Week 3 Diss DDHA 8600
By Day 3 Post an explanation of what additional legislative and/or regulatory actions might be taken to limit increases in healthcare expenditures at the state and federal level. Be specific and provide examples
State Level
There are several advantages to implementing reforms at the state level. State-level
reforms can be tailored to work best for each state, depending on its size and demographics and
the structure of its insurance markets. States also have considerable authority over the regulation
of health insurance and the provision of health care within their borders (Altman & Morgan,
2015).
A cost growth goal caps the growth in a state's total health care spending per capita, based
on growth in the gross state product per capita. A goal is a public pledge to hold health care costs
under a set target and could be established quickly and without
legislation. Massachusetts and Maryland have set such goals, and Rhode Island's Working Group
for Healthcare Innovation recently endorsed the establishment of one (Buck, 2003). Besides, all
states should institute a state scorecard on health and cost outcomes. A scorecard would permit
state stakeholders to comprehend the current spending and outcomes landscape and let the state
openly track progress toward goals, leading to an increase in the accountability of providers,
payers, and other stakeholders (Altman & Morgan, 2015).
Federal Level: Medicare
Medicare should directly expand the Acute Care Episode program--which bundles
payments for cardiac and orthopedic procedures--nationwide. Medicare has shifted the from fee-
for-service to bundled payments for all procedures and primary care. This move has showed that
bundling payments for hospital care and post-acute care would save Medicare almost $19 billion
in a decade-assuming full implementation. Other estimates that bundled payments would save
Medicare much more: $63 billion in a decade ("Health Cost Containment: State Initiatives and
Federal Health Reform", 2020).
Negotiating Pharmaceutical Prices
Current law, the Secretary of the Department of Health and Human Services (HHS) is
prohibited from negotiating lower drug prices on behalf of Medicare Part D beneficiaries. One
study has shown that the potential annual savings with FSS prices would be $21.9 billion [95%
confidence interval (CI), $21.1 billion to $22.8 billion]. If Federal Supply Schedule (FSS) prices
were substituted for only the top ten drugs, the annual savings would be $5.9 billion (95% CI.
$5.7 billion, $6.1 billion) (Gellad et al., 2008)
References
Altman, D., & Morgan, D. (2015). The Role of State and Local Government In Health. Health
Affairs, 21(4). Retrieved 17 June 2020, from.
Buck, J. (2003). Medicaid, Health Care Financing Trends, and the Future of State-Based Public
Mental Health Services. Psychiatric Services, 54(7), 969-975.
https://doi.org/10.1176/appi.ps.54.7.969
Gellad, W., Schneeweiss, S., Brawarsky, P., Lipsitz, S., & Haas, J. (2008). What if the Federal
Government Negotiated Pharmaceutical Prices for Seniors? An Estimate of National
Savings. Journal Of General Internal Medicine, 23(9), 1435-1440.
https://doi.org/10.1007/s11606-008-0689-7
Health Cost Containment: State Initiatives and Federal Health Reform. Nesl.org. (2020)
Retrieved 17 June 2020, from https://www.ncsl.org/research/health/cost-containment-in-
health-reform.aspx.
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Hi Tiffany,
Good examples! The Tobacco