State News

A new North Dakota law establishes a reinsurance pool for the individual health insurance market, reports the Insurance Journal. The bill, backed by the North Dakota Department of Insurance, creates a reinsurance mechanism called “invisible” reinsurance. A study conducted by the department in 2018 shows that the invisible reinsurance pool would reduce premiums and provide a low-cost alternative for healthier individuals. This would result in more individuals with health insurance, a more stable individual market and protection for health insurance companies from unpredictable high cost claims.

In South Carolina, a law originally written to help state and local governments collect debts is being used by private companies to seize tax refunds from people with past-due medical bills, according to The Post and Courier. In 2017 alone, healthcare organizations took approximately $92.9 million in more than 172,000 seizures to pay off medical debt. The program makes big money for the state—the Department of Revenue earned $12.6 million in 2017 through the fees for its collection programs. Tragically, about a third of the state’s population under 65 has past-due medical bills. This debt collection program is especially harmful for low-income individuals who rely on their tax refund. This program is also troublesome because a reviewof five years of Medicare’s investigations of hospitals showed 30 percent of claims have errors. It is often difficult for consumers to get their money back even if they were billed incorrectly.

Patients in the Kansas City region who are fed up with the bureaucracy of the health insurance industry are ditching the copays and high deductibles for a different way to get primary care, reports KCUR. Instead of using the traditional system, patients are turning to “direct primary care” clinics consisting of doctors who offer membership-based healthcare services, rather than accepting insurance. At one clinic, patients pay a monthly fee for unlimited routine visits and direct phone/email communication with their provider. Although their services are limited to primary care, these clinics offer a lifeline for patients who cannot afford the high cost of health insurance.

Patients in the Kansas City region who are fed up with the bureaucracy of the health insurance industry are ditching the copays and high deductibles for a different way to get primary care, reports KCUR. Instead of using the traditional system, patients are turning to “direct primary care” clinics consisting of doctors who offer membership-based healthcare services, rather than accepting insurance. At one clinic, patients pay a monthly fee for unlimited routine visits and direct phone/email communication with their provider. Although their services are limited to primary care, these clinics offer a lifeline for patients who cannot afford the high cost of health insurance.

Governor Gavin Newsom announced that Los Angeles county, one of the largest public purchasers of prescription drugs in California, will partner with the state to use their combined market power in an attempt to lower the cost of prescription drugs, reports The State Network. This announcement follows an executive order the governor signed directing California agencies to consolidate pharmacy purchasing authorities. The state Legislative Analyst’s Office reported that the Medi-Cal component of the executive order could potentially save the state hundreds of millions of dollars annually by increasing Medi-Cal’s bargaining power.

Policymakers in Grand Rapids, Michigan worked with Invest Health, a project of the Robert Wood Johnson Foundation and Reinvestment Fund, used data from the NYU School of Medicine’s City Health Dashboard (CHDB) to compare Grand Rapids’ data to the national average for many social and economic factors, physical environment, health outcomes, health behavior and clinical care, according to a blog post. The project’s Economic Opportunity Dashboard shows economic inequities and brings together historical data on city investments, citywide and by neighborhood. Based on findings from the Dashboard, academics and policymakers developed strategies to address the social and economic barriers identified as leading to disparate health outcomes in the Neighborhoods of Focus (the city’s first and third wards).

New billing practices at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) could ease the financial burdens of patients seeking care at the community hospital — 94 percent of whom are uninsured or covered by Medicare or Medi-Cal, according to TIME. The new policies would create income-based, out-of-pocket maximum costs for patients; make more patients eligible for financial assistance; ensure that out-of-network patients are billed the same amount as in-network patients; and end the practice of balance billing, through which patients are charged for costs their insurer declines to cover. The recommended changes were developed by San Francisco’s public health department at the request of the Mayor and Supervisor.

Creating health equity through public policies is the focus of a new report. The report identifies 13 policy priorities for improving health and well-being in the state, and recommends a comprehensive series of actions to close health gaps, broaden opportunity and ensure that everyone in New Jersey—no matter who they are, where they live or how much money they make—can live the healthiest life possible.

A collective in Summit County, home to 30,000 people in Colorado, is implementing a novel strategy to address high healthcare costs, according to Modern Healthcare. A knee replacement in the county costs 89 percent more, on average, than in the Denver metro area, while a craniotomy can cost a patient 163 percent more, on average. Peak Health Alliance, a collective of small and large businesses and individuals, representing roughly 6,000 people, has launched a unique model to negotiate discounted rates for medical services directly with the county’s main health system and only hospital provider, Centura Health. Following this negotiation process, Peak sends those contracted rates to health insurers to see who can craft the best plans. The effort was strengthened by a wealth of claims data that revealed that the county’s providers collected more than 500 percent of Medicare rates for outpatient hospital services in 2015 and 2016, driving many residents out of the county for care. Some of Peak’s success will depend on how well the selected insurer is able to manage the small population of members that drive 50 percent of the spending.