State News

Gov. Bruce Rauner announced plans to revamp the state’s Medicaid program, saying the changes could save money and improve health, according to the Chicago Tribune. The plan would expand Medicare managed care programs to 80 percent of Illinois residents on Medicaid and cut the number of insurers from 12 to 7. The plan also calls for more focus on coordinating care for patients and paying doctors and hospitals based on results rather than just for services.

A staggering number of Texas patients who go to in-network emergency departments still get hit with out-of-network fees, according to WFAA. A study by the Center for Public Policy Priorities found 40 in-network hospital emergency departments (EDs) where patients with Blue Cross Blue Shield, Humana or UnitedHealthcare are almost guaranteed to get a surprise medical bill, since 95 percent of their doctors are out of network. The report also identified 23 in-network hospital EDs at which surprise billing rarely happens.

The annual Kentucky Health Issues Poll revealed the cost of healthcare continues to prevent a significant number of Kentucky adults from obtaining needed medical care, as reported in the Lane Report. The poll found that 22 percent of adults in the state reported that a person in their household delayed or missed needed care due to cost. The rate has been essentially unchanged for the past three years.  

The rate at which Illinois hospitals are abstaining from managed Medicaid plan networks is being referred to as a “crisis,” according to Modern Healthcare. In 2011, the state passed a law requiring 50 percent of the state’s Medicaid population to enroll in a managed care plan by 2015. Some hospitals, however, are hesitant to be in these networks, citing unresolved issues related to issues in medical management, claim payments and credentialing of physicians.

Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.  

Medicaid Accountable Care Organizations in Colorado and Oregon both achieved improvements in service utilization, cost and quality of care, according to a new study in JAMA Internal Medicine. Oregon’s ambitious Coordinated Care Organizations were marked by heavy federal investment and a move to global budgets while Colorado’s Accountable Care Collaborative involved a much smaller state investment and retained fee-for-service provider reimbursement. The study showed that smaller investments such as Colorado’s can nonetheless lead to significant improvements.  

There are wide variations in the use of back surgery across the country, according to this New York Times article. The authors explore possible reasons for treatment variations, noting the fact that Casper, Wyo., has the highest back surgery rate in the country. Rates of Medicare back surgery in 2014 ranged from 3 per 1,000 in the Bronx, N.Y., to 11.5 per 1,000 in Casper.

Saint Luke’s Health System and UnitedHealthcare have launched an accountable care program to reduce healthcare costs and improve quality, according to Kansas City Business Journal. The program helps providers identify high-risk patients and increase care coordination efforts, including sharing patient records. As an incentive, if providers reduce the cost of a patient’s care and meet health outcome expectations, they split the savings with the Centers for Medicare and Medicaid Services.

A new task force, the Task Force on Responsible Retirement Reform for Local Government, has been created to address problems with pension and healthcare costs in Michigan, according to MI News. Recommendations from the task force are expected to be submitted to the Gov. Snyder in Spring of 2017. Members include subject matter experts who represent labor and management, investment managers, insurance and finance professionals and legislators.