5 Things Florida: Value-based care, Health in the budget, Overdoses on the rise

This may be the calm before the storm.

Thursday is the last published day on the US Supreme Court calendar to release opinions from its current term (though they have a few more weeks for orders). It’s a term that saw a meaningful challenge to the ACA last November. It was a case many in the media thought could not be overturned, based on the line of questioning from the justices. But for that to happen, Justices Roberts and Kavanaugh both will need to break from the 6-3 conservative majority to craft a majority opinion with the three more liberal justices. That seems a tough reach.

Anyone who tells you they know what’s coming should probably not be listened to, including me. But, for what it’s worth, I’d offer this is not a binary moment. The range of options which I think may be on the table for the justices to land a majority with is wide. Like the first NFIB case, expect the unexpected. You can read my break down of the Texas case from 2019 here, or my half correct prediction of the 2012 NFIB case (and subsequent explanation of Roberts’ creative opinion here).





With help from Emily Boerger

1. Republicans talk health care in the budget

Buoyed by $10.2 billion in federal aid, the $101 billion state budget signed by Gov. DeSantis last week is the largest-ever state spending plan. During the State of Reform conference, Republican legislators Rep. Tom Fabricio and Rep. Mike Beltran reflected on the $44.6 billion in the budget that went to health care.

Beltran applauded the legislature’s move to secure funding to expand Medicaid coverage for postpartum women to 12 months, expand Medicaid coverage for children in foster care, and allocate about $9 million to support the Office of Minority Health and Health Equity. Beltran qualified that he is not in favor of widespread expansion due to the cost. In the future, Beltran says lawmakers needs to get the budget back under $100 billion because the state will not enjoy the same level of federal aid that it received during the pandemic.


2. Rep. Joseph reviews the legislative session

When asked to reflect on the 2021 legislative session, Democrat Rep. Dotie Joseph says lawmakers took “a few steps forward, and a few steps back.” Joseph, who serves as Democratic Ranking Member of the House Finance and Facilities Subcommittee, offered her perspective on legislative wins and future areas for improvement during our “Policy Leadership: Democrats” panel at the State of Reform conference.

Joseph highlighted several priority bills that passed out of the House, but ultimately died in the Senate. The list includes HB 1155, which fines PBMs that fail to register with the state, and HB 1447, which creates the Commission on Mental Health & Substance Abuse. Joseph says addressing health disparities in Florida will be her top priority going into the next session. “If you are providing primary or maintenance care, I want to make sure you have the tools you need to understand little cultural nuances.”


3. The road ahead for value-based care

During this video conversation, four Florida health leaders came together for a cross-silo discussion on the road ahead for value-based care. They each offer solutions and recommendations to foster the VBC transition, and evaluate how the COVID-19 pandemic can be used as a catalyst for value-based models.

Elizabeth Miller, CEO of Sunshine Health, says there should be standardization of models across providers and clear communication at all levels of the health care system. Florida Hospital Association CEO Mary Mayhew agrees, and notes that they need clear, up-to-date data to measure the success of each model. The conversation also features insights from Nicole Bradberry, CEO of the Florida Association of ACOs, and Ray Parzik, Senior Director of Value Based Contracts at Florida Blue.

4. Overdoses up across Florida

Provisional data from the Florida Dept. of Health shows suspected non-fatal drug overdoses through September 2020 have increased over 23% in Florida compared to the same time in 2019. Melanie Brown-Woofter, president and CEO of the Florida Behavioral Health Association, says suicide deaths increased in 22 Florida counties from 2019 to 2020.

Brown-Woofter says these are all indicators that Florida needs to prepare for the long-term impacts of COVID-19 on opioid abuse and behavioral health. “We’ve seen it with the Great Depression, we’ve seen it with World War I and World War II, and we’ve seen it with the flu pandemics. These [crises] have a lasting impact.” She says some areas of the state – including Jacksonville, Tampa, Miami, Orlando, and Ft. Lauderdale – have been particularly hard hit with increased use of opioids, heroin, and methamphetamine.


5. Impact of climate change on health

An often overlooked aspect of climate change, says Dr. Patrick Breysse at the National Center for Environmental Health, is its impact on mental health – particularly for first responders, children, and people experiencing homelessness. He says increased frequency and severity of extreme weather events can lead to stress, depression, anxiety, PTSD, and suicidal thoughts.

Breysse’s comments came during a panel on the emerging impacts of climate change on health at the State of Reform conference last month. During the conversation, Dr. Todd Sack discussed the climate change responsibilities of the health care system, which he says accounts for about 10% of the United State’s greenhouse gas emissions. He also offered climate change solutions from health care organizations, hospitals, and health professionals during his comments which are available in full here.