ACR report card: Most states still average a ‘C’ for rheumatology care access, cost
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New York is the best state for patients with rheumatic diseases to live in, while Wyoming was ranked worst in the United States, according to a new report released by the American College of Rheumatology.
In its 2022 Rheumatic Disease Report Card — an update to its initial report released in 2018 — the ACR again graded most states as a “C” in terms of adequate access to rheumatology care, affordability, and encouraging healthy lifestyle habits. New York earned the highest grade, with a “B” average, while Wyoming scored an overall “D,” with “F” grades in both access and affordability.
The release of the report coincides with Rheumatic Disease Awareness Month.
“This report card provides invaluable insight into the state of rheumatic disease care in our country,” Rebecca Shepherd, MD, MBA, FACR, FACP, chair of the ACR insurance subcommittee, said in a press release. “Rheumatic diseases can be debilitating, but they don’t have to be. It is critical that health care stakeholders and policymakers address the issues highlighted in this report and work together to raise the grade on rheumatology care throughout the country.”
The study investigated how easy it is to “live a full life well” in each of the 50 states and Washington, D.C., read the release. According to the ACR, the goal of the report is to support and guide physicians, lawmakers and patients in addressing access and affordability for patients. The ACR assigned a letter grade for each state in several areas, including the availability of access to rheumatologic care, the affordability of rheumatic disease care and the way states work toward promoting active and healthy lifestyles for patients with these diseases.
The researchers also took into consideration any progress made by individual states since the 2018 report.
In total, 29 states, plus Washington, D.C., received overall “C” grades, while 15 states averaged “D” grades and just six states achieved a “B.” New York, Virginia, Maryland, California, Illinois and Louisiana were among the highest scoring states, while Wyoming, Nevada, South Carolina, Mississippi, Idaho and Alabama performed the worst.
States received grades based on a system where were distributed based on indicators. For indicators relying on numbers, such as patients per rheumatologist and the percentage of people in the state without health insurance, the top-scoring quintile states received five points, the next quintile received four out of five points, and so on.
Investigators also took account of indicators tracking legislative efforts, including the prohibition of specialty tiers and copay accumulators, the report said. In these instances, points were counted on an all-or-nothing basis.
Meanwhile, the access category measured whether states allowed insurance companies to employ step therapy and prior authorization practices. According to the ACR, states that received poor access grades tended to have high rates of uninsured residents, a severe shortage of rheumatologists and weak laws limiting restrictive insurer and pharmacy benefit manager (PBM) practices. New York was the only state to receive an “A” grade for accessibility.
Affordability metrics measured state efforts regarding the use of drug specialty tiers and copay accumulators, as well as to “regulate abusive PBM business practices that drive up costs for patients.” In all, 20 states received an “F” grade in this area. The highest-scoring state was Louisiana, the only state to receive an “A” grade in affordability.
The activity and lifestyle category measured rates of physical inactivity and the presence of CDC-funded arthritis activity programs. Six states, including California and Oregon, received “A” grades in this area, while Mississippi received an “F” grade.
“The time for action is now and solutions must be bold in scope,” the ACR said in the report. “Rheumatic diseases can be debilitating — but they don’t have to be. By raising awareness and enacting policies that improve rheumatic disease care access and affordability, we can raise the grade on rheumatology care for millions of affected Americans.”
References:
@ACRSimpleTasks. https://twitter.com/ACRSimpleTasks/status/1569771124837203974. Sept. 13, 2022. Accessed Sept. 13, 2022.
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