- 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.
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.