Vermont is the first state in the nation to approve importation of less-costly prescription drugs from Canada, according to NASHP. The new law creates a wholesale importation program to purchase high cost drugs through authorized wholesalers, who will purchase the drugs in Canada and make them available to consumers through an existing supply chain that includes local pharmacies. The law requires the Vermont's Agency for Human Services to work with stakeholders and the federal government to design and submit an importation proposal to the state legislature by Jan. 1, 2019. The agency must also submit its proposal to the federal government for final approval by July 1, 2019. The program must be operational within six months of approval of the financing strategy, certification and federal government sign-off.
The Centers for Medicare and Medicaid Services (CMS) approved Maryland’s request to continue and expand its unique all-payer model, according to Modern Healthcare. Under the model, the state is exempt from typical Medicare regulations and has the unique ability to set its own rates for hospitals. Starting Jan. 1. 2019, doctors' offices and nursing homes can voluntarily participate in the program as well. Through this model, Maryland officials aim to coordinate care better across hospital and non-hospital settings, including mental health and long-term care services.
Social workers, nurses and others coordinating care for high-need patients often work independently and with limited funding. Vermont’s three largest payers have committed to providing these individuals with additional financial support, and OneCare -- the state's largest ACO -- provides training and technology to help care coordinators collaborate. This report by the Commonwealth Fund highlights the Vermont ACO’s community-driven approach to care coordination, which may offer lessons about wringing greater value out of a fragmented health care system.
Most plans on the individual insurance market are likely to see steep price increases next year, with one going up nearly 85 percent. Doug Gray, executive director of the Virginia Association of Health Plans, stated that the most immediate reason for rising costs is President Donald Trump’s decision to cut cost-sharing reduction payments after Congress failed to repeal the Affordable Care Act, according to Richmond Times Dispatch. Virginia legislators expressed dismay at the rising prices and blamed them on the Trump administration’s actions. Gray added that the insurance rates also reflect the rising cost of hospital stays and prescriptions, among other things.
A new Connecticut law requires drug companies, health insurers and pharmacy benefit managers to disclose a wide range of drug pricing information to the state, reports CT Mirror. Key provisions that go into effect on Jan. 1, 2020, include: requiring drug companies to justify potentially unwarranted drug price increases over specified periods of time; requiring insurers to identify the 25 drugs with the highest cost to the plan, the 25 with the greatest year-over-year price increases and the 25 most frequently prescribed, as well as the premium growth that is attributable to prescription drugs; and requiring PBMs to report how much they collect in rebates and the share that they keep. Insurers will also be required to report whether they use the rebates to offset premiums or pass the money down to residents at the pharmacy counter. The bill does not include a previous requirement that the majority of rebates from drug companies be passed down to consumers when they buy drugs at pharmacies.
Illinois received federal approval for a state Medicaid waiver that will allow service providers to offer more care for individuals suffering from mental health and substance abuse disorders, according to an article in The Daily Northwestern. The Centers for Medicare and Medicaid Services approved the state’s application for a waiver, clearing the way for the state to use $2 billion of federally allocated Medicaid funds to invest in 10 new pilot projects that aim to improve patient experiences, including ones around mental health, violence, public safety and opioid abuse.
Telehealth has proven its value in providing much-needed mental health services to Armed Forces members and veterans dealing with PTSD. Now a Florida VA center is tweaking that platform to give veterans access to a unique form of therapy, according to an article in mHealthIntelligence. The Gainesville-based Malcom Randall VA Medical Center is seeing positive results with its Telehealth Creative Arts Therapy program, in which veterans dealing with PTSD connect via virtual visits with therapists offering treatment through music, movement and visual arts. The program is one of several telehealth services launched by the VA and Department of Defense to connect service members and veterans with healthcare outside of the often-crowded walls of the nearest VA hospital. Such programs also serve to improve access and health outcomes for veterans who can’t easily get to the nearest hospital or clinic or don’t want to go there.
According to the Observer-Reporter, a Pennsylvania Health Care Cost Containment Council report found that acute care hospitals statewide experienced a decrease in the amount they spent on uncompensated care in fiscal year 2017. However, the four hospitals in Washington and Greene counties had mixed marks on uncompensated care, which is uncollected debt and charity care. That was the fourth consecutive year, PHC4 noted, the percentage fell.
More than a third of Pennsylvania hospitals lost money running their facilities in Fiscal Year 2017, a 30 percent increase from the previous year, according to The Morning Call. But statewide hospitals are doing relatively well--with combined profits of $2.4 billion. Hospitals are under pressure to cut costs and implement programs that manage the health of their local communities, which can mean decreased payments and increased costs. These demands are particularly hard on smaller and rural hospitals, according to the Hospital and Healthsystem Association of Pennsylvania.
The Office of Hawaiian Affairs released a study on the health and well being of Native Hawaiian women (wahine) to follow an earlier study on the health of Native Hawaiian men, reports State of Reform. The report focused on six primary areas of review: mental and emotional wellness; physical health; motherhood; intimate partner violence and incarceration; economic well-being; and leadership and civic engagement. Recommendations include increased community and cultural investment, favorable policy enforcement and improved research and data.