After years of implementing complex health care legislation, one after another, stakeholders recognize that there is still work to be done, allowing progressive initiatives to mature.
The upcoming session will be a non-budget year in which leaders have urged their members to prioritize emergency legislation and speed up a move that would give the 125 General Assembly members more time to campaign for election.
Sen. Ed Charbonneau, R-Valparaiso, doesn’t anticipate similar major legislation for 2023. As Chairman of the Senate Health and Provider Services Committee, he authored, co-authored, and sponsored several hefty bills, including public health funding, oversight of pharmacy benefits, and more. Managers (PBMs) and five major non-profit hospital systems are tracking prices.
I think, too often, we come back and make changes before we even have a chance to catch up with the original things we did and reflect on whether we made the right decision the first time, Charbonneau said. It will probably be a good session to see how we performed (and) how they performed.
But others see the need for constructive changes sooner rather than later, including hospitals that were hit by a setback in the 2023 session.
Brian Tabor, president of the Indiana Hospital Association, said the organization is working on a proposal to address interconnected issues related to the state’s hospital assessment fees and Medicaid rates. Hospital claims are very low They would have to shift the costs to private insurers, which would drive up prices.
There are a lot of hospitals across our state that are struggling badly right now and we can’t wait until the budget session to bring this forward,” Tabor said.
Tabor said such steps would not require reopening the budget, but would still require legislation to replace existing law. However, after the $1 billion Medicaid accounting snafu earlier this week, addressing Medicaid rates in 2024 will be a tough sell. But Tabor said the entity’s proposal includes a state assessment on managed care plans, which could be used to leverage federal funding and offset Medicaid. Costs including hospital expenses.
What happened to the consumer database?
When it comes to legislative priorities to control rising health care costs, the Indiana Department of Insurance (IDOI), a relatively small agency, has many big responsibilities. A spokesperson for the agency did not agree to an interview request and did not respond to an emailed list of questions provided on Friday, December 15.
Pursuant to the 2020 law, the Department must construct and maintain All Payers Claim Database (APCD), which will aggregate claims data from multiple health payer sources, including insurers, health maintenance organizations, PBMs, and others, into a consumer-facing dashboard.
… We think it would be helpful to look at a bigger picture of all health care and health-related claims, IDOI Commissioner Amy Beard told the interim health care cost oversight task force in August.
But implementing the long-awaited dashboard has been a lengthy process and it is uncertain how much impact it will have on health care costs.
IDOI assigns a task to OnPoint Health Data Four-year, $8.2 million contract Based on review of materials from three meetings, including demo websites and contract data, designed and maintained the APCD, which appears to be close to the launch date.
At the last APCD Advisory Board meeting in September, the IDOI presentation included a preview of what the website might look like and APCD Executive Director Jonathan Handsborough reported that most presenter registrations had been completed.
Also in August, during a State Budget Committee meeting, Beard detailed penalties for health payers not submitting claims data to APCD.
Beard told the committee that civil penalties ensure proper accountability for reporting to the APCD and that it is important to ensure that the APCD collects as much data as possible to achieve its legislative objectives, such as identifying health care needs. To do and inform policy. …The Department is currently working closely with health payers to ensure their knowledge of submission requirements and processes as part of the implementation of this new program and is optimistic that compliance with these requirements will be high.
The proposed civil penalty would start at $100 per day per violation for the first 30 days and then increase to $1,000 per day per violation.
He also told committee members that IDOI had allocated $5.5 million in its budget for the APCD.
But while a Hoosier may be able to compare the cost of hip replacement at different hospitals, not everyone is convinced it will make a difference in bringing prices down. Charbonneau noted that employers, through company insurance policies, pay most of the costs and Hoosiers choosing between options are likely to consider other factors.
That said, if I had insurance I wouldn’t pay so much attention to the cost. If there is a hospital in the exact same area near me, it would be convenient for me to go there.
If only their employer or insurer is seeing the cost savings, consumers are less likely to travel further for a cheaper hip replacement, he said.
APCD advisory board member Tabor said the project had potential as long as it was truly comprehensive. He noted that OnPoint also created the Men’s APCD and included a lot of information, including prescription drugs.
I think what we don’t need is another database that’s just about price, Tabor said. When we started this discussion in 2020, one idea was, we just need to know hospital prices. We have him now; It is available (elsewhere) I see (APCD) as a tool not only for price comparison but also to help the consumer understand cost, quality and how to navigate a complex health care system.
Still, he flagged the possibility of a legal challenge, noting that federal law prevents states from regulating some large insurance plans and may not be able to legally force them to submit to the APCD.
Other ongoing projects
In addition to the APCD, IDOI has at least two other legislative responsibilities: regulating PBMs and developing a price monitoring system Across five nonprofit hospital systems, that compared with a Medicare rate of 285%.
For the latter, IDOI reported in August It had issued a request for services to find a third-party vendor and required hospitals to submit data by March 2024. By November, the calculations should be finalized with Medicare Compare for the final report to the Health Care Cost Task Force. December.
Also at the August meeting, Beard briefed the committee on ongoing efforts to license PBMs and audit pharmacy claims along with semiannual reports. Lawmakers spent a lot of time in the 2023 legislative session trying to understand the costs and benefits of PBMs, ultimately a reporting system Calculating claims and directing that rebate savings be passed on to consumers.
Health care in 2025 and beyond
Tabor said he hopes ongoing data collection efforts will help leaders take a more nuanced and thoughtful approach to health care, even if all of these efforts won’t happen in 2024.
When we get to 2025, and if we need legislation, we can focus on legislation that empowers market-based solutions. I think we have a lot of hospital transparency, but where we don’t have (transparency) is how the premiums are actually calculated,” Tabor said. Although I don’t like all the policies that have been implemented in the past, I think it is wise to think more deeply about making data-based policy decisions and not wandering from one session to the next.
Additional, smaller pieces of legislation for 2024 could address the workforce shortage in nursing, but not massive pieces of legislation by 2023 overall.
I think if we take a breath and we look at some of that data, we look at what’s being collected, I think we can hope that we’ll be more informed in 2025 and beyond. can make decisions, Tabor said.
Charbonneau didn’t rule out the possibility of some health care legislation, saying he was considering a bill to oversee the 340B drug pricing program, which would allow some financially strapped hospitals to purchase expensive pharmaceuticals at a discount. Is. However, Charbonneau wanted to know which hospitals used the program and whether some states serving wealthier populations were taking advantage of poorer systems.
I recently spoke with Dr. (and Indiana US Rep. Larry) Bushon about it. Charbonneau said he’s been trying to deal with it at the federal level and hasn’t been able to get much done yet. This appears to be a well-intentioned program that has kind of taken on a life of its own and moved far away from the mission it was intended for.
He stressed that he did not want to imply any impropriety or any illegality, but simply wanted to bring greater scrutiny to the current program to increase transparency.
As a former hospital CEO with a business background, Charbonneau said he is frustrated by the slow adoption of cost-saving measures at the state level when it comes to increasing quality and affordability in health care.
Over the years, it has become very depressing. We are not making progress in health care, Charbonneau said.
He said the Indiana Chamber of Commerce often The state was ranked low In terms of health care costs, he said it hurts the Indiana Economic Development Corporation’s ability to recruit companies to the Hoosier State.
“We have to work and get there,” Charbonneau said. But it seems like it will happen very slowly. But it will work. The more attention we pay to it, the more publicity we can get. The more we can educate more of our 6.8 million Hoosiers on all this, the better.
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