Ohio Health Policy News

Research by the federal Office of the National Coordinator for Health IT has found racial and ethnic disparities in patient access to, and usage of, electronic health records (Source: “Report confirms racial disparities in patient access to their health data,” Healthcare IT News, Jan. 5).

Published in the Journal of the American Medical Informatics Association, the ONC study found that in 2019 and 2020, "black and Hispanic individuals were significantly less likely to report being offered and subsequently accessing their portal."

Black and Hispanic people were not offered (5.2 percentage points less likely) and did not access patient portals (7.9 percentage points less likely) nearly as often as white people. 

But when offered access, disparities largely diminished. According to the study, "individuals offered a portal and encouraged to use it by their providers "were 21 percentage points more likely to access it."

"Taken together, our findings point to the important role of healthcare providers in increasing access to EHI by offering portals and encouraging their use," study coauthor Chelsea Richwine, an economist with ONC's Office of Technology, wrote.

Inaccuracies in Medicare's race and ethnicity data have hurt the program’s ability to assess health disparities, a new federal report found (Source: “Flawed Medicare data hampering analysis of health disparities, inspector general says,” Becker’s Payer Issues, June 15).

According to a report from the HHS Office of the Inspector General, Medicare's enrollment data is inconsistent with federal data collection standards, and the inconsistencies "inhibit the work of identifying and improving health disparities within the Medicare population,"

By comparing Medicare data to other federal sources, the report found that Medicare's race and ethnicity data is less accurate for certain groups, particularly for beneficiaries who identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic. 

The report includes recommendations that CMS develop its own source of race and ethnicity data, use self-reported race and ethnicity information to improve data for current beneficiaries, develop a process to ensure that the data is as standardized as possible and educate beneficiaries about CMS efforts to improve the race and ethnicity information.

A team of healthcare policy experts is calling for an overhaul of the ways in which Medicaid data is collected and analyzed to address health equity issues (Source: “Health Policy Experts: Medicaid Data Processes Must Be Improved to Achieve Equity,” Heathcare Innovation, May 25).

Writing in Health Affairs, the researchers say that “the COVID-19 pandemic has highlighted and exacerbated health care inequities in the United States. Calls to address health care disparities have intensified, and the Biden Administration has made equity a central component of its policy agenda. The confluence of these social and political forces has reinvigorated discussion about how to address health care inequities in public insurance programs, and refocused attention on Medicaid — which now covers more than 86 million Americans — as a lever for advancing health equity.”

The authors point to the 2021 decision by the Center for Medicare and Medicaid Innovation (CMMI) to explicitly add health care equity as one of its five core objectives. CMMI also specifically prioritized initiatives to improve care and outcomes for vulnerable and underserved populations in Medicaid.

“These efforts depend, however, on the ability to measure disparities in access to care, quality of care, and health outcomes by race and ethnicity,” the authors wrote. “Due to lack of high-quality data, it remains impossible to fully evaluate the state of health equity in the Medicaid program.”

A coalition of researchers and advocates launched a tool this week they hope will fill some of the gaps in data on racial disparities in the U.S. health system (Source: “A new tool tracks health disparities in the U.S. — and highlights major data gaps,” Stat News, May 26).

The Health Equity Tracker is a portal that collects, analyzes and makes visible data on some of the inequities entrenched in U.S. medicine.

“For far too long it’s been ‘no data, no problem,’” said Nelson Dunlap, chief of staff at the Satcher Health Leadership Institute at Morehouse School of Medicine, which developed the tool with funding and resources from Google.org, Gilead Sciences, Annie E. Casey Foundation and CDC Foundation.

By making data accessible that highlights racial health disparities, the tracker aims to empower local advocates to drive change in their communities — and inspire action to fill in holes in data that are themselves reinforced by structural racism. In the tracker’s display, 38% of federally-collected COVID-19 cases report unknown race and ethnicity.

The U.S. Department of Health and Human Services earlier this week changed rules for reporting COVID-19 data (Source: “How HHS’s new hospital data reporting system will actually affect the U.S. Covid-19 response,” STAT News, July 16).

Hospitals are now required to report data on COVID-19 patients and deaths directly to HHS, rather than to both HHS and the CDC, as they had been doing. HHS said it would help the administration better allocate supplies and drugs.

To some, the change could have some merits. They say the CDC’s data system was built for tracking hospital-acquired pneumonias and urinary tract infections, for instance, and it wasn’t perfect for keeping up with coronavirus data. But CDC supporters saw the change as further evidence of the agency being sidelined, and hospitals decried the implication that it was their reporting — rather than changing federal requirements — that was to blame for data issues and supply shortages.

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.

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 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.

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.

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.