If you have an idea that can reduce health care costs, there’s a good chance Colorado will try it.
State Health Care Savings Office I made plans for 2020 This included passing a partial publish option. Extension of the reinsurance program. Launch a statewide purchasing alliance. importing prescription drugs; launching the Commission on Affordability of Medicines; Increase transparency of hospital and prescription drug prices.
All of these agendas are at least beginning to be implemented, with the exception of import plans that require approval from the US Food and Drug Administration. However, since most are in their early stages, it is difficult to assess whether they will succeed in cutting costs.
Colorado is ultimately pursuing two avenues to reduce healthcare costs, said Bob Smith, executive director of Colorado Business Group on Health. Colorado’s option insurance plan is an example of pricing, he said, and purchase partnerships are an attempt to negotiate better deals through the marketplace.
“I think the state is trying to figure out which of these two approaches will give better results,” he said.
Gov. Jared Polis has challenged the idea that the state is testing two different philosophies and may choose a winner in the end. he said it would.
“America has inadequate health care,” he said. “We look for good ideas from left, right and inside.”
colorado options
Unlike a fully public health insurance option, the Colorado Option Plan is operated by an insurance company. What sets them apart from other plans is that they are standardized. In other words, out-of-pocket costs for all option plans are similar. They offer more services without out-of-pocket or other direct costs. Adjusted for inflation, we need to reduce premiums by 15% over the next three years.
Not All Colorado Option Plans Achieved 5% Reduction in 2023However, according to the Colorado Department of Insurance, the vast majority of those who purchase insurance through the marketplace have access to at least one plan. All counties have Silver level Colorado Option plans that are cheaper than the average Silver plan.
About 35,000 people signed up for the Colorado Option Plan this year. This includes about 10,000 people who were not eligible for tax credits because of their immigration status but received state aid.
The 25,000 people who are citizens and can choose any plan account for about 13% of people buying on the private market in Colorado, far more than the public options Washington won in its first year. said Colorado Insurance Commissioner Michael Conway.
“The new products with more than 13% of the market will be spectacular,” he said.
Adam Fox, deputy director of the Colorado Consumer Health Initiative, said premiums have been disappointing, but could start coming down next year when the state can hold public hearings to investigate prices. said.
He also said there is value in providing patients with health insurance options that have lower out-of-pocket costs and higher incentives for primary care. You don’t have to pay for diabetes test supplies.
“These aren’t the lowest cost plans, but they are the best value plans,” he said.
Reinsurance
According to Fox, reinsurance has been one of the biggest successes in cost-cutting efforts. And the state has long-term funding, so the profits will continue for at least the next few years, he said.
“Colorado, or at least parts of our state, used to be some of the most expensive (insurance) markets in the country,” he said. ”
this is basically a backstop, limits the amount an insurer selling in the market must pay if a customer’s care exceeds $30,000. More money is available in more expensive markets with fewer insurance options.
Insurance companies must use 80% of the premiums they collect to care for their customers, so lower premiums mean lower premiums. This decrease was largely overwritten by other expense increases. In other words, reinsurance was more a way of limiting interest rate hikes than of lowering them.
Connect for Health Colorado Estimates Premiums in 2023 would have been about 20% higher without reinsurance.
Purchasing tie-up
State employee health insurance and other partners Colorado Purchasing Alliance They are trying to direct employees to hospitals that offer better results at lower prices. However, it’s too early to tell whether the incentives the state is offering to employees who use decision-making tools to select higher-value providers will result in significant savings.
About half of Coloradoans work for non-Colorado employers, so health care costs aren’t a problem that the state can solve alone, Smith said. The Purchasing Alliance now works with employers across the country to set quality standards. For example, the rate at which a diabetic’s blood sugar level needs to be controlled. Local doctors can fill in the way they think best.
“The way we improve where there is room for improvement is very local,” he said.
Import of pharmaceuticals
If the FDA approves importation of medicines, participating residents can save up to 65% on certain common medicines, totaling $53 million to $88 million in savings, according to Colorado’s health policy. and the Office of Funding estimate. Colorado law allows the state to import drugs from other countries, but federal law only allows arrangements with Canada at this time.
The FDA has yet to approve similar proposals from Florida, New Mexico and New Hampshire. Submitted over a year agoThe Canadian government opposes the import plan over concerns that supplying the much larger American market could lead to shortages.
FDA Commissioner Dr. Robert Calif said in an interview that he cannot comment on specific state proposals, but that the quality of plans that states present will be a key factor in determining how quickly they can move forward. .
Colorado has learned from other states’ mistakes and should have a smoother process, said Kim Bimestefer, executive director of the state’s Office of Health Policy and Finance. The province has already identified partners for importing, testing and distributing drugs from Canada, she said.
“Florida was a little ahead of their skis,” she said. “That’s fine. We learned from Florida.”
drug pricing committee
of Affordable Board for Prescription Drugs is still finalizing its rules and plans to begin reviewing the drug in March.
The Board is limited to setting maximum prices for 12 drugs per year for three years. The general public can ask the board to review a particular drug, and the review will begin if the price of the drug rises by 10% within his one year. Branded drugs cost over $30,000 a year. Alternatively, generic drugs cost over $100 per month.
How effective a board is depends on how aggressively it sets maximum prices. Number of people taking controlled drugs. Whether there are unintended consequences, such as drug companies refusing to sell in Colorado.
price transparency
In June, the Police signed the bill Prohibit hospitals that don’t publish prices from suing patients Or send it to collection via unpaid medical bills. However, states do not enforce the law. Patients who believe the hospital has improperly pursued offensive tactics must sue to have their debts forgiven and claim damages.
No one has tracked these cases, so it is not clear whether anyone has filed a lawsuit and, if so, whether they won. It may discourage or increase transparency when publishing prices.
The Colorado Hospital Association reports that the majority of facilities comply with federal price posting laws, patient advocacy groups He says he often finds holes in the price lists posted on the websites of Colorado hospitals.
Medicare and Medicaid Service Centers Ultimately Decide Who’s Compliant, But They Just Fined 2 hospitals nationwide To not post prices in 2022.
Fox said transparency helps people scheduling care but not so much for people with medical emergencies.
discount hospitalization
Colorado hospitals must now screen uninsured patients to see if they qualify for discounted medical care based on their income.
No one keeps track of how many people received high bills before and after the law went into effect, but Fox said he called the Colorado Consumer Health Initiative since then. Fewer people are asking for help.
“We are already seeing some benefits from our consumer assistance program,” he said.
insulin price cap
colorado Limit your monthly insulin out-of-pocket to $100 A health insurance plan regulated by the Department of Health. People who don’t have insurance or have plans that aren’t state-regulated can sign up for a program that lets them buy insulin for $50 a month.
No one keeps track of how many people have used the cap or how much money they have saved. But diabetics report being able to get insulin easily, said Lieutenant Gov. Diane Primavera, who heads an office that saves people money in health care.
“There are people behind every number,” she said.
more coming?
The Department of Health Policy and Finance plans to release a review of hospitals’ adherence to published prices in February and roll out tools for comparison shopping in June. This is in addition to an existing tool for providers to compare the cost of similar drugs, which the division estimates is used by 43% of prescribers who see Medicaid patients. I’m here.
Several laws passed last year covering health care costs will not come into force until 2024.one of them House Bill 1370This requires the insurer to pass on the rebate for the drugs received to the customer. The insurance sector estimates that rebates account for about 21 cents for every dollar spent on brand-name drugs, but the savings vary.
The bill currently before Congress builds on Colorado law that limits insulin copayments. Attach a similar cap to an epipen, to treat life-threatening allergic reactions. Polis said he doesn’t expect states to continue to grapple with the price of a single drug indefinitely, but epipens and insulin are special cases.
“These are cheap to manufacture. They’ve been around for decades,” he said. “It’s not like the brand new drug that he spent his billion dollars developing.”
In a state speech, Police called for legislative changes to stop nonprofit hospitals from charging exorbitant fees. The Internal Revenue Service requires you to show that a tax-exempt hospital is providing it. “Regional Benefits” However, it is broadly defined and includes things like employee training and philanthropy.
“[In exchange for not paying taxes]they have to take responsibility not to overcharge their patients,” Police said in an interview, noting that if states can “ignite their bellies,” insurance He added that the company could be an ally.
Several initiatives, such as a reinsurance program, have stabilized the cost of health insurance in the state, Fox said. He said it remains to be seen whether the new law will actually reduce costs for individuals or the state as a whole.
“Each of these measures that we have advocated in Colorado are intended to address different aspects of the health care system,” he said. prize.”
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