August 29, 2013

States experimenting to lower health care costs

The Associated Press

(Continued from page 1)

Health spending per capita

     Avg. annual growth   1991-2009

 Percent growth

United States

$6,815

6.50%

Alabama

$6,272

5.90%

Alaska

$9,128

8.40%

Arizona

$5,434

7.80%

Arkansas

$6,167

6.60%

California

$6,238

5.90%

Colorado

$5,994

7.30%

Connecticut

$8,654

5.80%

Delaware

$8,480

7.70%

District of Columbia

$10,349

4.50%

Florida

$7,156

6.90%

Georgia

$5,467

6.60%

Hawaii

$6,856

6.20%

Idaho

$5,658

7.90%

Illinois

$6,756

5.80%

Indiana

$6,666

6.30%

Iowa

$6,921

6.10%

Kansas

$6,782

6.20%

Kentucky

$6,596

6.70%

Louisiana

$6,795

5.70%

Maine

$8,521

7.40%

Maryland

$7,492

6.60%

Massachusetts

$9,278

6.40%

Michigan

$6,618

5.60%

Minnesota

$7,409

7.00%

Mississippi

$6,571

7.00%

Missouri

$6,967

6.70%

Montana

$6,640

7.00%

Nebraska

$7,048

6.90%

Nevada

$5,735

9.20%

New Hampshire

$7,839

7.60%

New Jersey

$7,583

6.00%

New Mexico

$6,651

7.70%

New York

$8,341

5.90%

North Carolina

$6,444

7.90%

North Dakota

$7,749

6.20%

Ohio

$7,076

5.80%

Oklahoma

$6,532

6.70%

Oregon

$6,580

7.50%

Pennsylvania

$7,730

5.70%

Rhode Island

$8,309

6.30%

South Carolina

$6,323

7.30%

South Dakota

$7,056

6.90%

Tennessee

$6,411

6.60%

Texas

$5,924

7.30%

Utah

$5,031

7.90%

Vermont

$7,635

7.30%

Virginia

$6,286

6.90%

Washington

$6,782

7.30%

West Virginia

$7,667

6.30%

Wisconsin

$7,233

6.70%

Wyoming

$7,040

7.60%

Economists say soaring health care costs are driven primarily by industry consolidation and expensive new medical technologies and prescription drugs.

The Affordable Care Act's cost-containment section reduces Medicare reimbursements to providers and requires commercial insurance companies to issue refunds if more than 20 percent of their revenue goes to profits, salaries and overhead. Hospitals will face penalties when patients develop conditions while in their care.

The federal law also promotes "accountable care organizations" within Medicare, which are charged with improving coordination to reduce wasteful spending.

But much of the experimentation on reducing costs is driven by state governments and private businesses.

Oregon has tried to tackle rising costs by focusing on Medicaid, which serves 550,000 people in the state and is expected to grow by 200,000 under the Affordable Care Act's Medicaid expansion that starts next year.

Gov. John Kitzhaber last year spearheaded a new model of delivering services under Medicaid. His initiative led to a state law that created "coordinated care organizations," which attempt to integrate mental, physical and dental care as they improve the way chronic conditions are managed. These organizations are required to manage their costs within a fixed rate of growth.

Some coordinated care groups are hiring staff to work intensely with Medicaid patients who frequently visit the emergency room.

"We try to deal with the medical part. But everything they go through, we have to take into account, because if you don't have money to pay your bills, you're going to have stress" that complicates medical problems, said Ruby Ibarra, a community health specialist for Multnomah County, which is part of a coordinated care organization in the Portland area.

Elsewhere in the state, Trillium Community Health Plan in Eugene has a program starting this month that gives up to $200 in prepaid debit cards to pregnant mothers who quit smoking.

Oregon's law also has led to the rapid expansion of "health homes," supporting a system of primary care that calls for clinics to stay open longer and offer same-day appointments.

The health home model has been successful at improving preventive care in Enterprise, Ore., a town of 2,000 in the remote northeastern corner of the state.

"You don't feel like you're just pushing papers around here. You really feel like you have an important part to play in improving people's health," said Dr. Elizabeth Powers, one of four physicians at Winding Waters Clinic in Enterprise, an early adopter of the health home model.

The clinic serves all patients, including those with Medicaid, Medicare and private insurance. The federal Affordable Care Act also encourages wider adoption of the health home model.

In New Jersey, hospitals have reported success with a Medicare program that paid doctors who saved money for hospitals. Officials said it contributed to lower costs and shorter hospital stays without increasing mortality or readmission rates because doctors began considering the costs of their orders.

The experiment, known as "gainsharing," is expanding this year to more hospitals, including some outside New Jersey.

In Massachusetts, the first state to enact comprehensive health care reforms, lawmakers last year supported a goal of restraining the rise in health care costs to a level no greater than the state's overall growth rate. To accomplish this, legislators passed a multi-tiered state law that expands the role of physician assistants and nurse practitioners to act as primary care providers, making it easier for patients to access care outside the emergency room.

The law also requires providers to disclose more information to consumers about costs and quality and allows the state to review proposed consolidations to assess the effect on those factors.

(Continued on page 3)

Were you interviewed for this story? If so, please fill out our accuracy form

Send question/comment to the editors




Further Discussion

Here at PressHerald.com we value our readers and are committed to growing our community by encouraging you to add to the discussion. To ensure conscientious dialogue we have implemented a strict no-bullying policy. To participate, you must follow our Terms of Use.

Questions about the article? Add them below and we’ll try to answer them or do a follow-up post as soon as we can. Technical problems? Email them to us with an exact description of the problem. Make sure to include:
  • Type of computer or mobile device your are using
  • Exact operating system and browser you are viewing the site on (TIP: You can easily determine your operating system here.)