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Exploring the Use of Reference Pricing by Insurers and Employers [1]

As insurers and large employers grapple with how to reign in health care costs, a growing number are turning to reference pricing, a benefit design that limits the amount an insurer will pay for certain health care services.  As reported by the Associated Press, the Obama administration recently indicated that the use of reference pricing by large group and self-funded group plans does not violate the Affordable Care Act’s cap on patients’ annual out-of-pocket costs.  A current HCFO-funded study is examing the impact of one company's reference pricing program on consumer choice and provider pricing for laboratory and diagnostic imaging services...

July 2014
By HCFO Staff

As insurers and large employers grapple with how to reign in health care costs, a growing number are turning to reference pricing.  Reference pricing is a benefit design in which an insurer defines the maximum amount that it will cover for a particular health care service.  Enrollees who seek care from providers charging more than this “reference price” are responsible for paying the difference between the actual price of the service and the insurer’s cap.  As reported by the

Grants: 
The Impact of Reference Pricing on Consumer Choice and Provider Pricing Strategies for Laboratory Tests and Diagnostic Imaging [2]
Topic: 
Benefit Design [3]
Topic: 
Consumer Behavior [4]
Topic: 
Costs and Cost Containment [5]
Topic: 
Insurance Coverage [6]
Topic: 
Provider Payment and Behavior [7]
Topic: 
Purchasing [8]

The Doctor Will “See” You Now: States and Researchers Explore the Quality and Value of Telemedicine [9]

Telemedicine, which involves providing health care services through a variety of electronic mediums including the internet, presents an opportunity to address barriers patients may face in accessing health care. At least fourteen states, including Florida, are considering legislation to increase the use of telemedicine through broader insurance coverage.

May 2014
By HCFO Staff

Telemedicine, which involves providing health care services through a variety of electronic mediums including the internet, presents an opportunity to address barriers patients may face in accessing health care. The Star Tribune [10]recently detailed “Doctor on Demand,” a mobile app that provides face-to-face virtual appointments for $40 per 15-minute session.

Grants: 
Studying the Process and Quality of Virtual Medical Care [11]
Topic: 
Acute Care [12]
Topic: 
Health Information Technology [13]
Topic: 
Organization and Supply of Care [14]
Topic: 
Quality of Care [15]

Proposed Rule Would Relax MLR in Response to Health Plans’ ACA Enrollment Activities [16]

An article in MedPage Today describes potential changes to the Affordable Care Act's (ACA) medical loss ratio (MLR) requirement in light of the administrative and technical challenges insurers faced during the implementation of health insurance marketplaces. HCFO-funded work has examined the relationship between MLRs and the stability, or destabilization, of insurance markets as well as the potential impact of the ACA MLR requirement on insurers and enrollees in the individual market in each state.

April 2014
By HCFO Staff

March 31 marked the end of the first open enrollment period under the Affordable Care Act’s (ACA) newly launched health insurance marketplaces. As insurers plan for the next open enrollment period, they will be evaluating their experiences to date in complying with the ACA’s medical loss ratio (MLR) requirement. This provision of the ACA requires that at least 80 percent of insurers’ premiums are spent on medical care and quality improvement, with the balance available for administrative costs like marketing.

Grants: 
Analyzing the Impact of the Medical Loss Ratio Under Health Reform on the Individual Market for Coverage in Each State [17]
Grants: 
Assessing the Impact of States' Authority to Review Health Insurance Rates on the Cost of Premiums [18]
Topic: 
Access [19]
Topic: 
Insurance Coverage [6]
Topic: 
Legal and Regulatory Environment [20]
Topic: 
Vulnerable Populations [21]

Understanding the Effects of Palliative Care on Patient Functioning [22]

Patients suffering from chronic medical conditions and chronic pain are increasingly turning to palliative care as a way to relieve their symptoms and manage their care. In a recent New York Times article, columnist Jane E. Brody explains the benefits of using palliative care to treat chronic pain and the challenges that our medical system faces in making this type of care more widely utilized.

March 2014
By HCFO Staff

Patients suffering from chronic medical conditions and chronic pain are increasingly turning to palliative care as a way to relieve their symptoms and manage their care. Palliative care is an area of health care that focuses on relieving and preventing the suffering of patients.

Grants: 
Identifying The Use, Cost, and Quality Tradeoff in the Medicare Hospice Benefit [23]
Topic: 
Chronic Care [24]
Topic: 
End-of-Life Care [25]
Topic: 
Medicare [26]

Media Accounts Raise Price Transparency Questions, RWJF Grants Seek Answers [27]

In the past year, national news stories have focused a lot of attention to the prices charged for health, underscoring how much prices for a given health care service can vary, sometimes within a given health care setting, and how difficult it can be to determine actual prices paid...

February 2014
By HCFO Staff

In the past year, national news stories have focused a lot of attention to the prices charged for health care.  This coverage has included Stephen Brill’s Time Magazine piece, “Bitter Pill: Why Medical Bills Are Killing Us [28],” and a series of articles [29] by Elizabeth Rosenthal in The New York Times.  Accounts like these have underscored how mu

Grants: 
Price Data Solicitation Grant: Impact of Price Transparency Tools on Consumer Behavior [30]
Topic: 
Price Data and Transparency [31]

Insuring Parents and Children Under Health Reform: Implications for Family Costs and Coverage [32]

Beginning in 2014, many low- to middle-income families are gaining health care coverage with help from provisions in the Affordable Care Act.  These include the availability of subsidized private coverage in the state and federal marketplaces, as well as the expansion of the Medicaid program in more than two dozen states...

January 2014
By HCFO Staff

Beginning in 2014, many low- to middle-income families are gaining health care coverage with help from provisions in the Affordable Care Act (ACA).  These include the availability of subsidized private coverage in the state and federal marketplaces, as well as the expansion of the Medicaid program in more than two dozen states.  Yet as an article in The Connecticut Mirror [33] reports, the varying eligibility requirements for each insurance option mean members of a si

Grants: 
Insuring Both Parents and Children: Lessons from Prior State Expansions [34]
Topic: 
Costs and Cost Containment [5]
Topic: 
Insurance Coverage [6]
Topic: 
Medicaid and SCHIP [35]

Can Economic Factors Influence the Choice of Prostate Cancer Treatment? [36]

An article in the Los Angeles Times reports on the decision by Blue Shield of California to stop covering proton beam therapy for early-stage prostate cancer. In an ongoing HCFO-funded study, Jack Hadley, Ph.D., George Mason University, is examining factors that may influence the type of prostate cancer treatment received by Medicare beneficiaries...

November 2013
By HCFO Staff

New medical technology has the potential to improve health outcomes for patients, sometimes at costs lower than that of existing technology, sometimes at higher cost.   In the case of prostate cancer, a potentially serious condition that will be newly diagnosed in more than 238,000 men in the United States in 2013, proton beam therapy represents an innovation in treatment.  Unlike traditional radiation therapy, proton beam therapy more precisely targets cancer cells while leaving normal cells unharmed.   Recent research, however, suggests that this new technology ma

Grants: 
Using Prostate Cancer to Study Whether Payment Rates and Market Structure Influence Treatment Choice for Medicare Beneficiaries [37]
Topic: 
Medicare [26]
Topic: 
Provider Payment and Behavior [7]

The Role of Rate Review in Managing Premiums [38]

In the lead up to the launch of insurance marketplaces on October 1, many state insurance regulators poured over premium rates; among them members of Connecticut’s Insurance Department. In a recent article in The Courant, Matthew Sturdevant explained that before insurers could sell products on Connecticut’s health insurance exchange, they needed the department’s approval of those premiums across the four metal levels, bronze, silver, gold and platinum

October 2013
By HCFO Staff

In the lead up to the launch of insurance marketplaces on October 1, many state insurance regulators poured over premium rates; among them members of Connecticut’s Insurance Department.

Grants: 
Assessing the Impact of States' Authority to Review Health Insurance Rates on the Cost of Premiums [18]
Topic: 
Insurance Coverage [6]

The Hospital Value-Based Purchasing Program: How Are Hospitals Responding? [39]

Medicare is reducing its payments to hospitals by one percent as part of the Hospital Value-based Purchasing (HVBP) Program, a provision of the Affordable Care Act. However, hospitals are given the incentive to earn back those reimbursements if they are able to demonstrate they have met benchmarks for clinical standards and patient satisfaction.

September 2013
By HCFO Staff

Medicare is reducing its payments to hospitals by one percent as part of the Hospital Value-based Purchasing (HVBP) Program, a provision of the Affordable Care Act.

Grants: 
The Effect of Year One of Hospital Value-Based Purchasing on Quality of Care [40]
Topic: 
Acute Care [12]
Topic: 
Medicare [26]
Topic: 
Provider Payment and Behavior [7]
Topic: 
Quality of Care [15]

Reducing Readmissions: How Are Hospitals Responding to New Penalties? [41]

High rates of hospital readmissions are widely recognized as a significant problem among Medicare beneficiaries.  These re-hospitalizations not only drive up health care costs, but may reflect low quality of care, poor coordination among providers, and a lack of understanding among patients about how to manage their own conditions.

August 2013
By HCFO Staff

High rates of hospital readmissions are widely recognized as a significant problem among Medicare beneficiaries.  These re-hospitalizations not only drive up health care costs, but may reflect low quality of care, poor coordination among providers, and a lack of understanding among patients about how to manage their own conditions.  In a recent article [42] in The New York Times, Judith Graham explores the strategies some hospitals are using to reduce read

Grants: 
Examining Intended and Unintended Consequences of the Hospital Readmissions Reduction Program [43]
Topic: 
Acute Care [12]
Topic: 
Coordination of Care [44]
Topic: 
Quality of Care [15]
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Links:
[1] http://www.hcfo.org/publications/exploring-use-reference-pricing-insurers-and-employers
[2] http://www.pbs.org/newshour/rundown/feds-approve-cost-cont<div class=
[3] http://www.hcfo.org/topics/benefit-design
[4] http://www.hcfo.org/topics/consumer-behavior
[5] http://www.hcfo.org/topics/costs-and-cost-containment
[6] http://www.hcfo.org/topics/insurance-coverage
[7] http://www.hcfo.org/topics/provider-payment-and-behavior
[8] http://www.hcfo.org/topics/purchasing
[9] http://www.hcfo.org/publications/doctor-will-%E2%80%9Csee%E2%80%9D-you-now-states-and-researchers-explore-quality-and-value-telemedicine
[10] http://www.startribune.com/lifestyle/health/254242211.html
[11] http://www.hcfo.org/grants/studying-process-and-quality-virtual-medical-care
[12] http://www.hcfo.org/topics/acute-care
[13] http://www.hcfo.org/topics/health-information-technology
[14] http://www.hcfo.org/topics/organization-and-supply-care
[15] http://www.hcfo.org/topics/quality-care
[16] http://www.hcfo.org/publications/proposed-rule-relax-mlr-response-health-plans%E2%80%99-aca-enrollment-activities
[17] http://www.hcfo.org/grants/analyzing-impact-medical-loss-ratio-under-health-reform-individual-market-coverage-each-stat-0
[18] http://www.hcfo.org/grants/assessing-impact-states-authority-review-health-insurance-rates-cost-premiums
[19] http://www.hcfo.org/topics/access
[20] http://www.hcfo.org/topics/legal-and-regulatory-environment
[21] http://www.hcfo.org/topics/vulnerable-populations
[22] http://www.hcfo.org/publications/understanding-effects-palliative-care-patient-functioning-0
[23] http://www.hcfo.org/grants/identifying-use-cost-and-quality-tradeoff-medicare-hospice-benefit
[24] http://www.hcfo.org/topics/chronic-care
[25] http://www.hcfo.org/topics/end-life-care
[26] http://www.hcfo.org/topics/medicare
[27] http://www.hcfo.org/publications/media-accounts-raise-price-transparency-questions-rwjf-grants-seek-answers
[28] http://content.time.com/time/magazine/article/0,9171,2136864,00.html
[29] http://topics.nytimes.com/top/reference/timestopics/people/r/elisabeth_rosenthal/
[30] http://www.hcfo.org/grants/price-data-solicitation-grant-impact-price-transparency-tools-consumer-behavior
[31] http://www.hcfo.org/topics/price-data-and-transparency
[32] http://www.hcfo.org/publications/research-headlines
[33] http://www.ctmirror.org/story/2013/10/10/7-things-know-about-husky-and-obamacare
[34] http://www.hcfo.org/grants/insuring-both-parents-and-children-lessons-prior-state-expansions
[35] http://www.hcfo.org/topics/medicaid-and-schip
[36] http://www.hcfo.org/publications/can-economic-factors-influence-choice-prostate-cancer-treatment
[37] http://www.hcfo.org/grants/using-prostate-cancer-study-whether-payment-rates-and-market-structure-influence-treatment-ch
[38] http://www.hcfo.org/publications/role-rate-review-managing-premiums
[39] http://www.hcfo.org/publications/hospital-value-based-purchasing-program-what-initiatives-are-hospitals-taking-meet-new-
[40] http://www.hcfo.org/grants/effect-year-one-hospital-value-based-purchasing-quality-care
[41] http://www.hcfo.org/publications/reducing-readmissions-how-are-hospitals-responding-new-penalties
[42] http://newoldage.blogs.nytimes.com/2013/07/26/more-on-preventing-hospital-readmissions/?_r=0
[43] http://www.hcfo.org/grants/examining-intended-and-unintended-consequences-hospital-readmissions-reduction-program
[44] http://www.hcfo.org/topics/coordination-care
[45] http://www.hcfo.org/taxonomy/term/13/all
[46] http://www.hcfo.org/taxonomy/term/13/all?page=2
[47] http://www.hcfo.org/taxonomy/term/13/all?page=3