The policy community generally has assumed Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. After surveying senior hospital and health plan executives, the researchers found, however, that MA plans nominally pay only 100–105 percent of traditional Medicare rates and, in real economic terms, possibly less.
- States With Stronger Health Insurance Rate Review Authority Experienced Lower Premiums In The Individual Market In 2010–13 August 2015
States have varying degrees of review authority over health insurance carriers’ rates, including prior approval authority over proposed rates and requirements for loss ratios, the proportion of premium revenues spent on medical claims. The Affordable Care Act (ACA) requires carriers in certain categories of health insurance to provide public justification for rate increases of 10 percent or more. The researchers collected data on how states changed their rate review authority and requirements in the years immediately after enactment of the ACA.
Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care. In this study, the researchers found that practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization.
The complex financing system that supports health care spending in the US makes estimation of the incidence of financing both daunting and important. In this study, the researchers compute and describe the final incidence of financing health care to provide assumptions for benchmarking and assessment of the equity implications of financing health care in the future.
- Face-to-Face Price Transparency July 2015
Efforts to inject greater price transparency into healthcare continue to gain momentum. Public Agenda, with support from the Robert Wood Johnson Foundation, recently conducted a national survey to explore the knowledge, behaviors and attitudes of consumers regarding price information in healthcare.
Under the Hospital Readmissions Reduction Program, hospitals are financially penalized for higher-than-average thirty-day readmission rates for Medicare patients. A new study examined the possibility that hospitals strategically avoided the readmissions penalty—a would-be unintended consequence of the program that could offset some of the intended savings to Medicare.
Physician practices are increasingly integrating with hospitals. Using 2007-2012 medical claims from a continuously enrolled national sample of traditional Medicare beneficiaries and commercially insured individuals from Truven Medicare and Commercial databases, the researchers analyzed trends in cardiologist-hospital integration.
- How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums? July 2015
The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. The researchers empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey.
- Readmissions To New York Hospitals Fell For Three Target Conditions From 2008 To 2012, Consistent With Medicare Goals June 2015
The Medicare Hospital Readmissions Reduction Program (HRRP), an initiative of the Affordable Care Act, imposes considerable financial penalties on hospitals with excess thirty-day readmissions for patients with selected high-volume conditions. The researchers investigated the intended impact of the program by examining changes in thirty-day readmissions among Medicare patients admitted for three conditions targeted by the program in New York State, compared to Medicare patients with other conditions and with privately insured patients, before and after the program’s introduction.
Cost sharing, often seen in the form of copayments, coinsurance, and deductibles, is commonly used to reign in health care spend¬ing. While the intent of cost sharing is to promote greater patient engagement around value-based health care choices, it can lead to patients avoiding necessary medications or services. Value-based insurance design plans (VBID) plans reduce this effect by limiting or eliminating cost sharing for medications and services that offer patients a high value return on their health.