A small ACA program saves $384 million over two years.  The Affordable Care Act (ACA) created opportunities for hospitals to experiment with alternative payment models that would theoretically incentivize doctors to provide higher-quality care for lower costs.  While some were unable to do so, the Pioneer Accountable Care Organization model seems to be showing positive results: the hospitals in the program saved an average of $300 per patient, amounting to a total of $384 million over two years.  According to health journalist Sarah Kliff, “if hospitals in the Pioneer ACO program covered Medicare patients at lower-than-expected costs, they kept 70 percent of the savings in 2014 (the other 30 percent went back to the federal government). But if they spent more than expected, they would have to pay the feds back the difference.  All of a sudden, the Pioneer ACO program gave doctors a reason to spend less in a system that typically rewards anyone who spends more.”  Presbyterian Healthcare Services in New Mexico experimented with this model but has since backed out to focus on its Medicare Advantage program.  Hopefully, the ACO Pioneer model can be replicated and produce savings for consumers here in New Mexico and throughout the nation.

-          Barbara Webber, Executive Director

Consumers Union survey finds that nearly 1/3 of Americans with private health coverage were hit with surprise medical bills over the past two years.  Among those who dealt with a billing issue, only 28% were satisfied with how the issue was resolved, 75% of whom wound up having to pay the bill in full.  As we wrote about several weeks ago, states are examining how best to protect consumers from these costs.  We hope that New Mexico will begin to do so during the next legislative session.  Until then, here’s what you can do if you believe your doctor or insurance company have wrongly charged you for any service: First, file an internal appeal with your insurance company.  If your claim is denied, you can request an external review from the NM Consumer Assistance Bureau.  Note that if your employer self-insures its employees, the US Department of Labor will handle your claim.  Medicaid appeal assistance is available through Law Access NM (ABQ: 998-4529; Statewide: 1-800-340-9771).  Now is the time to start thinking about policy solutions to curb the negative outcomes of surprise medical bills.

-          Colin Baillio, Communications and Outreach

Many health plans are violating ACA standards for Essential Health Benefits (EHB) that influence women’s health. A report released this week by the National Women’s Law Center analyzed health plans in 15 states and found that many had not been adhering to Affordable Care Act’s contraceptive and maternity/newborn care benefit requirements.  Although New Mexico was not included in the report, these findings imply that issuers in other states may be following the same pattern.  These essential services are especially important for women who need access to birth control. About 99% of all women use contraceptives at some point in their lives to control when and if they become pregnant. This is extremely important considering the overwhelming data showing the age and timing of a pregnancy is highly correlated with education and employment opportunities, as well as lifetime earning capacity. New Mexico’s women deserve the right to adequate and timely access to contraceptives.  

-          Andrea Andersen, Health Policy Intern

Texas Medical Board votes to restrict use of telemedicine to remotely treat patients. When many states are making efforts to increase the availability of telemedicine, Texas has decided to take the opposite action. In mid-April of 2015, the Texas Medical Board voted to approve rules to limit the use of telephone and video technology to diagnose and treat patients remotely. This is concerning, given the serious health service access problems faced by rural areas in Texas and throughout the United States.  While patient safety is a serious concern, scaling back an important technology in a state with such great rural access needs is troubling, especially when comprehensive safety guidelines are available.  The medical board claims that the components of a successful doctor-patient relationship are not sufficiently satisfied through the use of telemedicine – but a digital doctor-patient interaction is better than no interaction. Health Action New Mexico believes that all people should have convenient access to medical advice and consultation, and supports the use of telemedicine as a device for improving this access. 

-          Ellie Perkins, Dental Health Intern

Dr. Atul Gawande says that Americans are over-tested, over-diagnosed, and over-treated. Since doctors are in an authoritative position, patients tend to trust their judgement on the best path to health.  However, sometimes less treatment is the key to reaching that goal.  “[Doctors] can recommend care of little or no value because it enhances our incomes, because it’s our habit, or because we genuinely but incorrectly believe in it, and patients will tend to follow our recommendations,” says Dr. Gawande.  The problem is that prescribing too much care is often detrimental to the patient and make care more costly for everyone.  “Our ever more sensitive technologies turn up more and more abnormalities—cancers, clogged arteries, damaged-looking knees and backs—that aren’t actually causing problems and never will. And then we doctors try to fix them, even though the result is often more harm than good.”  While well-informed consumers are key to a smart health care system, doctors play a critical role in making our system more efficient and improving treatment for patients.  Sometimes that means doing less than more.

-          DeAnza Sapien JD, Advocacy Coordinator