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Stories of the year: Good news for insurance exchange, but opioid crisis worsens

A billboard designed to highlight public awareness in Anne Arundel County tracks the annual toll as of April 30, 2018: 332 overdoses and 56 deaths. (Maximilian Franz)

A billboard designed to highlight public awareness in Anne Arundel County tracks the annual toll as of April 30, 2018: 332 overdoses and 56 deaths. (Maximilian Franz)

Following a 2017 best described as tumultuous, 2018 was the year health care in Maryland, in some ways, got its groove back.

A new reinsurance program helped lead to lower premiums and more enrollment on the state’s individual market. Doctors and hospitals celebrated the approval of a new contract for Maryland’s unique hospital global budget system. And several hospitals raised money for new projects.

But 2018 did not leave all the troubles behind in 2017. Deaths in Maryland’s opioid epidemic continued to rise with use of the synthetic opioid fentanyl.

And Maryland lost some health care leaders as former CareFirst BlueCross BlueShield president and CEO Chet Burrell retired and former Baltimore City Health Commissioner Leana Wen took the top job at Planned Parenthood.

1. Lower premiums, higher enrollment

Maryland took steps in 2018 to fortify the state’s individual health insurance market after years of instability and rising premiums.

After CareFirst BlueCross BlueShield and Kaiser Permanent, the only insurers on the state’s individual market, raised premiums by double-digits for 2018, leading to decreased enrollment.

The enrollment drop seemed to confirm fears that the individual market was entering a “death spiral” where only the sickest people were willing to pay premiums in order to get insurance.

But the state legislature passed and Gov. Larry Hogan signed legislation creating a state reinsurance program, funded by state tax on health insurance companies. The reinsurance program allows insurers to be reimbursed for high-cost claims, reducing some of the negative effects of covering more sick people.

The move appears to have worked. Hogan and Maryland Insurance Commissioner Al Redmer announced last September that premium decreases for CareFirst and Kaiser had been approved for 2019. For CareFirst, it was the first time the insurer had decreased premiums on the individual market.

Coupled with those decreases, the state insurance exchange announced this month that enrollment was up for 2019, reclaiming the losses it had taken this year. Especially encouraging was that participation by younger people increased, indicating the premiums fell to a level acceptable for people without costly illnesses.

But supporters of the reinsurance program remain wary, noting that reinsurance was only intended to be a short-term fix, with the funding for the program designed to run a couple of years.

The state will have to watch how the effective elimination of the federal individual mandate and the decision by a federal judge in Texas to throw out the Affordable Care Act could affect the market moving forward.

2. Opioid crisis continues to claim lives

Maryland’s deadly opioid crisis continued to batter the state. 2018 is on pace to be Maryland’s deadliest year yet, according to preliminary numbers from the state.

Synthetic opioid fentanyl appears to be fueling the death rate, as it did in 2017.

But more resources are being developed to fight the epidemic.

Baltimore City is opening a stabilization center, described as an emergency room for addiction and mental health. The city has also certified its hospitals based on the level of care they provide for patients at-risk for substance use disorder.

In Harford County, a public-private partnership is collaborating on a crisis center with focuses on addiction and mental health.

And last September, CareFirst awarded a combined $2.1 million to 11 community health groups fighting substance use disorders.

The state also made a change in its leadership addressing the opioid crisis. Steve Schuh, who made addressing the opioid crisis a priority as Anne Arundel county executive, was named executive director of Maryland’s Opioid Operational Command Center. Former director Clay Stamp returned to his role in Talbot County.

3. All-Payer model extended

For years, Maryland has stood alone with its Medicare waiver. In the Maryland All-Payer Model, the state sets rates for procedures at hospitals. But in 2018 Maryland said it would look beyond hospitals for the first time.

Last July, Gov. Larry Hogan signed a new contract with the federal Centers for Medicare and Medicaid Services where the state ex expected to save more than $1 billion while improving health outcomes. The contract goes five years with an option for another five years.

This contract, the Maryland Total Cost of Care All-Payer Model, will include models for improving patient outcomes and population health and a new Maryland Primary Care Program. Both the new contract and the primary care program go into effect Jan. 1.

The primary care program will bring physicians into the all-payer model for the first time, getting incentives for finding ways to keep patients healthier and out of hospital emergency rooms.

4. Wen leaves Baltimore for Planned Parenthood

Dr. Leana Wen, Baltimore’s health commissioner. (The Daily Record / Maximilian Franz)

Dr. Leana Wen, Baltimore’s health commissioner, left to lead Planned Parenthood. (The Daily Record / Maximilian Franz)

Baltimore lost a leader in the opioid crisis and a number of other public health issues when city health commissioner Leana Wen left for Planned Parenthood last month. Wen, an emergency room physician, had led the city health department since 2015.

As health commissioner, Wen focused on issues large and small. The opioid epidemic was a top priority for Wen, who issued a blanket order across the city to make the opioid-reversing drug naloxone available to everyone.

Wen’s other issues ranged from women’s health and access to healthy food to encouraging office workers to stay fit and handing out eyeglasses to kids in city schools. The 50,000th pair of glasses was handed out this month.

In 2018, Wen helped lead the city into several battles against the Trump Administration, including a lawsuit over the administration’s handling of the Affordable Care Act a lawsuits seeking to restore federal funding for a teen pregnancy education program tand a fight against a federal change to Title X that could keep clinics that provide abortions or refer women to clinics that provide abortions from receiving federal funding.

The city has not yet named a new health commissioner.

5. CareFirst gets a new CEO

For the first time in more than a decade, Maryland’s largest health insurance company has a new leader.

Chet Burrell retired as CareFirst BlueCross BlueShield’s president and CEO last July after nearly 11 years leading the insurer. COO Brian Pieninck was tapped to take Burrell’s place.

Burrell’s priorities as CEO had included instituting a patient-centered medical home model to try to corral the rising costs of members with chronic disease. In retirement, Burrell plans to invest in medical device companies, serve on nonprofit boards and an advise his son as he starts two medical schools.

Pieninck’s priorities could go in another cost-saving direction by trying to find ways to stem the rising costs of drugs. About one-third of CareFirst’s health care spend comes from pharmaceuticals, whether prescription drug costs or drugs administered during hospital stays.

Under Pieninck, CareFirst also plans to move into the Medicare and Medicaid markets, providing more competition in a market that includes health systems in addition to traditional insurance providers.

6. Hospitals bring in money

Maryland hospitals received millions of dollars in philanthropic aid in 2018, much of it earmarked for helping to treat or cure specific diseases.

Last February, Johns Hopkins Medicine received a $50 million contribution from the United Arab Emirates to create a new institute for stroke research and clinical care. With locations in Baltimore and Abu Dhabi, the Sheikh Khalifa Stroke Institute will use advances in engineering, artificial intelligence and precision medicine for the diagnosis and treatment of stroke patients.

The University of Maryland Medical Center will build a new tower to house its comprehensive cancer center after receiving a $25 million contribution last October from Baltimore businessman Leonard Stoler and his wife Roslyn. The gift was the largest private contribution in the hospital’s history.

Greater Baltimore Medical Center received a $500,000 contribution from Alstrom Syndrome International to create a center of excellence for Alstrom Syndrome, a rare genetic condition that causes blindness, deafness and multi-organ system failure.

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