUR. The rebates are required by the Affordable Care Act (ACA), which specifies that insurers must spend a certain proportion of what they collect in premiums — usually 80 percent — on their members’ healthcare. The rest can go toward the company’s own costs and profits. Sunflower’s hefty refund puts Kansas’ average rebate at more than $1,000, or seven times the national average. The state’s insurance department, which regulates premiums, has asked Sunflower for information about how it landed so far above the ACA threshold.

In 2018, Massachusetts met the Total Health Care Expenditures benchmark set by the Health Policy Commission, growing by 3.1 percent to $8,827 per resident, according to analysis by the Center for Health Information and Analysis. The report also notes that the public insurance program, MassHealth, launched its accountable care organization (ACO) program in 2018 and shifted more than 60 percent of its members to an ACO in that year. Alternative payment model (APM) adoption declined slightly among commercial health plans in 2018, especially within smaller plans.

California enacted a first-in-the-nation state law to combat pay-for-delay deals, in which brand-name pharmaceutical manufacturers pay a generic competitor to settle patent litigation and keep a lower-cost version of the drug off the market, reports NASHP. Delaying market entry of generic drugs can keep prices for brand-name drugs high, costing California consumers an estimated $3.5 billion in higher drug costs each year.

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.