North Carolina’s largest insurer says that its push to reform its payment system through value-based care has already saved more than $153 million in its first year of operation, reports the Triangle Business Journal. Blue Cross Blue Shield of North Carolina launched its value-based care plan, Blue Premier, in January 2019, alongside five of the state’s largest hospital systems, replacing the traditional “fee-for-service" model and reimbursing providers on quality of care rather than quantity of services provided. The company says it has generated an estimated $153 million in cost savings, quality improvements and a slowdown in the rate of spending on healthcare. In addition, Blue Premier physicians increased screenings for colorectal cancer by 3,041 members and controlled blood pressure for 13,412 more members than in 2018, showing health benefits alongside cost savings.
New York has slashed health insurers’ requested rate hikes by an average of 85 percent, reports Syracuse.com. Health insurers had asked the state for an average increase of 11.7 percent for policies sold in the individual market. The state gave them an average increase of 1.8 percent, which the state Department of Financial Services said is the lowest increase for individual health plans in a decade. This decision comes in light of the fact that some insurers reported record profits for the first half of the year due to postponement of elective and non-emergency services, resulting in lower than expected claim payouts. The Department says these profits could be offset by higher than expected claim payouts in the second half of 2020 and in 2021.
In mid-April, Pennsylvania state officials announced the creation of a COVID-19 Response Task Force for Health Disparity to help communicate issues about how the pandemic is affecting the state’s minority and marginalized populations. After months of weekly meetings and outreach from task force members to marginalized community members, the task force completed a report that includes six recommendations focused on these policy topics related to health disparity, ranked in order of urgency: housing, criminal justice, food insecurity, health disparity, education and economic opportunities. According to the report, each area either directly or indirectly affects the health of Pennsylvanians and must be addressed to appropriately remove the disparities that have existed for generations and have been exacerbated by the pandemic.
Ohio’s “minority health strike force” has issued a report containing 34 recommendations aimed at dismantling racism, removing public health obstacles, improving the social, economic and physical environments and strengthening data collection to better track disparities. These efforts are part of the state’s developing blueprint to reduce health inequities, the Columbus Dispatch reports. African Americans make up around 14 percent of Ohio’s population but comprise close to 19 percent of the state’s COVID-19 deaths, according to data from the Ohio Department of Health.
Payers can reduce unnecessary healthcare spending by incentivizing consumers to choose lower-cost healthcare providers, reports HealthPayerIntelligence. Focusing on Suffolk County, Massachusetts, the study from the Pioneer Institute used data from the Massachusetts Center for Health Information and Analysis to track resident healthcare spending on 16 services. They compared the cost difference between services used in 2015 and what they would have been had residents gone to lower-priced providers. The health system could have saved nearly $22 million in one year. To incentivize members to transition toward lower-cost providers, researchers recommend rewards and cash-back programs.
Half of New Jersey adults experienced problems affording healthcare in the past year and three-fourths worry about affording it in the future, according to the latest Consumer Healthcare Experience State Survey by the Healthcare Value Hub. In a press conference consumer advocates from New Jersey, a patient facing high drug costs, U.S. Senator Cory Booker and New Jersey Assemblyman John McKeon all spoke on the issues of high drug costs facing their communities and constituents. Assemblyman McKeon has sponsored a bill to create a Prescription Drug Affordability Review Board, reports New Jersey 101.5, to meet every six weeks, evaluate drug prices and set limits on how much payers pay for high-cost prescription medications – a policy that received widespread bipartisan support in the Hub’s New Jersey survey.
The Department of Family and Community Medicine at the University of Alabama at Birmingham has been awarded a $7 million grant to address the need for training additional family medicine physicians to serve in rural and underserved areas of the state, reports the Birmingham Times. The grant, from the U.S. Department of Health and Human Services, will enable the department to develop high school and college pipeline programs, medical student programming and faculty development programs to enhance curriculum and mentoring efforts. The University of Alabama at Birmingham has laid the groundwork for the enriched training program – the Comprehensive Urban Underserved and Rural Experience (CU2RE).
The Pennsylvania Insurance Commissioner released the 2021 requested rate filings for health insurance plans under the ACA, highlighting that the average rate requests would result in an average decrease in premiums in the individual market, allowing consumers greater flexibility and increased access to affordable, comprehensive coverage, reports the Pennsylvania Pressroom. Key initiatives, like establishing a state-based health insurance exchange and reinsurance fund, have driven down premium rates for 2021 and are the reason that premiums are, on average, going down in the individual market.
Proponents are continuing to set up the Colorado Purchasing Alliance, despite setbacks caused by the coronavirus, reports the Colorado Sun. The alliance, a group that brings together employers and individuals to use their collective leverage to negotiate better deals from providers and insurance companies, will launch in 2021 with as many as 200,000 people enrolled. Similar to the other purchasing alliance in Colorado, the Peak Health Alliance, the Colorado Purchasing Alliance aims to significantly reduce healthcare costs and improve coverage.
A 2013 payment reform implemented by Oregon’s Medicaid program was associated with a 42.4 percent relative reduction in traditional primary care services—driven primarily by decreased use of imaging services, according to Health Affairs. The payment reform changed the Medicaid program’s reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. The authors stated that Oregon’s initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.