State News

Using a $2.2 million grant from Arnold Ventures, the Virginia Center for Health Innovation (VCHI) is launching a statewide pilot to reduce the use of low-value services, according to Health Data Management. In 2012, the American Board for Internal Medicine identified 550 tests and procedures as having a low value. Accessing insurance claims data, VHCI looked at 42 measures for 5 million patients using a health-waste calculator and found more than 2 million unnecessary services, costing approximately $747 million. The pilot will be implemented across 900 clinical sites in Virginia and will involve an employer task force on low-value healthcare.  VCHI will initially focus on providers and seven sources of low-value care and then will expand to include a set of consumer-driven measures.

Proposed legislation in Oklahoma would establish a pilot program to attract physicians to rural parts of the state, according to The Journal Record. If signed into law, the bill would provide an income tax credit of up to $25,000 annually for up to five years for doctors who set up practices in communities of less than 25,000 people. To qualify for the income tax credit, doctors would have to have completed their medical training or medical residency in Oklahoma and would have to live in the same rural counties where they practice.

The Oklahoma State Department of Health was awarded a five-year grant from the U.S. Health Resources and Services Administration totaling more than $890,000 to improve access to healthcare services for people who are uninsured, isolated or medically vulnerable, reports The Oklahoman. The health department will work with the federal agency to produce a statewide primary care needs assessment, identify unmet healthcare needs and barriers to care (like workforce shortages) and advance strategies which improve access to comprehensive primary healthcare services in Oklahoma.

In 2010 Maryland, for some rural hospitals, replaced fee-for-service payment with a global budget approach called Total Patient Revenue (TPR) to incentivize hospitals to manage resources more efficiently. A study in Health Affairs found evidence consistent with both the incentive to provide care more efficiently and the incentive to provide less care during the 2010-2013 study period. For TPR hospitals, service use fell sharply – ED admissions declined 12 percent, direct (non-ED) admissions fell 23 percent, ambulatory surgery center visits fell 45 percent and outpatient clinic visits/services fell 40 percent. The authors conclude that most of the drop in inpatient admissions at TPR hospitals was offset by higher admissions at Maryland hospitals outside the global budget or moved to neighboring states.  Since hospital revenues are maintained under TPR, if care that is no longer provided within budget moves off budget, total healthcare costs could rise. The authors found evidence of higher overall healthcare spending for the FFS Medicare population. Unfortunately, no published studies have examined the effect of TPR on population health or on overall healthcare costs. In 2014, Maryland replaced the limited TPR program with Global Budget Revenue (GBR) for all Maryland Hospitals. The authors conclude that capitation models require strong oversight to ensure that hospitals do not respond by shifting costs to other providers.

Georgia law makers passed House Bill 186, which revamped the state's Certificate of Need laws. According to Atlanta News Now, the bill was enacted to ease the restrictions on hospital businesses, and will allow hospitals to provide services to all patients that walk through their doors, without concern of cherry-picking by smaller healthcare start-ups. This bill will regulate smaller outpatient ambulatory and cancer centers at a county level.

Cherokee tribal land in Oklahoma will soon be home to the largest Native American health facility in the U.S, according to FOX 25 News. The facility will include the country’s first tribally affiliated medical school with the goal of training more future doctors in Oklahoma and getting them to stay. Cherokee officials hope the medical school will help bridge the gap when it comes to doctor shortages, which are a serious issue in rural communities.

Total spending on Vermonters’ healthcare surpassed the $6 billion mark in 2017, but the rate at which that number is growing slowed, reports the VTDigger. Expenditures for Vermont residents grew 1.7% from 2016-2017, a significant improvement from recent years, as spending grew an average of 3.2% annually from 2012-2017. Vermont’s 2017 spending growth was also far below the national growth of 3.8%. Nevertheless, out-of-pocket costs for Vermonters’ healthcare ($776 million in 2017) continues to rise, increasing 1.8% from 2016. Out-of-pocket expenses also were a concern raised in a recent state health insurance survey, which found a low number of uninsured but a rising number of “underinsured” residents. About 36% of Vermonters under age 65 don’t have insurance policies that can adequately cover their needs based on their income.

The Centers for Medicare & Medicaid Services has approved a Florida section 1115 pilot program that provides behavioral health services and housing to adult Medicaid beneficiaries with serious mental illness, substance abuse disorders, or both, according to HealthLeaders. The program, called the Behavioral Health and Supportive Housing Assistance Pilot, will provide transitional housing, tenancy support services, mobile crisis management and self- and peer-support, along with home and community-based services to people who are homeless or at risk of homelessness. The hope is that the program will promote independence for beneficiaries and improve health outcomes.  

The Washington Health Alliance has released several new reports on negotiated reimbursements from commercial payers, reports State of Reform. One report shows that reimbursement for a vaginal delivery at one medical center varies from $7,196 to $19,402, depending on the commercial payer. Another report reveals that overall inpatient utilization from 2015-2016 was down enough ($51.2 million) to offset price growth ($21.7 million). A third report analyzing “how well health plans are meeting the needs of their members and working to improve quality and reduce the cost of healthcare" identified Kaiser's HMO product as the overall top rated insurance plan, with Regence the top rated PPO plan.