State News

A new report from MedStar Health Research Institute and the Rutgers Center for State Health Policy describes early lessons from Mountain-Pacific Quality Health’s innovative “ReSource Teams” designed to expand access to care in three rural Montana communities. The ReSource teams consist of community health workers and volunteers who visit patients in their homes and consult remotely with registered nurses, pharmacists and behavioral health providers. ReSource Team members shared their perspectives on accessing and combining data sources to track patients’ hospital and social services needs and utilization; using ICD-10 Z-codes to monitor and respond to patients’ social determinants of health needs; and connecting patients to care in the context of limited and highly fragmented community resources.

A new report from the United Hospital Fund, supported by the New York State Health Foundation, examined patient and family decision making around post-acute care, which includes service provided by home health agencies, inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The analysis found a robust evidence base around improving post-acute decision support and provided a number of policy recommendations and solutions to increase supports for patients and their families when making decisions about where to receive post-acute care.

A new Arizona law, set to take effect 90 days after the 2019 legislative session ends, extends the maximum time that residents are allowed to have a short-term insurance plan from one to three years, according to AZ Central. Consumer advocates oppose the “junk plans,” arguing that they hurt consumers because they cover far fewer services than regular coverage. Increasing the contract time, they say, enables insurers to financially benefit at the expense of consumers for longer periods of time. Some states have passed laws restricting short-term plans in an effort to protect consumers. California banned short-term insurance plans altogether and Delaware issued rules limiting short-term plans to three months, with no extensions or renewals.

Three Kansas City-area hospitals are among 17 in Missouri and seven in Kansas that are being penalized by Medicare this year for high infection and patient-injury rates, reports KCUR. Truman Medical Centers, Research Medical Center and Belton Medical Center will see their Medicare payments reduced by one percent because of high rates of complications, as part of the Affordable Care Act’s effort to improve patient care. The article lists the 24 Missouri and Kansas hospitals that have been penalized this year (out of 800 general hospitals nationwide).

Three Kansas City-area hospitals are among 17 in Missouri and seven in Kansas that are being penalized by Medicare this year for high infection and patient-injury rates, reports KCUR. Truman Medical Centers, Research Medical Center and Belton Medical Center will see their Medicare payments reduced by one percent because of high rates of complications, as part of the Affordable Care Act’s effort to improve patient care. The article lists the 24 Missouri and Kansas hospitals that have been penalized this year (out of 800 general hospitals nationwide).

A survey conducted by the Healthcare Value Hub found that one in two Pennsylvania adults struggled to afford healthcare, according to the Philadelphia Inquirer. Alarmingly, Pennsylvanians are coping with their affordability burdens by making decisions that may jeopardize their health such as: delaying care, avoiding getting care, skipping a test or treatment, failing to fill prescriptions or skipping doses. Pennsylvania adults pointed to, in particular, the rising cost of prescription drugs as a “major reason” for high healthcare costs. This is supported by other data that show that prescription drugs are one of the key drivers of high healthcare costs in the U.S. Other data show that certain populations – including medically vulnerable and older Pennsylvanians – are particularly hard hit by soaring drug prices. The survey revealed that there is support across party lines for government actions to curtail unfair prescription drug pricing and unreasonable price hikes.

Nebraskans would get some help avoiding surprise health care bills under a bill heard by the Banking, Commerce and Insurance Committee, reports the Omaha World-Herald. Legislative Bill 569 targets situations in which patients go to a hospital or doctor who is part of their health insurance plan, only to find out when the bills come that part of their care was provided by a laboratory, an anesthesiologist, a pathologist or other provider who is not part of that network. The patient then is saddled with paying higher out-of-network costs, which can be significantly higher than in-network costs.

D.C. residents who call 911 are no longer guaranteed an ambulance ride to hospitals if responding medics and a nurse determine that their ailments are minor, according to The Washington Post. Instead, after an assessment by firefighter and EMT crews, patients who are not in serious straits will be connected (by phone) with a nurse, who will help them find care at a clinic or a primary care facility. The new policy is the city’s latest attempt to deal with a crippling call volume that frequently causes emergency responders to be unavailable for life-threatening situations.

The state of Maryland and CMS signed an agreement to implement the Maryland Total Cost of Care Model, which marks the first time CMS will hold a state accountable for total cost of care incurred by resident Medicare fee-for-service beneficiaries, according to JAMA. This 8-year model began on Jan. 1, 2019, and will test whether accountability for Medicare spending will spur statewide healthcare delivery transformation, potentially reducing expenditures, preserving or enhancing quality for beneficiaries and improving individual and population level outcomes. This model builds on Maryland’s All-Payer Model, providing incentives for hospitals to increase high-value care for patients seeking care from their institutions and their community services by centering improved population health as the foundation for the model to achieve savings.