Archive for Pennsylvania


Hospitals, Insurers, City Government Launch Health Equity Effort

The pursuit of health equity is the subject of a new collaboration between health systems, health insurers, and a big city government.

The new effort, dubbed “Accelerate Health Equity,” will seek to bring “…together organizations across the region to produce tangible improvement in health inequities, and ultimately achieve measurable, positive changes in health outcomes in Philadelphia.”  Among the participants in the endeavor are AmeriHealth Caritas, Children’s Hospital of Philadelphia, the City of Philadelphia, Drexel University, Independence Blue Cross, Jefferson Health, Main Line Health, Penn Medicine, Philadelphia College of Osteopathic Medicine, Temple Health, and Trinity Health Mid-Atlantic.

The group envisions its approach to pursuing health equity and addressing social determinants of health as consisting of three components:

  • Launching Pilot Programs: Individual pilot programs tied to identified areas that impact health outcomes.
  • Measuring Progress:   A publicly available digital health equity dashboard based on data provides an in-depth view of 16 health equity challenge areas and will also track progress of pilot programs.
  • Collaborating to Scale:  Pilot programs will be evaluated and information will be disseminated to inform health and service providers and quickly scale successful pilot programs to expand their reach and impact.

The 16 health equity challenges the group intends …

Pennsylvania to Introduce Medicaid PDL on January 1

Starting on January 1, Pennsylvania will employ a preferred drug list for its Medicaid program – a list that applies to both fee-for-service and managed care patients.

And as many as 150,000 of the state’s 2.8 million Medicaid beneficiaries may find themselves facing changes in their prescription drugs.

The purpose of the PDL is to save money – an estimated $85 million a year, according to the Pennsylvania Department of Human Services, which administers the state’s Medicaid program.

While physicians may submit requests to the state for exemptions for specific patients for specific purposes, those exemptions may be relatively uncommon:  the managed care plans that serve the vast majority of the state’s Medicaid population face daily fines starting at $1000 a day if their adherence to the new PDL falls below 95 percent.

Learn more about Pennsylvania’s new Medicaid PDL and how it may affect providers and patients in the Philadelphia Inquirer article “Nearly 150,000 in Pa. could be forced to change medications beginning on Jan.1.  Here’s why.”


State to Experiment with Global Budgets for Rural Areas

The Commonwealth of Pennsylvania plans to launch an experiment in which participating health insurers will fund global budgets to care for residents served by selected rural hospitals.

The program seeks to preserve access to care in rural parts of the state by stabilizing the financial health of struggling rural hospitals.

According to a Pennsylvania Department of Health news release,

The Rural Health Model is an alternative payment model, transitioning hospitals from a fee-for-service model to a global budget payment. Instead of hospitals getting paid when someone visits the hospital, they will receive a predictable amount of money. Payment for the global budget will include multiple-payers, including private and public insurers.

The global budgeting project is a joint venture of the state’s Department of Human Services, Department of Health, Insurance Department, the Pennsylvania Office for Rural Health, five participating hospitals, and five health insurers.  The federal Center for Medicare and Medicaid Innovation, another partner, is investing $25 million over five years to fund a rural health redesign center to support the project’s launch.

The state hopes to add more hospitals and insurers in the future.

The project is needed, according to the state, because “Nearly half of all rural hospitals in …

PA Hospitals Reducing Readmissions, Mortality

Pennsylvania hospitals have seen a state-wide decrease in their mortality and readmission rates, according to new data released by the Pennsylvania Health Care Cost Containment Commission.

According to the new numbers, which cover hospital performance from January 1 through September 30 of 2015, hospital mortality rates fell for ten of the 16 conditions PHC4 tracks while readmissions fell for nine of the 13 conditions for which the agency collects data.

PHC4 estimates that this improved performance saved 3900 lives and avoided 2700 hospital readmissions.

For a closer look at the data PHC4 collected, the conditions it tracked, and a hospital-by-hospital, region-by-region, and state-wide look at hospital performance go here, to the PHC4 web site, to find a summary of the report, the news release that accompanied its publication, and three separate reports with all of the numbers and findings.


PA Looking to Update Nursing Home Regulations

A special task force has proposed major changes in regulations that govern nursing homes in Pennsylvania.

The Nursing Home Quality Improvement Task Force, created by Department of Health Secretary Dr. Karen Murphy, recommended four areas of focus for new regulations:

  • Improve collaboration between policy makers, lawmakers, providers, health care professionals, and most importantly, the residents of nursing homes and their advocates;
  • Change regulations and expand facility inspections to focus on the quality of life for residents who live in that facility;
  • Perform more comprehensive and consistent surveys to collect data that allows for consistent evaluation of quality of life in nursing homes; and
  • Redesign workforce composition and competencies.

It offered these recommendations after concluding that it found

…a misalignment between outdated nursing home care regulations and the type of care that is needed in today’s nursing homes. It concluded that in the past, state regulations were designed to evaluate the quality of the actual nursing home facility, but did not fully account for the quality of life of the residents themselves.

Learn more about the state’s plans for its nursing homes in this Department of Health news release.…