Publications

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...

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.

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.

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.

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...

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...

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...

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

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.

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.