Between 2010 and 2012 in Massachusetts, Health Maintenance Organizations (HMOs) used physician cost control incentives but Preferred Provider Organizations (PPOs) did not, and the HMOs had a slower cost growth, according to researchers from Columbia University and Harvard University. Researchers were looking at the evolution of health insurer costs, paying attention to the composition of enrollees and determined that cost growth cannot be understood without account for (1) consumers' switching between plans and (2) differences in cost characteristics between new entrants and those leaving the market. Over the period of this study, HMOs were using a global payment model and had a slower cost growth than the PPOs who did not have a global payment model for their physicians. However, healthy patients were also switching over to HMO plans and sicker patients were switching out of them. When these factors were controlled for in the study, there was substantially higher growth costs for all plans, though growth was still higher for PPOs than HMOs. This demonstrates a need to test global payments into larger market to evaluate the relationship of physician incentives in changing market structures, prices, and referrals.
A new Oregon law requires pharmaceutical manufacturers to publicly disclose reasons for steep increases in drug prices, according to the Portland Tribune. Specifically, when the price of a prescription drug increases by more than 10 percent, the manufacturer is required to report the reasons to the Oregon Department of Consumer and Business Services. The information reported must include the cost of production of the drug, advertising, marketing, research and profits from the drug, and whether there are generic alternatives available. Civil penalties of up to $10,000 per day for noncompliance are built into the law.
According to Providence Business News, an analysis of Partners Healthcare of Massachusetts' proposed acquisition of Care New England may threaten the affordability of Rhode Island's commercial health insurance premiums through rate increases. However, Health Insurance Commissioner Marie L. Ganim is confident her office can keep rates reasonable.
Nebraska’s chapter of the Visiting Nurse Association (VNA) is launching a telehealth program to improve care management and coordination for its home-based patients, according to an article in mHealth Intelligence. The Omaha-based VNA is deploying 4G tablets with preloaded software and Bluetooth-connected devices to enable patients to gather and transmit vital signs to caregivers. The tablets also provide information and daily reminders on medications and other health-related tasks. With reimbursement for home telehealth programs limited, many of these services are either funded through grants or covered by the healthcare provider. Other programs are exploring alternative paths to sustainability.
In the recent teachers strike in West Virginia, teachers were striking because of low pay increases, however they were also upset over rising healthcare costs that takes up any pay increases that are received, according to a story in U.S. News & World Report. While the teachers have agreed to return to work for a 5 percent pay increase, in the long run that may prove to be insufficient as healthcare costs rise faster than inflation. The story argues that the real lesson to be learned from West Virginia’s teacher strike is that it is time to get serious about bringing down healthcare costs.
A new report published in Health Affairs evaluated Oregon’s Coordinated Care Organizations’ (CCOs) progress towards the elimination of health disparities using claims-based measures of utilization, access and quality to assess baseline disparities and test for changes over time. The CCOs’ transformation and implementation of health equity policies was associated with reductions in disparities in primary care visits and white-black differences in access to care, but no change in emergency department use, with higher visit rates persisting among black and American Indian/Alaska Native enrollees, compared to whites.
The integration of podiatric services could enhance chronic care management, improve health outcomes, reduce healthcare costs and ultimately benefit the shift toward value-based care, according to an article in HealthITAnalytics. A study was conducted on podiatric interventions and their effect on diabetes, obesity, back pain and fall prevention care. These conditions have a significant impact on New York residents: approximately two million New Yorkers have diabetes, 25 percent of whom develop foot ulcers. Researchers found that for diabetic patients with foot ulcers, podiatric services had the potential to reduce approximately 13,500 inpatient admissions annually and could save nearly $510 million in diabetes costs. In obese patients, podiatric treatment could reduce subsequent inpatient admissions by approximately 19 percent and save almost $1.1 billion in healthcare costs.
Rural hospitals are having trouble providing healthcare to their patients, and officials say the Florida Legislature’s budget plan isn’t likely to help, according to an article in Florida Trend. Last year, Florida’s Legislature cut $521 million from Medicaid funding—$11.4 million of which affected rural community hospitals. For example, because of state cutbacks, Doctors’ Memorial Hospital in rural Perry, Florida was paid approximately $2.5 million less than the cost to treat Medicaid patients between 2015 and 2017. It varies by hospital, but nearly half of rural patients rely on government plans like Medicare and Medicaid. Many rural hospitals also face the issue of providing care to uninsured patients who may not be able to afford their care. The Senate’s proposal offers $50 million in new funding for hospitals to balance last year’s cuts. However, the House’s budget plan would cut an additional $2.9 million in funding for rural hospitals.
According to an article in WDHN, Statera Health announced they have signed a Value-Based Medicare Advantage agreement with United Healthcare for its Medicare subscribers in Houston County, Alabama. Statera is southeast Alabama’s population health organization, and is an affiliation between local physicians, Statera and Southeast Alabama Medical Center (SAMC). Statera’s mission is to enable SAMC, and local physicians, and payers like United Healthcare to collaborate together with the goal of balancing healthcare costs in the community with improving quality healthcare for our patients. The goal of Statera’s coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.
A new report by the Massachusetts Health Policy Commission highlights widespread variation in per patient spending among the state's 14 largest healthcare providers, according to Modern Healthcare. Providers affiliated with academic medical centers generally spent more than other types of organizations, with spending differences between the highest and lowest cost providers exceeding $1,500 per patient. The commission recommended bolstering competition, increasing transparency, improving incentives for payers and purchasers to seek out high-value care, and implementing alternative payment models to reduce variation.