Payment Reform

The National Academy for State Health Policy (NASHP) provided a grant to the Colorado Department of Health Care Policy and Financing to develop a new payment methodology for physician-administered drugs (PADs). PADs are drugs delivered by intravenous infusion or injection in clinical settings. The category includes costly drugs, such as chemotherapy and other specialty medications. […]

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  • State Health Policy Blog

    Highlights of States’ ‘Surprise’ Medical Balance Billing Laws

    Surprise balance bills occur when patients receive unanticipated charges for health care services because they were unaware that care was delivered by an out-of-network provider or facility. In some cases, surprise balance bills can amount to hundreds if not thousands of dollars in medical expenses. A growing number of states have passed or are proposing […]

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  • Comparison of Bills Creating State Prescription Drug Affordability Review Boards

    A growing number of states are considering legislation to create prescription drug affordability review boards during the 2019 session. These boards would enable states to set “allowable rates” for certain high-cost drugs identified by the board, similar to the approach states use to regulate utilities or insurance premiums. NASHP released drug affordability review board model […]

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  • State Health Policy Blog

    Hospital Price Transparency: The Next Frontier

    The Centers for Medicare & Medicaid Services (CMS) took an important first step toward increasing the  transparency of hospital finances when it required hospitals to post their charge information, effective January 2019. But, these charges are not prices paid — they are typically the starting point against which commercial payers negotiate discounts. States with all-payer […]

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  • State Health Policy Blog

    Annual Federal Insurance Rule Includes Proposals to Address Prescription Drug Cost

    The Trump Administration’s effort to address drug prices surfaced unexpectedly in the Department of Health and Human Services (HHS)’s recently issued proposed annual rule that regulates state health insurance markets, including coverage sold through the Affordable Care Act (ACA) marketplaces. The proposal encourages the use of generic drugs over brand-name drugs by both health plans and enrollees […]

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  • Publications

    States Use Policy Levers and Emerging Research to Address Antipsychotic Use in Children in Foster Care

    State policymakers must often take action during an emerging crisis even when evidence identifying the best policy approach is not be available. This report, Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System, explores successful state responses to dramatic increases in antipsychotic prescription rates in Medicaid-enrolled children […]

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  • State Health Policy Blog
    Guest Blog: Massachusetts Report Recommends More Health Care Price Transparency and Simpler Payment Methods

    Guest Blog: Massachusetts Report Recommends More Health Care Price Transparency and Simpler Payment Methods

    Amara Azubuike and Sandra Wolitzky are assistant attorneys general in the Massachusetts Office of the Attorney General. A new report released in October 2018 by Massachusetts Attorney General Maura Healey finds that complicated and varied methods used to determine health care payment rates contribute to administrative cost increases and make it difficult for market participants […]

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  • Toolkits
    Toolkit: State Strategies to Develop Value-Based Alternative Payment Methodologies for FQHCs

    Toolkit: State Strategies to Develop Value-Based Alternative Payment Methodologies for FQHCs

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  • FQHC Readiness

    FQHC Readiness

    The National Academy for State Health Policy (NASHP) designed this toolkit to support states interested in developing a value-based alternative payment methodology (APM) for federally qualified health centers (FQHCs). The following section on FQHC readiness and practice transformation discusses key considerations and promising strategies based on lessons learned from states during NASHP’s Value-Based Payment Reform […]

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  • Measurement and Reporting

    Measurement and Reporting

    The National Academy for State Health Policy (NASHP) designed this toolkit to support states interested in developing a value-based alternative payment methodology (APM) for federally qualified health centers (FQHCs). The following section on measuring performance discusses key considerations and promising strategies based on lessons learned from states during NASHP’s Value-Based Payment Reform Academy. Types of […]

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