The measure also ups Medicaid payment rates for outpatient procedures performed at hospitals.

Kentucky Governor Andy Beshear has signed a law that will expand healthcare services for people in the state while also boosting Medicaid payment rates for outpatient procedures performed at hospitals.

"More than any other entity, Kentucky’s hospitals have felt the strain of increased demand on resources and services as we’ve dealt with the impacts of a global pandemic over the past three years as well as devastating weather events," Beshear said in a statement on the Kentucky government website. "We must do everything we can to support our hospitals and ensure they are equipped to provide the services and care needed in their communities. I am thrilled to sign HB 75 into law, ensuring that our hospitals, especially our rural providers, can continue to improve health outcomes for all our Kentucky families."

Through HB 75, hospitals will be reimbursed for outpatient services and have access to federal resources. The law requires Kentucky’s Department for Medicaid Services to review outpatient services and provide additional payments to hospitals to lower the payment gaps between Medicaid reimbursements and what is paid by private health insurance. The law also lets Medicaid create a hospital rate increase program for people enrolled in its fee-for-service program to pay up to the upper payment limit of the federal Medicare program. The legislation is retroactive to Jan. 1, 2023.

"The passage of HB 75 and the Governor signing the bill into law will help to strengthen and stabilize hospitals and health systems throughout the commonwealth, especially those in rural areas of Kentucky who have been historically vulnerable," Donald Lloyd, president, and CEO of St. Claire HealthCare in Morehead, said in the statement. 

Advantage Care Physicians is 'ramping up' its approach to value-based care.

Healthcare providers are as unique as the patients they treat every day, and each has its own mission and singular approach to how it delivers care and Advantage Care Physicians (ACPNY) is no exception.

ACPNY is a downstate New York-based primary and specialty care provider servicing four of the five boroughs of New York City—Staten Island, Manhattan, Queens, and Brooklyn—as well as Western Long Island. With over 350 physicians and half a million patients, ACPNY operates under a patient-centered medical home model (PCMH). A PCMH model is a way of delivering high-quality primary care with greater emphasis on the patient using a "culturally appropriate, and team-based approach," according to the Centers for Disease Control and Prevention.

Paul Hebert is the Chief Administrative Officer for ACPNY, and he recently connected with HealthLeaders to discuss what makes the organization different from others and ACPNY’s approach to financial success.

HealthLeaders: What makes ACPNY’s approach to patient care unique?

Paul Hebert: I’ve been with Advantage Care Physicians for close to four years and before that, I spent all of my career on the payer side. I worked at Aetna for 21 years, and at United for 10 years in a lot of different financial and operational roles. So, when I came into Advantage Care, I asked myself, what is Advantage Care all about? Then I started to learn about their 'care for the whole you' approach and how we think about a patient individually. That is when it hit me that the single largest drink that Advantage Care brings to the table is that patient and provider relationship.

When I looked at this from a purely financial perspective and asked, 'how much does this cost?' and 'where do we see the benefits associated with that approach?' it was the persistency number that blew me away. If a patient comes in to see one of our providers, we maintain a relationship with that patient 96% of the time. We've curated relationships that are important to our patients. For example, we have a radiology provider in Lenox Hill Radiology on-site at most of our locations. We also have [lab test provider] Quest on site. We have curated relationships with hematology and oncology providers through our relationship with New York Cancer and Blood at nine of our sites. We have advanced dermatology at our sites. So, it's really simple and very seamless for our patients to move into specialties that their primary care doctor doesn’t offer, many times at the same location as their primary.

It’s a really wonderfully curated model around the most efficient and effective high-quality care delivery.

HL: What are your financial responsibilities as the chief administrative officer and what strategies are in place to maintain the organization's financial well-being?

Hebert: That’s an evolving answer. In the past Advantage Care had a lot of HMO patients on the primary care side and was paid capitation. The risk there is you see a patient often and you may not be covering your costs, but the advantage is if you have a healthy patient that’s coming in twice a year, you’re getting paid to provide that care and the services around it, so that can be financially beneficial to you.

The world has changed, and HMO products and capitation are dwindling. So, when we look at alternatives—and this has been an evolving process over the last four or five years, certainly started before I came but it's accelerated since I got here—we are moving into the value-based contracting world. We are moving into sharing risks associated with the care and the outcomes of that care for these patients.

We have roughly 300,000 patients that are under some form of a value-based care contract. Obviously, there are incentives if we can manage the cost of care while maintaining high-quality care that’s based on a series of measures. I always joke that if you've seen one value-based contract, you've seen one. They're always different. There are always attributes of some kind of MER [medical expense ratio] measure. It's certainly a quality measure, but it's the weighting of those quality measures and determining the gates that you have to clear to be able to be paid that share of the savings. So, we've really amped up our approach to value-based care. We've even reworked our compensation model for our providers to reflect those metrics and measures that fall under a value-based care contract.

HL: What has the outcome of this approach been?

Hebert: At first providers were a little apprehensive, but now that we’ve been incredibly transparent on what drives our financial results through reporting and score carding, [they have a better understanding]. There are discussions about our financial results with our leaders and physicians at least every month. I’m always getting questions from our physicians, and they come to me with ideas on what else we can be doing. Some ideas are great, and some are borderline crazy—but they’re always well-intentioned and provide good foundational thinking.

When you look at quality metrics, and an opportunity to close gaps in care, there are a lot of ideas around outreach and how we can get in touch with our patients, and how we can leverage all of the interaction points that we have with a patient, whether it's through primary care or even specialty care and now that we can capture all this in our EMR and Epic, it doesn't matter what position you are in ACPNY, you can see what's going on with a patient and you can start to talk to them about a mammogram, a flu shot, or a COVID-19 vaccine. Those reminders that pop up on the screen, now our call center folks can have those conversations too. So, it's kind of a cohesive strategy around continuing to educate folks on what they need to do to stay healthier.

The analysis found that most adults with past-due medical debt owed at least $1,000, and more than one in five owed at least $5,000.

Medical debt is a predominant problem in the United States, with many patients choosing to forego care rather than take on this massive financial burden. But those who do seek care often end up with outstanding bills they struggle to pay.

Indeed, 15% of nonelderly adults in the U.S. reported having past-due medical bills, according to analysis from the Urban Institute, with support from the Robert Wood Johnson Foundation. Of those with outstanding debt, 73% say they owe some or all of it to hospitals. The research focused on adults with family incomes below and above 250% of the federal poverty level and found that 15.4% of adults live in families with past-due medical debt. About two-thirds of these adults have incomes below 250% of the federal poverty level.

"The persistence of medical debt highlights the ongoing challenges families face in obtaining affordable healthcare, including high prices for services, gaps in access to health insurance coverage, and inadequate protection against out-of-pocket costs for many people with high-deductible insurance plans," the report says. "The concentration of past-due medical debt among families with low incomes and the large share who owe a portion of that debt to hospitals suggests that expanded access to hospital charity care and stronger consumer protections could complement coverage expansions and other efforts to mitigate the impact of unaffordable medical bills."

The analysis found that most adults with past-due medical debt owed at least $1,000, and more than one in five owed at least $5,000. Adults with past-due hospital bills were more likely to have much higher total amounts of medical debt than adults with only debt from non-hospital providers. 

"High rates of medical debt underscore the challenges millions of families and adults—especially families and adults struggling to make ends meet—face trying to pay their medical bills," Gina Hijjawi, senior program officer at the Robert Wood Johnson Foundation said in a release. "We see that individuals with disabilities, and Black and Latino adults are disproportionately represented among adults carrying past-due medical debt. Consumers need standards in place that protect them from undue medical debt and help them obtain affordable care."

The healthcare provider says it is able to remain operational through the summer.

Hazel Hawkins Memorial Hospital recently announced that efforts to turn around its financial crisis have been paying off, securing enough funds to keep operating through the summer—previously it was expected the organization would run out of money by April.

"The Herculean efforts by our team are finally catching up with the crisis," Mary Casillas, Interim CEO for Hazel Hawkins, said in the announcement. "What we are seeing now is the ability to sustain the current operations for the district through late summer."

For months Hazel Hawkins Memorial Hospital has worked to improve its financial positioning and avoid a bankruptcy filing. The Hollister, California-based provider with 25 staffed beds and over $300 million in revenue, says it has received and scheduled near-term payments from MediCal, Medicare, and Anthem. The hospital has also implemented cost savings measures and reductions in staffing costs. While having made some progress, Hazel Hawkins Memorial Hospital still considers its financial situation "critical."

"We are not out of the woods yet, but we are in a much better position to complete a partnership agreement or sale by this fall, Casillas said in the announcement. "Though our cash position has improved dramatically over the past few weeks, we need more help. We hope that the community can see our progress and get behind our efforts to save access to quality healthcare for thousands of San Benito County residents."

Hazel Hawkins Memorial Hospital stated back in February that finding a "strategic partner" or a buyer would be the best way to help it out of its current economic predicament.

"Our team has begun the process of reviewing the first LOI and we have been alerted that there may be more LOIs submitted in the coming weeks," Casillas said. "The importance of finding the right partner or buyer is crucial for our community as it will pave the way to access to critical healthcare services here in San Benito County."