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Jun
12

HCCI Data Byte: Unintended effect of federal COVID vaccine policy on claims billing patterns

In HCCI's most recent Health Care Cost and Utilization Report, we observed substantial growth in spending on vaccines among individuals with employer-sponsored health insurance (ESI), which we attributed largely to uptake of COVID-19 vaccinations in 2021. Although they may be largely responsible for this trend, federal procurement complicates analyses of COVID-19 vaccines using claims data. Resear...

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Jun
06

Facility Fees and How They Affect Health Care Prices: Policy Explainer

In this brief, we explain the basics of "facility fees," which have been gaining attention at the state and federal levels. We discuss what a facility fee is, why patients might receive a bill for a facility fee for non-hospital services, why there is controversy around these bills, and what policymakers are doing to address them. Download and read the brief below. As described in the br...

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Jun
01

Out-of-Pocket Spending Grew Over 200% among ESI Enrollees Diagnosed with Cancer

Cancer diagnoses can have devastating psychological and financial tolls on patients and their families. Previous research shows that Medicare beneficiaries who are newly diagnosed with cancer experience health care costs that can reach close to a quarter of household income in the year following diagnosis. People with employer-sponsored insurance (ESI) may experience even greater financial burden ...

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May
25

Use of and Spending on Top Prescription Drugs in Employer Sponsored Insurance, 2021

Recent policy and other initiatives aim to reduce spending on prescription drugs. At the federal level, the Inflation Reduction Act targets reductions in drug spending in Medicare through price negotiation, capping out-of-pocket spending by patients, and requiring drug manufacturers to pay rebates when prices rise faster than inflation. At the state level, there are initiatives to increase drug pr...

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May
23

Over 80% of ESI Enrollees Used Evaluation and Management Services in 2021, with Primary Care and Telehealth the Most Commonly Used

Evaluation and Management (E&M) services provide an entry point for many people into the health care system. This category of services includes most office visits to a primary care physician or specialist, including behavioral health services, as well evaluation and management services provided in an emergency room or outpatient setting. These visits typically involve a physician or other heal...

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May
12

The Price of Childbirth Can be Twice as High Even in the Same Hospital

According to HCCI's data, the price of a hospital admission for childbirth among birthing people with employer-sponsored health insurance (ESI) varies by a factor of three across hospitals within a local area. Even within the same hospital and within the same type of delivery, some births cost twice as much as others. Different prices for the same service in the same hospital with the same type of...

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May
12

From Prenatal through Postpartum Care, it Cost More Than $24,000 to Have a Baby on Average

Total Spending Averaged $24,336 across the Prenatal, Childbirth, and Postpartum Periods among ESI Enrollees HCCI has highlighted the high cost of childbirth in the United States, but delivery is only one component of the full financial cost of having a baby. The cost of prenatal and postpartum care may cause people to forgo appropriate services, even as this care could help improve maternal health...

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Apr
25

Focusing on Seven Services Could Eliminate More Than Two-Thirds of Low-Value Care in HCCI's ESI Data

There is substantial evidence that people in the U.S. receive health care services judged to be of low-value. These services are identified as low value based on recommendations from the U.S. Preventive Services Task Force (USPSTF) and professional medical societies that there is little to no clinical value associated with their provision and potential for harm in specific clinical scenarios. Thes...

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Apr
04

Insulin Prices in ESI Nearly Doubled from 2012-2021, with Effects of Emerging Biosimilars Evident in Recent Years

Insulin is a life-saving medication for millions of Americans who live with diabetes. As the price of insulin has risen, people who depend on insulin have had to make difficult decisions about whether to pay for their medication or other necessities. Some have been forced to ration their supply, with devastating results. Recent legislation has limited insulin out-of-pocket...

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Mar
30

Uptake of Biosimilars Remains Low Among People with Employer-Sponsored Insurance

Biologic drugs represent advances in medical research and treatment but are a major driver of drug spending in the United States. Spending on biologics increased by 50% between 2014 and 2018 in the U.S. even though just 2% of Americans used them. Biosimilars, clinically equivalent, lower-cost versions of original biologic drugs, analogous to generic versions of brand name "small molecule" drugs, c...

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Mar
28

Rising Share of Chemotherapy Services Provided in Outpatient Departments is Associated with Higher Costs for Patients and Payers

Every year, 1 million people in the U.S. receive chemotherapy for cancer treatment. Most chemotherapy treatment requires patients to be present in a physician's office or hospital outpatient department to receive the treatment (typically an infusion or injection). Chemotherapy plays a critical role in treatment for many patients with cancer, but it also often leads to high financial costs for pati...

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Mar
20

HCCI Spotlights Colorectal Cancer Awareness Month: Use of Cologuard Doubled over 2018-2020, Despite Drops Early in the COVID-19 Pandemic

Colorectal cancer screenings are essential for early disease detection, prevention, and treatment. Since 2014, Cologuard, a DNA-based screening test that can detect colorectal cancer and precancerous cells, has been available to individuals 45 and older at average risk for colorectal cancer. In contrast to colonoscopies, which must be done at a health care facility, Cologuard is non-invasive ...

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Mar
17

HCCI Spotlights Colorectal Cancer Awareness Month: Colonoscopy Prep Drugs Underscore the Tradeoff Between Cost and Patient Preference

Colorectal cancer is the third most common cancer diagnosed in the U.S., and the second most common cause of cancer deaths among men and women combined. Screening via colonoscopy is highly effective in terms of improving prognosis of colorectal cancer via early detection; over 90% of patients who are diagnosed early (i.e., when the cancer is small and has not spread) live five years or l...

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Jan
31

Seasonal Trends in Antibiotic Use were Disrupted by COVID-19

November and December of 2022 saw growth in rates of flu, RSV, and COVID, that renewed attention to a seasonal trend of increased respiratory illnesses in the winter months. Data from Medicare, Medicaid, and private insurance illustrate the seasonal ups and downs of respiratory infections. Earlier HCCI research showed that hospitalizations from respiratory illness increased in the winter months (N...

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Jan
24

​HCCI Data Brief: Sexual and Reproductive Health Among People with Employer-Sponsored Insurance

Reproductive and sexual health services play an important role in daily life and wellbeing for many people. These services include preventive services (such as screenings for sexually transmitted infections and reproductive cancers), contraceptive services, and services relating to pregnancy and childbirth. The objective of this report is to provide national and state data on the use of repro...

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Jan
18

Going Beyond the Healthy Marketplace Index: A Closer Look at Four Metro Areas

Each year, HCCI creates the Healthy Marketplace Index (HMI) to examine how health care spending varies across the United States. The HMI shows health care spending, prices, and use compared to the national median for close to 200 local metro areas. By describing how health care spending varies geographically and how use and price contribute to spending in each area, HMI is a starting point in unde...

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Jan
13

HCCI Data Byte: Using 5-Digit Enrollee and Hospital Zip Code Data to Examine Travel Times for Children's Hospital Services

HCCI's commercial claims dataset includes claims for over one-third of the population with health insurance through their job (employer-sponsored insurance, or ESI). There are a number of unique features of these data that make them valuable for answering important health care and health policy questions. One such feature is the 5-digit zip codes of ESI enrollees (i.e., where people live) and thei...

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Dec
20

Trends in STI Screening Utilization

Sexually transmitted infections (STIs) are infections caused by pathogens spread through sexual contact. STIs can progress from an infection into a sexually transmitted disease (STD). Chlamydia, gonorrhea, syphilis and HIV are the most commonly screened for STIs in the US. The CDC STD Surveillance Data estimates that there were more than 2.5 million cases of chlamydia, gonorrhea, and syphilis...

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Dec
20

ESI Enrollees Paid $853 on Average Out-of-Pocket for Health Care in 2020, But Some People Paid Over Four Times as Much

High out-of-pocket costs for health care services can put necessary care and medications out of reach for many people. In one survey, nearly half of adults reported difficulty paying for health care services. In this brief, we used HCCI's commercial claims dataset, which includes health care spending information for over one-third of the population who receives health insurance through their job, ...

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Dec
14

Growing Rate of Billed Emergency Department Use in Childbirth Inpatient Admissions

A recent KHN article reported on the growing presence of "obstetric emergency departments" (OBEDs) in U.S. hospitals. Hospitals suggest that OBEDs, which are generally located within labor and delivery departments and often indistinguishable from standard triage rooms, allow pregnant patients with potential emergent conditions (or when they are in labor) to be seen quickly by hospitalists. Pa...

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Nov
30

Measuring the Prevalence of Obesity Using a Distributed Electronic Health Record Network

Obesity is a serious and costly chronic disease that has been increasingly common among the U.S. population. Electronic health record (EHR) data have the potential to support research and patient care interventions. The timeliness and availability of aggregated clinical data can be used in near-real time to monitor obesity prevalence based on body mass index (BMI) at the population-level to guide ...

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Nov
16

Telehealth Use Increased more than 50-fold for Primary Care Visits and Behavioral Health Services in Early Months of the COVID-19 Pandemic

Telehealth facilitates medical care, allows for the sharing of health information, and offers patient health education through remote communication. In 2020, the onset of the public health emergency prompted many localities to restrict in-person gatherings to prevent transmission of the virus. Health care providers responded by expanding telehealth services in an effort to continue serving their p...

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Nov
15

COVID-19 Hospitalizations in 2020 were Highest for People Living in the Most Socially Vulnerable Areas and American Indian and Alaska Native People

The onset of the COVID-19 pandemic fundamentally shifted health and health care in the US in 2020. Hospitals have been central to responding to the pandemic and treating COVID, which means that hospitalizations can provide an important lens to understanding the pandemic's impact. Earlier HCCI research looked at hospital use and spending among people with employer-sponsored insurance (ESI) before t...

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Nov
12

HCCI Spotlights National Diabetes Month: ESI Enrollees with Diabetes Face High Out-of-Pocket Costs. A Cap on Insulin Costs Would Help Many.

Diabetes is a chronic health condition that affects over 10% of the U.S. population. It is possible for people  who are diagnosed with diabetes to live a healthy, long life if the condition is managed properly. However, management often involves significant health care use, which can be costly for patients. Over the past few months, we used HCCI's commercial claims dataset to e...

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Nov
10

Prevention and Screening Rates among ESI Enrollees are Lower in Rural and Socially Vulnerable Areas, with Smaller Differences in Medication Adherence

Inequities in health care access and outcomes among vulnerable populations are well-documented, as is the fact that where you live affects health outcomes to a similar or even greater extent than your health behaviors. Previous HCCI work shows that employer-sponsored health insurance (ESI) plays an important role in many vulnerable communities. Among the population in the United States with health...

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