Ohio Health Policy News

Medicaid PBM report to stay secret for now, judge rules

Plans to release a report documenting the costly practices of pharmacy middlemen were shelved by Ohio Medicaid officials on Tuesday at the request of a judge reviewing claims by CVS Caremark that the analysis contains confidential information and trade secrets (Source: “Report on pharmacy middleman pricing to stay secret -- for now,” Columbus Dispatch, July 17, 2018).

Franklin County Common Pleas Judge Jenifer French asked for the delay to allow CVS Caremark time to identify information in the 51-page report that it considers proprietary and believes should be redacted before the report is released to the public and lawmakers.

French did not rule on CVS’ request for a temporary restraining order to block the report's planned release late Tuesday afternoon. Instead, she ordered Medicaid and CVS officials back to court on July 25 after they’ve had a chance to discuss the concerns. She also asked to privately review a copy, which shows higher-than-industry costs paid by taxpayers to cover Medicaid patients' drugs.

Ohio House committee hears from supporters of prescription price transparency bill

Calls intensified this week for the General Assembly to force more transparency from pharmacy middlemen accused of billing Ohio’s Medicaid managed-care plans for much more than they reimburse pharmacists (Source: “Ohio legislators hear support for bill seeking transparency in prescription pricing,” Columbus Dispatch, April 10, 2018).

Ten witnesses — cancer patients, representatives of national consumer groups and others — appeared before the House Government Accountability and Oversight Committee to testify in favor of House Bill 479, which would require that pharmacy customers be told about and receive the cash price for medicine whenever it’s cheaper than an insurance co-payment.

Ohio pharmacists have said that their contracts with pharmacy-benefit managers in some cases include clauses that prohibit them from telling customers that the cash price for drugs is cheaper than their co-payments.

The Ohio Department of Insurance ordered the PBMs last week to stop enforcing any gag rules. But Heather Free, pharmacy director for the nonprofit Equitas Health, told the committee on Tuesday that the legislation it’s considering remains essential “to ensure that PBMs do not engage in the harmful clawback practice.”

Pharmacy-benefit managers say they negotiate better prices from drugmakers and pharmacies than customers would otherwise receive.

Ohio bill aims to streamline school vaccination data collection

Ohio lawmakers are considering changes to standardize the way schools collect data on student vaccinations — including requiring that a doctor sign off when a parent wants to opt out — as many schools still struggle to meet state standards for immunizations (Source: “Lawmakers seek changes as school vaccination rates remain low,” Dayton Daily News, March 22, 2018).

Medical professionals backing the effort say Ohio needs a more streamlined process to ensure health professionals and parents have accurate data on vaccination rates. But the proposal is already drawing criticism from some parents, who want to protect their ability to choose not to vaccinate without interference from a doctor.

Schools are required to report that information for all students in kindergarten, seventh and twelfth grades, and for students who enter a new school. House Bill 559 would create a standardized form that every school in Ohio would use to collect vaccine information from each student at the required grade levels. A health care professional — whether a physician, nurse practitioner or health department nurse — would complete the form to show what vaccines the child has received.

Parents wishing to opt their child out of certain vaccines would still be able to do so for religious or personal beliefs, but they would need a health care professional to fill out the same form, acknowledging that they had a conversation prior to opting out. The bill also calls for the school-level data collected by the Ohio Department of Health each year to be published online, so that public health officials, stakeholders and parents can know the opt-out rate by school building.

Ohio healthcare transparency law in legal limbo

Two years after it passed unanimously in Ohio’s state Legislature, a law meant to inform patients what health care procedures will cost has yet to be implemented (Source: “Health-care price transparency faces opposition in Ohio from hospitals and doctors,” Kaiser Health News via Cincinnati Enquirer, July 23, 2017).

One of the most stringent in a group of similar state laws being proposed across the country, Ohio’s Healthcare Price Transparency Law stipulated that providers had to give patients a “good faith” estimate of what non-emergency services would cost individuals after insurance before they commenced treatment.

But the law didn’t go into force on Jan. 1 as scheduled. The Ohio Hospital Association, one of the most vocal critics of the law, has filed a court injunction that is currently delaying enactment.

Joining the hospital association in its legal action are a wide range of provider groups including Ohio State Medical Association, the Ohio Psychological Association, the Ohio Physical Therapy Association, and the Ohio chapters of the American Academy of Pediatrics, the American College of Surgeons, and the American Osteopathic Association. These groups say that the law, which applies only to elective procedures, is too broad and that forcing providers to create estimates before procedures would slow down patient care.

But Jerry Friedman, a retired health policy adviser for the Ohio State University Wexner Medical Center, said the opposition doesn’t stem from genuine concern about patients but from a desire to keep the secret rates that providers have negotiated with insurers under wraps. Transparency would mean explaining to consumers why the hospital charged them $1,000 for a test, he said, adding that providers “don’t want to expose this house of cards they’ve built between hospital physician industry and the insurance industry.”

Rep. Jim Butler, an Oakwood Republican who authored the law, said, “If you really want patients to be empowered, they really need the information.”

The law’s next test will come in August, when the first court hearing on the association’s lawsuit is scheduled. The Kasich administration said it couldn’t comment on the law because of the pending litigation.

Ohio ranks 46th in latest HPIO Health Value Dashboard

The Health Policy Institute of Ohio this week released the latest edition of its Health Value Dashboard, which ranks states and the District of Columbia on a combination of population health and healthcare spending metrics. According to the Dashboard, Ohio ranks 46th in the nation in health value.

The Dashboard is unique in its emphasis on "health value," rather than on population health outcomes alone. No other national rankings factor in the impact of healthcare spending. The Dashboard also takes a more comprehensive approach in looking at health by evaluating social, economic and physical environments - which are significant contributors to overall health. The Dashboard provides in-depth data on 118 metrics.

The HPIO Health Value Dashboard shows that Ohioans live less healthy lives (43rd in population health) and spend more on health care (31st in healthcare spending) than other states.

The 2017 Health Value Dashboard is the second edition of the rankings. HPIO released its first Dashboard in late 2014. Ohio ranked 47th in health value in the inaugural edition.

New CDC interactive tool provides neighborhood-level health data

A new web-based interactive tool released yesterday by the Centers for Disease Control and Prevention will let anyone find and search health data at the neighborhood level for 500 U.S. cities that include Cleveland, Columbus and Cincinnati (Source: “CDC releases interactive neighborhood-level health data for 500 cities, including Cleveland,” Cleveland Plain Dealer, March 2, 2017).

The 500 Cities project, a collaboration between CDC, the Robert Wood Johnson Foundation, and the CDC Foundation, is part of a nationwide effort to provide this health information for geographic areas smaller than counties. The effort began in 2015 and includes city and census tract-level estimates for 27 chronic health conditions, behaviors, risk factors and preventive service use for the largest 500 cities in the United States.

"Measures of health outcomes are generally gathered at the state and county level," said Oktawia Wojcik, a research-evaluation-learning unit program officer at the Robert Wood Johnson Foundation, speaking to reporters about the project. "This really masks important differences among geographic areas that are smaller than counties, making it difficult to identify health disparities and target interventions."

Hospitals, other providers fighting Ohio price transparency law

The Ohio Hospital Association and several other provider organizations have filed a lawsuit against the state of Ohio to block a law requiring price disclosures to patients before they are given non-emergency treatment (Source: “Ohio hospitals want to overturn price disclosure law,” Dayton Daily News, Dec. 27, 2016).

Before non-emergency services are rendered, a healthcare provider would have to give patients written estimates on how much their insurer will be billed for each procedure, test or service, how much their insurers will pay, and calculations for the patients’ out-of-pocket costs. The hospitals, doctors and others suing the state call it “poorly written, confusing, ambiguous ... and impossible legislation.”

The bill’s sponsor, Rep. Jim Butler, R-Oakwood, countered that the health care lobby is resisting price transparency. “It is definitely not something that is impossible for them to carry out. They just don’t want to carry it out. That’s the problem,” Butler said.

In late December, Williams County Common Pleas Court Judge J.T. Stelzer issued a 30-day restraining order, blocking the law from taking effect Jan. 1, and scheduled a hearing for Jan. 20. The list of groups joining the lawsuit is extensive: Ohio Hospital Association, Ohio State Medical Association, Ohio Psychological Association, Ohio Physical Therapy Association, Ohio Chapter of the American Academy of Pediatrics and others.

The Kasich administration declined to comment on the suit, saying it doesn’t talk about pending litigation.

Ohio, 42 other states get ‘F’ for healthcare price transparency

Ohio is one of 43 states that were given an F for healthcare price transparency in a new national scorecard (Source: “Price transparency eludes consumers in 43 states,” Modern Healthcare, July 26, 2016).

Just seven states achieved a passing grade for making usable healthcare price information available to consumers, a new study finds. The other 43 states failed at price transparency because they didn't collect claims data from all payers or they failed to make the data accessible to the public through a website, according to the 2016 Report Card on State Price Transparency Laws.

The report is the fourth installment by the Health Care Incentives Improvement Institute and Catalyst for Payment Reform, two independent health policy organizations. The report is meant to be a state-by-state resource that shows policymakers, health providers and consumers how states are progressing at price transparency.

"Many states have the laws on their books requiring the release of health care price information, but score poorly because of the design and implementation of those laws," said co-author Suzanne Delbanco, CPR executive director.

Three states received A grades. This year Colorado and Maine joined New Hampshire as top performers due to “the increased quality of their reporting and transparency websites.” Oregon made the most progress, jumping to a B grade from an F the previous year. Vermont and Virginia received C grades and Arkansas a D. The rest were failing grades.

CMS releases new hospital star ratings

The Centers for Medicare and Medicaid Services published the much-anticipated Overall Hospital Quality Star Ratings on Wednesday after industry stakeholders and Congress pressured the agency to continue to delay their release (Source: “CMS releases star ratings for hospitals,” Modern Healthcare, July 27, 2016).

The ratings are a composite metric of one to five stars, with five being the best. They intend to convey the overall quality of nearly 4,000 hospitals in the U.S. and are posted to the CMS' Hospital Compare site. In grading hospitals on their overall quality, the CMS used 64 measures, such hospital-acquired infection rates or emergency room wait times, that had already been posted to the Hospital Compare site. It grouped those measures into broader categories, then weighted them. Hospitals had to meet minimum reporting requirements in order to be eligible to receive a star rating.

Hospitals and other industry groups have stridently criticized the rating system as oversimplifying a complex matter—the quality of a multi-faceted institution—and the underlying methodology as flawed. They warned it would provide inaccurate information to consumers and damage hospitals' reputations.

2016 state health assessment draft released

The Governor’s Office of Health Transformation and the Ohio Department of Health today released a draft of the 2016 state health assessment.

The state health assessment is a comprehensive and actionable picture of health and wellbeing in Ohio. The purpose of the state health assessment is to:

• Inform identification of priorities for the upcoming state health improvement plan
• Provide a template for state agencies and local partners (uniform set of categories and metrics to use in related assessments)

The report includes information from several sources in order to provide a comprehensive picture of health and wellbeing in Ohio. Using existing data, this document presents data profiles on health outcomes and a broad range of factors that impact health outcomes, healthcare spending and disparities. These data profiles are followed by summaries of new information collected for this assessment, including qualitative information gathered through key informant interviews and regional forums. The Health Policy Institute of Ohio was commissioned to facilitate the state health assessment process and produce the publication.

The public is invited to provide input on the state health assessment until noon on July 5, 2016.

The final state health assessment is expected to be released later this summer, followed by the release of the 2016 state health improvement plan later this year.