Research Roundup - December 2015


Missouri Hospital Counts on Procedure Price List to Increase Business

By Bram Sable-Smith | NPR | Nov. 30, 2015

Putnam County Memorial Hospital, a small hospital in Missouri, is making a price list that consumers can see up front (before they receive their procedure) because many consumers pay cash for their hospital procedures. 

New York

Navigating the New York State Value-Based Payment Roadmap

By Rob Houston, et. al. | United Hospital Fund | November 2015

A new guide from the United Hospital Fund distills information about New York’s value-based payment roadmap (A Path toward Value Based Payment: New York State Roadmap for Medicaid Payment Reform) and the process for implementing it for healthcare providers, health plans, policymakers and other Medicaid stakeholder audiences. The guide frames the state’s plans to transform the way it finances healthcare services, moving from volume- to value-based payments.

What’s Driving Variation in New York’s Hospital Spending and Prices?

James Knickman | Huffington Post | Dec. 16, 2015

This article evaluates the results of a new groundbreaking study on hospital spending and price variations (see Healthcare Pricing Project below) and what it means for New York. The study finds that many parts of the state have low hospital spending compared to national averages, but other parts have much higher spending, prices vary widely within a community, and prices are higher when there is less competition from other hospitals in the same community. [Link]

For more state news go to:

Recent Reports

Groundbreaking Study Looks at Prices and Spending in Private Insurance

Healthcare Pricing Project | December 2015

Using a new, large-scale database of private insurance claims, this groundbreaking study documents how hospital prices vary within and across geographic areas, examines how hospital prices influence the variation in health spending and analyzes the factors associated with hospital price variation. According to the New York Times, healthcare researchers who have seen the new findings say they are likely to force a rethinking of some conventional wisdom about healthcare. In particular, they cast doubt on the wisdom of encouraging mergers among hospitals. 

Study Shows Costs Too High for a Quarter of Privately Insured

Commonwealth Fund | November 2015

Healthcare costs are unaffordable for 25 percent of working-age adults with private insurance coverage, according to the new Commonwealth Fund Healthcare Affordability Index. Released in the issue brief How High Is America’s Healthcare Cost Burden?, the index measures premiums, deductibles and out-of-pocket spending as a share of income. It is based on a survey of privately insured adults, 90 percent enrolled in employer plans and 10 percent in marketplace plans or individual coverage.

The Impact of Rate Review on Health Insurance Premiums

HCFO/RWJF | October 2015

During the past decade, increases in health insurance premiums have exceeded the rate of inflation, with significant variation among states. This report evaluated state rate review authority in the individual market during the years following the ACA's enactment (2010-2013) and shows that states with prior approval authority and minimum loss ratio requirements do a better job of constraining increases in health insurance premiums.

Piercing the Darkness: A Generalizable Approach to Reliably Measuring Quality of Care

Francois de Brantes, et al. | Healthcare Incentives Improvement Institute | November 2015

This report from the Healthcare Incentives Improvement Institute is designed to help states improve transparency  by providing important quality information about physicians. The report shows how measures of complications of care can be built off claims data.  By leveraging this methodology, states with all-payer claims databases can calculate rates of complications, adjusted for the severity of patients cared by a physician, in a statistically reliable way.

State Survey of Healthcare Price Transparency Initiatives

Elizabeth Nicholson | The Source on Healthcare Price & Competition | Oct. 21, 2015

State legislatures have shown a lot of interest in healthcare price transparency initiatives this year. At least 27 states have proposed price transparency legislation. This report describes what different states are doing on transparency aimed at healthcare providers and insurance companies. 

Measuring the Value of Prescription Drugs

Peter Neuman and Joshua Cohen | New England Journal of Medicine | Nov. 18, 2015

Escalating drug prices have alarmed physicians and the American public, and led to calls for government price controls. Less visibly, they have also spawned a flurry of private-sector initiatives designed to help physicians, payers and patients understand the value of new therapies and thus make better choices about their use. The authors argue that by focusing on a drug's benefits, value-based approaches can encourage drug companies to produce more of what people want--products that improve health.

Has the ACA Increased Competition in the Individual Market?

Josh Farnmeier | The Incidental Economist | Dec. 10, 2015

A basic premise of the Affordable Care Act (ACA) is that greater competition among insurers in regional, individual (non-group) markets would provide better options and value to consumers. The author calculated that insurance competition increased in 20 states while decreasing in 30 states. Competition in individual markets is likely to change going forward. With this year’s proposed mergers among some of the largest national insurers, much attention has been paid to how these mergers could affect consumers and providers and how they may reduce competition across states. 

For more on drug costs, price transparency, health plan competition and other value related topics, go to:

Commentary/ News

Prescription Drugs’ Sizable Share of Health Spending

By Drew Altman | The Wall Street Journal  | Dec. 13, 2015

The cost of prescription drugs is the hot healthcare issue, but almost every discussion about it includes this caveat: As big a problem as rising drug prices have been for consumers and payers, drug spending represents only 10% of national spending on health. Yet, drug spending represents almost double that share of health spending (19%) in employer health insurance plans.

Patients Want to Price-Shop for Care, but Online Tools Unreliable

By Elana Gordon | NPR | Dec.1, 2015

Many healthcare consumers use online tools, like cost estimators, to find the least expensive care. But when these tools are not accurate with up-to-date information, consumers may receive medical bills much higher than they expected.

Top Three Value-based Reimbursement Challenges in 2015

By Aine Cryst | Managed Healthcare Executives | Nov. 27, 2015

As the value to volume shift accelerated this year, here are three of the major challenges that payers and providers faced: (1) matching risk with provider readiness; (2) forming a strategy, and (3) determining the right fit for telehealth. 

Supreme Court Takes up Healthcare Price Transparency

By Dan Gorenstein | Marketplace | Dec. 2, 2015

The U.S. Supreme Court heard arguments on  a case that could make it harder to know how much largest employers and health plans are paying hospitals and doctors.The plaintiff in the case, Liberty Mutual, which self-insures, argues the state can’t make the company share claims data as part of data collection for the state’s All Payer Claims Datasets. The question before the court is whether sharing data can be compelled by the state under ERISA. 

Calls for Transparency on Bad Physicians Grow Louder

Jacqueline Fellows | HealthLeaders Media | Dec. 10, 2015

The Medical Board of California (MBC) has appointed a task force to explore making the probationary status of physicians more transparent for consumers. Consumers Union's Safe Patient Project has recommended some guidance on disclosure. It suggests including a paragraph detailing the offense that led to probation, the physician's practice restrictions because of the probation, and directions for contacting MBC for more information about the offense. 

For more on APCDs and pay for performance strategies, go to:

Not yet a subscriber to this FREE monthly newsletter? Sign up here.