HEALTHCARE SYSTEM REFORM
How the United States Can Use Telehealth Expansion to Achieve Market Savings
Kendall Kohlmeyer, Student Fellow October 2, 2020
The COVID-19 pandemic necessitated the rapid expansion of telehealth services. This has led the federal government and many states to expand insurance coverage for telehealth services through emergency waivers of certain requirements. Implemented ideally, widespread telehealth use could lower the overall cost of health care in commercial markets by lowering per-patient and per-visit costs for specialty and primary care providers, while increasing patient satisfaction and quality of care. However, if done poorly, telehealth expansion could increase healthcare costs by providing easy access to care that is unlikely to improve health …
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The Source Roundup: October 2020 Edition
Alex Montague, Health Policy Researcher October 1, 2020
With the passing of Justice Ruth Bader Ginsburg and nomination of Amy Coney Barret to the Supreme Court just weeks before the presidential election, many are turning their attention to health care and the fate of the Affordable Care Act (ACA). With this backdrop, this month’s Source Roundup looks at 1) what is at stake as the ACA faces the Supreme Court again in California v. Texas, 2) new information about rising healthcare prices, 3) anticompetitive contract practices between providers and insurers, and 4) the potential of a public option …
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Spotlight on State: Kansas
Amy Y. Gu, Managing Editor September 28, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Kansas state page. Kansas was one of the first states to mandate an all-payer claims database (APCD). In operation since 2010, the Data Analytic Interface (DAI) is maintained by the Kansas Department of Health and Environment (KDHE) and the Division of Health Care Finance (DHCF) and collects medical, dental, and pharmacy claims, eligibility files and …
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Spotlight on State: Michigan
Kendall Kohlmeyer, Student Fellow September 21, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Michigan state page. Michigan is one of the few states that bans Most Favored Nation (MFN) clauses in healthcare contracts between providers and health care corporations. The ban resulted from a landmark antitrust enforcement case against Blue Cross Blue Shield of Michigan that settled in 2013. In provider consolidation, the state has a …
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Spotlight on State: Indiana
Kendall Kohlmeyer, Student Fellow September 18, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Indiana state page. Indiana made significant advances in promoting healthcare price competition and transparency in 2020. Most notably, the legislature passed a law to mandate an all-payer claims database (APCD) that will include claims from Medicare, Medicaid or a Medicaid managed care organization, health maintenance organizations (HMOs), pharmacy benefit managers (PBMs), and other …
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Spotlight on State: Wisconsin
Kendall Kohlmeyer, Student Fellow September 15, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Wisconsin state page. Wisconsin operates one of the largest private APCDs in the country, even though it is not mandated by statute. The Wisconsin Health Information Organization (WHIO), a private organization, gathers and makes healthcare claims data publicly accessible. With insurance claims data from sixteen commercial health plans and the state Medicaid program, …
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Spotlight on State: Massachusetts
Kendall Kohlmeyer, Student Fellow September 11, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Massachusetts state page. Massachusetts remains a leader on the healthcare cost containment, price transparency, and market regulation fronts. Massachusetts’ Health Policy Commission (HPC), a unique and independent state agency, monitors healthcare spending growth in the state. Based upon the data it collects, the Commission recommends delivery and payment reform policies with the goal of improving …
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Spotlight on State: Nevada
Kendall Kohlmeyer, Student Fellow September 4, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Nevada state page. The Nevada legislature convenes in odd-numbered years. For several years, Nevada law has required all healthcare plans to cover telehealth services for an insured to the same extent they would cover services provided by other means. This includes plans from managed care organizations (MCOs), health maintenance organization (HMOs), benefit contracts, and group …
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The Source Roundup: September 2020 Edition
Kendall Kohlmeyer, Student Fellow September 1, 2020
This month in health policy research, surprise billing and changes in market structures fuel concerns about competition and consumer choice. In addition, some studies on pharmaceutical costs produced hopeful reports. Healthcare Market Competition and Consolidation Consolidation Trends In a Health Affairs study, Consolidation of Providers into Health Systems Increased Substantially, 2016-18, Michael Furukawa et al. analyzed provider consolidation trends. The rate of physician affiliation with a health system increased by 11 to 51 percent in 2018. Based on the 556 health systems the authors identified, the median number of …
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Surprise Billing: Proposed Federal Solutions From Both Sides of the Aisle
Source Fellow August 11, 2020
By: Danika Rothwell, Student Fellow Paul DeWolfe needed back surgery. He knew the operation would be covered by his insurance and was careful to make sure the hospital he chose was in his insurer’s network. DeWolfe sat down and did the math. He figured his portion of the bill would cost roughly $3,000. When DeWolfe recovered from his procedure, he was shocked to receive a bill for $18,590.83.[1] Despite all his attentive preparation, some of the physicians who treated him at his in-network hospital were, in fact, out-of-network. This story …
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