Healthcare Value Quiz

Do you think you're a healthcare value expert? We've developed this 20-question quiz to test your knowledge of healthcare value. Have fun—and good luck! 

Question 1:
True or False.  Aging of the population is a major cost driver. (Click for answer)
a. True
b. False

False.
Despite being a widely held belief, aging of the population is not a major driver of year-over-year growth in medical spending. The reason: the average age of our population goes up very slowly. More info from the Hub.

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Question 2:
Compared to 11 other high-income countries, the U.S. spends the most on healthcare. How does the U.S. rank in terms of mortality from treatable and preventable conditions? (Click for answer)
a. 1st (best)
b. 5th
c. 9th
d. 11th (worst)

ANSWER:
d. 11th (worst). Unfortunately, we don’t get what we should for all that spending.
Source: Commonwealth Fund

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Question 3:
Which state had the lowest annual healthcare spending per person in 2015, according to the U.S. Bureau of Economic Analysis? (Click for answer)
a. Massachusetts
b. Utah
c. Colorado
d. California

ANSWER:
b. Utah
Utah had the lowest spending at $4,796 per person; the U.S. average was $6,436 and D.C. was the highest at $11,021 per person. Source: Bureau of Economic Analysis

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Question 4:
What percent of healthcare spending is both out of pocket and for shoppable services? (Click for answer)
a. Around 50%
b. Around 33%
c. Less than 7%

ANSWER:
c. Less than 7%
This has profound implications for strategies that attempt harness the shopping power of consumers to “fix” our health care markets.

Source: Health Affairs Blog: Healthcare Consumerism: Can the Tail Wag the Dog? and Hub Research Brief No. 11, Rethinking Consumerism in Healthcare Benefit Design

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Question 5:
What are the three elements of the Triple Aim? (Click for answer)
a. Improving patient experience, improving population health and reducing per capita cost.
b. Reducing medical harm, reducing per capita cost and reducing fraud.
c. Improving patient experience, reducing medical harm and improving health of populations.
d. Improving patient experience, reducing fraud and reducing per capita cost.

ANSWER:
a.
Introduced by Don Berwick in 2008, the triple aim (improving patient experience, improving population health, and reducing per capita cost of care) has become a meme and a guiding principle for health policymakers.

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Question 6:
From 2000 to 2015, per capita healthcare spending increased what percent each year? (Click for answer)
a. 1.6%
b. 2.9%
c. 4.9%
d. 7.1%

ANSWER:
c. 4.9%
According to CMS’s National Health Expenditure Data, health spending far outpaced growth in personal incomes which grew at just 3.1%. 

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Question 7:
How many healthcare quality measures are in use today? (Click for answer)
a. More than 100
b. More than 500
c. More than 750
d. More than 1,000

ANSWER:
d. More than 1,000
The National Quality Forum has endorsed 700 measures but the federal government and others also use measures not endorsed by NQF, or variations of NQF endorsed measures. In 2015, the Wall Street Journal reported, “33 federal programs asked providers to submit data on 1,675 quality measures.”  

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Question 8:
Name the one state that requires insurers to publish the network status of ER doctors working at in-network hospitals. (Click for answer)
a. Texas
b. Massachusetts
c. Vermont
d. Illinois

ANSWER:
d. Texas
Texas requires insurers to note the network status of ER docs and other professionals working in the hospital setting. An analysis of this data by the Center for Public Policy Priorities found, among other things, that 56% of Humana’s hospitals had NO in-network ER docs.

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Question 9:
True or False.  Proponents of high-deductible health plans claim that having “skin in the game” will cause consumers to become better healthcare shoppers, thus incentivising the market to provide better value. Evidence supports this claim. (Click for answer)
a. True
b. False

ANSWER:
False.
A trio of important studies finds that high deductibles do not cause consumers to shop based on price or quality and does not help them to differentiate between low-value care and high-value care. The main impact is to avoid initiating care but that includes avoiding care for high-value services. Source: Hub Research Brief No. 11, Rethinking Consumerism in Healthcare Benefit Design

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Question 10:
True or False.  In 2009, Atul Gawande famously wrote about medical service utilization in McAllen, Texas, which was almost twice as high as El Paso, an otherwise similar locale. Gawande found that utilization differences were fully explained by differences in the quality of care provided and patient mix. (Click for answer)
a. True
b. False

ANSWER:
False.
Gawande found the opposite. Vast differences in spending were unrelated to differences in quality, or age, sex or race of patient mix. Instead: McAllen providers adopted a greater “entrepreneurial spirit” and a “culture of money.”

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Question 11:
Which factor contributes the most to year-over-year increases in health spending? (Click for answer)
a. Increasing prices
b. Increasing utilization
c. Increasing administrative overhead
d. Increasing wasteful spending

ANSWER:
a. Increasing prices
Multiple sources show that year-over-year increases in prices are our major healthcare spending driver. A recent analysis from HCCI finds that in 2015 healthcare prices rose 9 percent for prescription drugs and 6.6 percent for inpatient services. In contrast, utilization decreased by 0.3 percent for prescriptions and 3.8 percent for inpatient services.

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Question 12:
How many states have enacted laws pertaining to the reporting of hospital acquired infections? (Click for answer)
a. 15 states, plus D.C.
b. 26 states, plus D.C.
c. 32 states, plus D.C.
d. 45 states, plus D.C.

ANSWER:
c. 32 states, plus D.C.
Although estimated to be the third leading cause of death in the U.S., surprisingly little is done to measure, study and address the full spectrum of medical harm that affects the lives of millions of people every year.

• 32 states plus the District of Columbia have passed laws that have some kind of reporting requirement pertaining to hospital-acquired infections.

• 27 states plus the District of Columbia have systems to monitor the occurrence of serious reportable events (“adverse” or “never” events).

Sources: ASTHO, Eliminating Healthcare Associated Infections, Arlington, VA, (2011) and Hanlon, Carrie, et al., 2014 Guide to State Adverse Event Reporting Systems, NASHP, Washington, D.C. (2015)

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Question 13:
What are three states that have overall healthcare spending targets? (Click for answer)
a. MA, MD and GA
b. VT, MA and CA
c. CO, MA and MD
d. MA, VT and MD

ANSWER:
d. MA, VT and MD
Measuring state level health spending and setting targets for growth are rarely implemented but critical steps in getting better healthcare value for consumers.
• Massachusetts: since 2012, compares growth in total health care spending per person to a benchmark set annually by the state’s Health Policy Commission.
• Maryland: since 2013, caps per capita hospital cost growth for inpatient and outpatient care at 3.58% a year.
• Vermont: Under new waiver, plans to limit annual per capita expenditure growth to 3.5%.

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Question 14:
What portion of healthcare spending is considered “waste” according to the Institute of Medicine? (Click for answer)
a. 10%
b. 25%
c. 33%
d. 40%

ANSWER:
c. 33% (source)

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Question 15:
What was the second major American city to pass a soda tax (in June of 2016)? (Click for answer)
a. Miami
b. Philadelphia
c. New York
d. Austin

ANSWER:
b. Philadelphia
Following Berkeley, Calif., Philadelphia passed a soda tax. More recently, San Francisco, Oakland and Albany, Calif., and Boulder, Colo., all passed soda taxes.

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Question 16:
What is the ONLY state that gives its insurance commissioner power to examine proposed health insurance rates using affordability criteria? (Click for answer)
a. Maryland
b. Massachusetts
c. Rhode Island
d. Wyoming

ANSWER:
c. Rhode Island
The state has the authority to review and reject proposed rates varies widely but few realize that affordability is rarely a criteria used when reviewing rates. Researchers find that stronger authority results in lower premium increases.

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Question 17:
True or False.  In a 2010 report, the Massachusetts AG analyzed thousands of normally secret provider contracts and found health plans pay some doctors and hospitals as much as 2 times more for essentially the same care. Her analysis showed these differences were explained by differences in quality and patient mix. (Click for answer)
a. True
b. False

ANSWER:
False.
In fact, she found that “wide disparities in prices are not explained by differences in quality, complexity of services, or other characteristics that might justify variations in prices paid to providers.Instead, prices reflect the relative market leverage of health insurers and health providers.”

Source: Office of Attorney General Martha Coakley, Examination of Health Care Cost Trends and Cost Drivers (June 22, 2011).

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Question 18:
What portion of total health spending is for drugs (retail and non-retail)? (Click for answer)
a. 6%
b. 10%
c. 13%
d. 19%

ANSWER:
Both C and D are acceptable. While drug spending in the retail sector hovers around 9-10%, non-retail (drugs administered in the hospital or clinic) is substantial. Combined retail and non-retail drug spending comprises about 13% of total spending (Altarum). For the Medicare population, these two forms of drug spend total about 19% of total spend (KFF).

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Question 19:
What portion of health outcomes is determined by the clinical care that people receive? (Click for answer)
a. 10%
b. 20%
c. 40%
d. 80%

ANSWER:
Both 10% and 20% are correct. There is growing awareness that non-clinical factors, such as social and economic environment, behaviors, physical environment and other factors have a major impact on the health outcomes we experience. Depending on the outcome being measured, the contribution of clinical care has been estimated to be 10% or 20%.

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Question 20:
What’s your favorite source for reliable, evidence-based information on the strategies that lead to better healthcare value for consumers? (Click for answer)

ANSWER:
Correct!! The Healthcare Value Hub.
Thank you for taking our quiz. Please contact us with your healthcare value questions.

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