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.
Reducing excess readmissions is top of mind among all hospitals in Cleveland. Administrators at the Cleveland Clinic, MetroHealth System and University Hospitals understand the financial implications of patients returning within 30 days of discharge.
- “What’s Your Price?” Many Americans Seek Health Care Prices, Fewer Compare across Providers May 2015
As Americans shoulder more of their health care costs, a new study suggests that many are hungry for price information. Yet, despite widespread interest in health care prices, several hurdles stand in the way of making health care price information more accurate, comprehensive, and readily available to consumers.
In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. The researchers used a difference-in-differences analysis of Medicare fee-for-service claims, to compare Medicare spending for beneficiaries attributed to Pioneer ACOs (ACO group) with other beneficiaries (control group) before (2009 through 2011) and after (2012) the start of Pioneer ACO contracts, with adjustment for geographic area and beneficiaries’ sociodemographic and clinical characteristics.
The growing number of consumers using less traditional methods for accessing their health care is prompting many hospital systems to explore expanding their walk-in clinics and online access. Additionally, many hospital systems are exploring new ways to provide less expensive but still high quality care and are making investments in new ways to measure patient outcomes. A recent article in The New York Times highlights how the Cleveland Clinic is responding to these changes.
To make smart choices about their health care, individuals need accurate and timely information about quality and price. States have broad responsibilities for the regulation of health insurance and the provision of medical care and are also major purchasers of health care for their employees. Thus, states have important roles in fostering price transparency.
Increasingly, health plans, employers, and other payers are developing tiered provider networks, which rank and stratify providers according to cost and quality performance. In a HCFO-funded study, Meredith Rosenthal, Ph.D., and Anna Sinaiko, Ph.D., from the Harvard School of Public Health examined the effect of a three-tiered network on patients’ choice of physician or health plan.
As Americans shoulder more health care costs, Public Agenda research suggests that many are hungry for more and better price information. However, some obstacles remain to increasing the number of Americans who compare prices before getting care.
Increasingly, policymakers and health services researchers are interested in measuring prices of health care services and understanding how the price of services varies as a function of quality, market structure, managed care penetration, public payer prices, and other factors. Before any conclusions can be reached about determinants of price, price measures must be constructed and their construct validity assessed.
A recent article in USA Today explores potential reasons for price variation across geographic locations and highlights how consumers can use this information to make better decisions about their health care. Price transparency will be the focus of an upcoming summit sponsored by the Robert Wood Johnson Foundation, March 16-18, in Washington, DC.