Research Roundup - September 2015

State News

Maryland: Price Jump for Most Popular Health Plan on Maryland Insurance Exchange

By Andrea McDaniels, The Baltimore Sun | Sept. 4, 2015 

The Maryland Insurance Administration announced  that CareFirst BlueCross BlueShield, Maryland’s largest insurer, is raising rates up to 26 percent on average after absorbing more than $100 million in losses incurred as more older and sicker patients received coverage under federal healthcare reform.

Massachusetts: Capped Drug Prices Won't End the Rise of Health-Care Costs

By Kenneth Thorpe, Philadelphia Inquirer | Sept. 3, 2015

Massachusetts’ lawmakers are considering a law that imposes price limits on some of the most expensive medications and would make Massachusetts the first state to cap drug prices. New York, California and Pennsylvania are also considering similar bills. Critics of this bill argue that this will not likely reduce total spending as effective prescription drugs often help hold down overall spending in ways that are not always immediately apparent.

Vermont: State Continues Waiver Negotiations to Develop All-Payer Payment System

By Neal Goswami, Rutland Herald | Sept. 20, 2015 

Vermont lawmakers continue to work with the federal government for a waiver to create an all-payer rate setting payment model. The state sees the move as a way to shift away from a fee-for-service model to one that pays healthcare providers based on health outcomes. The change requires a series of waivers from the federal government and would enable the Green Mountain Care Board to set the rates for all payers, including Medicaid, Medicare and private insurance.

Recent Reports/Resources

State Innovation Model (SIM) Grants: A Scorecard for Consumer Advocate Engagement

By Melissa Burroughs, Families USA | September 2015

Families USA created a new resource that evaluates consumer engagement in the State Innovation Model (SIM) testing grants in Arkansas, Massachusetts, Minnesota, Oregon and Vermont. Consumer advocates and other stakeholders can use this scorecard as a resource for developing or improving their strategies for engaging stakeholders.

Employer-Sponsored Premiums See Relatively Modest Rise, but Deductibles Up Sharply

By Gary Claxton, et al., Health Affairs | Sept. 21, 2015

Single and family premiums for employer-sponsored health insurance rose an average of 4 percent in 2015, continuing a decade-long period of moderate growth, according to the Kaiser Family Foundation/ Health Research & Educational Trust (HRET) 2015 Employer Health Benefits Survey. However, both the share of workers subject to deductibles and the amount of those deductibles have increased sharply. Since 2010, deductibles have increased 67 percent, much faster than the rise in individual premiums (24%) and nearly seven times the rise in wages (10%) and general inflation (9%).

Accounting for Patient Characteristics When Setting Readmission Penalties

By Lena Sun, Washington Post | Sept. 14, 2015

A new study published in JAMA Internal Medicine examines Medicare’s penalty calculations for hospitals with high rates of readmissions. The study found that nearly two dozen variables, such as patients’ education, income and ability to bathe, dress and feed themselves, explain nearly half of the difference in readmission rates between the best- and worst-performing hospitals. Medicare calculations currently adjusts for a more limited set of demographic characteristics, such as age, sex and the health of patients.

State Variation in Narrow Networks on the ACA Marketplaces

By Dan Polsky and Janet Weiner, The Leonard Davis Institute of Health Economics | August 2015

Within the current marketplaces, it is difficult for a consumer to assess network size, even as a broad concept, according to researchers at the Leonard Davis Institute of Health Economics, University of Pennsylvania. A prior report was one of the first attempts to measure the breadth of provider networks in plans sold on the health insurance marketplaces. This follow up report uses the same “T-shirt” sizes to categorize networks but this time at the state level. Researchers find some states are characterized by mostly large or x-large networks (such as Delaware, Kansas, and North Dakota), others feature small networks (such as Georgia, Florida, and Oklahoma), and others are fairly well balanced across sizes (such as Minnesota, New York, and Washington).

Reference Payment for Colonoscopy Reduces Insurer Spending

By James Robinson, et al., JAMA Internal Medicine | Sept. 8, 2015

The implementation of reference payment for colonoscopy was associated with a 28% reduction in health spending and no change in complications. Under this reference payment initiative, CalPERS paid the facility’s negotiated price (allowed charge), without consumer cost sharing, if the patient selected an ambulatory surgery center. However, it limited its payment contribution to $1500 for patients selecting other types of colonoscopy providers.

“Cowboy” Doctors Account for a lot of Unnecessary Care, Medicare Expenditures

By Ron Shinkman, Fierce Health Finance | Aug. 24, 2015

“Cowboy” doctors - or providers who provide intensive yet unnecessary care - account for twelve percent of all Medicare expenditures and more than 33% of end-of-life expenditures. A Harvard University study found that these doctors are likely to be male and located in the South and Southeast regions of the country, and could account for the significant regional differences in Medicare expenditures. This is part of the greater issue of low-value care being provided to Medicare beneficiaries, which is believed to account for $8.5 billion in unnecessary healthcare spending each year.

Commentary/ News

Health Insurers Push for Mergers, Play Down Antitrust and Consumer Concerns

By Robert Pear, The New York Times | Sept. 22, 2015

The chief executives of two of the nation’s largest health insurance companies told Congress that consumers would benefit if the federal government approved their plans to acquire two other big insurers. But Consumers Union expressed doubts. “There are strong indicators, to us, that these mergers could create too much concentration, in too many markets, and cause too much harm to consumer choice,” said George Slover, CU’s senior policy counsel. Witnesses cited evidence that having more insurers on an exchange tends to reduce premiums for consumers.

Use Medicare’s Muscle to Lower Drug Prices

New York Times editorial | Sept. 21, 2015

A poll last month by Consumer Reports found that a third of the patients who take prescription drugs are paying significantly more this year, forcing many to cut back on other necessities or load up on credit card debt. Another poll in August by the Kaiser Family Foundation found that about a quarter of those surveyed said they had trouble paying for prescription drugs. This editorial calls for Medicare to be given the power to negotiate prices with drug makers.

Medicare Yet To Save Money Through Heralded Medical Payment Model

By Jordan Rau and Jenny Gold, Kaiser Health News | Sept. 14, 2015

According to federal data, Accountable Care Organizations (ACOs) have not yet shown overall savings for the Medicare program. In 2014, 196 ACOs saved Medicare money, while 157 ACOs cost more than expected. Medicare ultimately did not realize any savings because it paid out bonuses to 97 ACOs, but only three of the costly ACOs had to repay Medicare for losses their patients incurred.The ACO program’s bottom line has been hurt by the reluctance of most ACOs to accept responsibility for high spending by their patients.

Don't Eliminate the One Health Agency Aimed at Fixing Our Broken System

By Bill Frist, Forbes | Sept. 19, 2015

The Agency for Healthcare Research and Quality (AHRQ) is under attack. The House Budget Committee eliminated funding for AHRQ in June, effectively killing the agency by redirecting its budget to the National Institutes of Health. Bill Frist -- former transplant surgeon and U.S. Senate majority leader -- argues that it makes no sense to get rid of the very agency within the Department of Health and Human Services whose mission is to find ways to improve healthcare quality and outcomes and reduce costs.

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