Payment and Delivery Reform
FEATURED ARTICLE
Highlights of States’ ‘Surprise’ Medical Balance Billing Laws
/in Policy Blogs, Charts Consumer Affordability, Cost, Payment, and Delivery Reform /by NASHP StaffSurprise balance bills occur when patients receive unanticipated charges for health care services because they were unaware that care was delivered by an out-of-network provider or facility. In some cases, surprise balance bills can amount to hundreds if not thousands of dollars in medical expenses. A growing number of states have passed or are proposing […]
Comparison of Bills Creating State Prescription Drug Affordability Review Boards
/in Policy Charts Administrative Actions, Cost, Payment, and Delivery Reform, Model Legislation, Newly-Enacted Laws, Prescription Drug Pricing, State Rx Legislative Action /by NASHP StaffOregon’s Accountable Health Model Addresses Health Equity and Health-Related Needs: Four Lessons from CCO 2.0
/in Policy Oregon Blogs Accountable Health, Chronic and Complex Populations, Community Benefit, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Primary Care/Patient-Centered/Health Home, Social Determinants of Health /by Amy ClaryStates developing accountable health models often look to Oregon for inspiration. Oregon established its Coordinated Care Organizations (CCOs) in 2012, pursuant to a Medicaid Section 1115 demonstration waiver. CCOs are local networks of all types of health care providers — including physical, behavioral, and oral health providers — that the state pays a global capitated […]
Webinar Recording: Reference-Based Pricing – Leveraging State Purchasing Power to Lower Health Care Spending
/in Policy Montana, North Carolina Webinars Administrative Actions, Cost, Payment, and Delivery Reform, Health System Costs, Prescription Drug Pricing /by NASHP StaffHospital Price Transparency: The Next Frontier
/in Policy Colorado, Maine, Massachusetts, New Hampshire, Washington Blogs Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Managed Care, Value-Based Purchasing /by Josephine PorterThe Centers for Medicare & Medicaid Services (CMS) took an important first step toward increasing the transparency of hospital finances when it required hospitals to post their charge information, effective January 2019. But, these charges are not prices paid — they are typically the starting point against which commercial payers negotiate discounts. States with all-payer […]
NASHP’s Health and Housing Institute Celebrates First Anniversary
/in Policy Blogs Community Benefit, Cost, Payment, and Delivery Reform, Health Equity, Housing and Health, Population Health, Social Determinants of Health, Value-Based Purchasing /by Malka BerroThis month, the five member states of the National Academy for State Health Policy’s (NASHP) Health and Housing Institute are marking their first anniversary of breaking down agency silos and advancing reforms to improve health and housing for vulnerable populations, including those experiencing homelessness, struggling with behavioral health or substance use disorders, or transitioning out […]
The State of States’ Health Policies: What Governors Highlighted in their 2019 Addresses
/in Policy Blogs Behavioral/Mental Health and SUD, Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Housing and Health, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Medicaid Managed Care, Population Health, Prescription Drug Pricing, Social Determinants of Health, State Insurance Marketplaces, State Rx Legislative Action, Value-Based Purchasing /by Anita CardwellState of the state and inaugural speeches give governors the opportunity to highlight their recent policy successes and outline key plans and priorities for the coming year. These speeches are strong indicators of governors’ policy goals and often include proposals and funding recommendations for their legislatures. As a result of 2018 gubernatorial races in 36 […]
How Governors Addressed Health Care in their 2019 State of the State Addresses
/in Policy Charts Accountable Health, Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Housing and Health, Infant Mortality, Integrated for Pregnant/Parenting Women, Lead Screening and Treatment, Maternal, Child, and Adolescent Health, Population Health, Safety Net Providers and Rural Health, Social Determinants of Health /by Anita Cardwell and Sarah LanfordAnnual Federal Insurance Rule Includes Proposals to Address Prescription Drug Cost
/in Policy Blogs Administrative Actions, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Prescription Drug Pricing, State Insurance Marketplaces, State Rx Legislative Action /by Sarah Lanford and Maureen Hensley-QuinnThe Trump Administration’s effort to address drug prices surfaced unexpectedly in the Department of Health and Human Services (HHS)’s recently issued proposed annual rule that regulates state health insurance markets, including coverage sold through the Affordable Care Act (ACA) marketplaces. The proposal encourages the use of generic drugs over brand-name drugs by both health plans and enrollees […]
States Use Policy Levers and Emerging Research to Address Antipsychotic Use in Children in Foster Care
/in Policy Reports Behavioral/Mental Health and SUD, Children/Youth with Special Health Care Needs, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, EPSDT, Health Coverage and Access, Health Equity, Health System Costs, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Quality and Measurement /by Johanna Butler, Jennifer Reck and Maureen Hensley-QuinnState policymakers must often take action during an emerging crisis even when evidence identifying the best policy approach is not be available. This report, Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System, explores successful state responses to dramatic increases in antipsychotic prescription rates in Medicaid-enrolled children […]
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
State Delivery System and Payment Reform Map
/in Policy Maps Care Coordination, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health System Costs, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Primary Care/Patient-Centered/Health Home, Quality and Measurement, Value-Based Purchasing Cost, Payment, and Delivery Reform /by NASHP