State News

Two Minnesota healthcare giants—Mayo Clinic and Blue Cross blue Shield of Minnesota—have agreed to a unique five-year contract that will downside risk and eliminate some prior authorizations, according to Modern Healthcare. This change will be implemented in part to lift restrictions on Mayo Clinic’s patients with serious or complex illnesses and make coverage more seamless under Blue Cross policies. Both companies have decided it is better to work together rather than aiming administrative artillery at each other. The agreement will add more conditions and treatments that don’t need prior authorization under the new contract, and will expand the amount of value-based care that will take place between the companies.

Portland nonprofit Project Access Now, working with charitable funding from the metro area’s nonprofit hospital systems, has expanded its program offering free or heavily discounted generic drugs to working-class people with high-deductible health plans. According to The Lund Report, program participants pay either $4 per prescription or get their medications at no cost. Linda Nilsen, the executive director of Project Access Now, stated that, “pharmaceutical access is key to assuring improved health outcomes -- the remaining uninsured and underinsured still face significant barriers to getting the medications they need.” She believes that access to pharmaceuticals is key to improving health outcomes.

Marilyn Bartlett, the director of Montana’s Health Care and Benefits Division got an urgent directive from state legislators in late 2014 to get healthcare costs under control, or else, according to Kaiser Health News. Bartlett designed a new way for the state to do business with hospitals, which accounted for 43 percent of employee healthcare costs. The state began giving these facilities a “reference price” or how much they would be willing to pay for each hospitalization, using Medicare rates as a baseline, and ultimately deciding to reimburse at 234 percent of Medicare rates. Despite some initial opposition from hospitals, after two the state is calling the effort a success. Montana saved $15.6 million compared to what they would have paid without the change. Their reserve fund has even grown so much the state has used it for other needs.

A California Nurses Association (CNA) analysis of hospital financial data reveals a 33 percent drop in the overall amount of charity care provided by California’s nonprofit hospitals from 2011 to 2016, reports State of Reform. The California Hospital Association suggests that the drop demonstrates that patients need less help covering medical bills due to increased insurance coverage under the Affordable Care Act. However, the CNA report shows that despite lower uninsured rates, there are still 12 million Californians struggling to pay medical bills. The analysis reveals that, during the same time period, nonprofit hospitals accumulated nearly $37 billion in profits.

The Alaska Division of Insurance solicited comments on two topics related to healthcare costs, according to State of Reform. The division is seeking proposals for amendments or alternatives to the 80th percentile rule, with particular focus on alternatives that address the potential impacts on the cost of care and protect consumers from surprise balance billing. A recent report by the University of Alaska found that the 80th percentile rule likely has driven up costs. The division is also surveying small business employers to identify issues and barriers to affordable coverage. This is the first step towards applying for a second 1332 Innovation Waiver to address costs in the small-group market, as premium increases have averaged more than 31 percent over the past two years.

New data from Ohio's Quantum Health reveals that its Precision Specialty Pharmacy Management program reduced cost by 55 percent, or an average of over $80,000 per case annually, for members transitioning from insurance carriers to the company's consumer healthcare navigation model. According to Markets Insider, Chief Medical Officer Dr. Dana Andrews attributes the results to the company's active collaboration with the members and their providers to identify those who could receive the medication in a more cost-effective site of care. Currently in the U.S., the 1 to 2 percent of people who take specialty medications drive nearly 40 percent of all drug spending.

Early figures in Rhode Island are showing overdose-related deaths are in decline compared to previous years, according to The Westerly Sun. Statistics from the Rhode Island Department of Health indicates the states’ overdose rate in January 2018 is the lowest rate for January since 2012. And, the February 2018 overdose death rates are the lowest February rate since 2013. Officials say there is still a lot of work to do to address the epidemic; it is a fluid process and the state will continue to use a data focused approach. One initiative that has had an immediate impact was the implementation of an addiction-treatment program at the Adult Correctional Institution, resulting in a 61 precent decline in post-incarceration overdose deaths.

Roughly two-thirds of Texans say the state government is currently not doing enough to make sure low-income adults can get the healthcare they need, and the same share says the state should expand its Medicaid program, according to a Kaiser Family Foundation survey. One of 17 states that did not expand Medicaid under the Affordable Care Act, Texas has the largest number of uninsured residents among U.S. states (21 percent of adults between the ages 19-64). An almost equal number of respondents said top priority should be given to lowering what individuals pay for care (61 percent), reducing maternal mortality (59 percent), lowering prescription drug costs (56 percent), increasing access to health insurance (55 percent), and increasing funding for mental health programs (54 percent).