Rhode Island’s Office of the Health Insurance Commissioner’s affordability standards, created to moderate price growth by incorporating value-based purchasing arrangements in provider contracts are among Rhode Island’s efforts to promote value in healthcare, according to a study in Health Affairs. These efforts resulted in a large increase in commercial insurer spending on primary care services, an increase in the number of primary care providers, lower inpatient and outpatient fee-for-service spending and higher non-fee-for-service spending, primarily on primary care. Additionally, the state created an all-payer patient-centered medical home with payments tied to quality measures. However, quality and use did not change significantly after the implementation of these initiatives. Rhode Island’s laws can serve as a model for other states considering value-based payment models.
Prenatal care utilization and health outcomes for newborns have improved in Oregon in the three-year period following the state’s Medicaid expansion in 2014, according to two studies from Oregon State University featured in Health Affairs. Medicaid expansion was associated with a 2 percent increase in first trimester prenatal care utilization, a 23 percent reduction in preterm births and a 29 percent reduction in low birthweight among babies born to women covered by Medicaid.
A blog in Health Affairs highlights five challenges facing Vermont’s all-payer model (APM): incentivizing participation among providers; properly attributing patients to providers; paying for value; determining how financial risk should be distributed among providers; and overcoming the disadvantages of fee-for-service benchmarks. The all-payer model allows accountable care organizations in the state to receive payments from Medicare, Medicaid and commercial insurers and then align payments and quality measures for providers. While the APM offers theoretical advantages such as economies of scale, aligned incentives and potentially reduced administrative costs, without tax increases or public provision of services, operationalizing the model has been difficult.
New York’s Governor ordered state-run hospitals to stop suing patients over unpaid medical bills, and while most major private hospitals in the state voluntarily followed suit, one chain of hospitals has not, reports The New York Times. Northwell Health, the state’s largest health system, has sued more than 2,500 patients in 2020, despite the pandemic. The Northwell lawsuits each sought an average of $1,700 in unpaid bills, plus large interest payments; however, the system has sued for unpaid bills as small as $700. After this article was published, Northwell announced it would stop suing patients during the pandemic and would rescind all legal claims it filed in 2020.
The Massachusetts Governor signed into law a wide-ranging bill that includes expanding access to telehealth after the COVID-19 public health emergency abates, reports Healthcare IT News. The new law mandates that insurers cover virtual behavioral health services at the same rate as in-person services, rate parity for primary care and chronic disease-management services for two years and rate parity across the board for 90 days past the end of the state of emergency. In addition, the law makes permanent measures to expand scope of practice for a wide range of providers, requires providers to notify patients in advance about whether a procedure is out of network and mandates insurance coverage for all COVID-19 related emergency, inpatient and cognitive rehab services.
Oregon has had a longstanding focus on health equity and employed two foundational strategies that can serve as examples for other states seeking to further their health equity efforts, according to State Health & Value Strategies. The state has been very intentional with language used to describe equity efforts, how key terms are defined and has placed an emphasis on engaging community partners to ensure that the community voice is apparent in state-level policy decisions. The state also developed a framework to demonstrate the importance of moving upstream to the understanding that racism, discrimination and bias impact the health outcomes of people who have been subjected to long-standing, even centuries-old oppression. The development of common definitions and adoption of a framework for understanding where work needs to focus has allowed for robust internal and external coordination and impact around how to work towards achieving health equity.
The Department of Health released results on social determinants of health, health equity and health factors from the 2020 State Health Assessment, according to SHADAC. The report showed that among adults under 65,10 percent did not see a doctor in the past year due to cost. In addition, Black and Hispanic adults were less likely to have health insurance and more likely to not be able to see a doctor due to cost compared to non-Hispanic white adults.
Although Colorado passed a law last year limiting surprise medical bills, the law does not apply to air ambulances, which are regulated by the Federal Aviation Administration, reports The Denver Post. As a result, when a 4-week-old baby was taken to Children’s Hospital Colorado via air ambulance for an urgent surgery, the family was left with a medical bill of nearly $82,000, of which the insurer would pay only $18,000. Ultimately, the family worked with their insurer and the private air ambulance company to negotiate the bill down to $45,000.
Lorraine Rogge was billed $12,387 for a vaginosis, vaginitis and sexually transmitted infections testing panel after experiencing pelvic pain and cramping, according to Kaiser Health News’ Bill of the Month. Her insurer negotiated a rate of $7,172, of which the insurer paid $4,162 and Lorraine was responsible for $3,010. Although Lorraine’s repeated appeals to her insurance company were denied, after a call and email from Kaiser Health News, Carlsbad Medical Center agreed to waive the remainder of her account balance. The big takeaway is to always ask how much tests are going to cost and what exactly you are being tested for, especially when obtaining care from a new doctor.
Ohio has passed a new law to protect residents from surprise medical bills, according to The Center Square. The bill creates a baseball-style arbitration process between the provider and the insurance company—one that does not place patients in the middle. The legislation seeks to stop the practice of patients being charged for out-of-network services at the out-of-network rate when they are performed at an in-network facility.