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ABSTRACT: We compare healthcare spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their healthcare spending. Healthcare spending is 25 percent lower for MA enrollees than for enrollees in traditional Medicare (TM) in the same county with the same risk score. Spending differences between MA...

This data brief reports on outpatient observations stays in the Medicare Advantage population from 2010 through 2014. The results show that the rate of observations stays increased in total as well as following hospitalizations.    Download PDF File Here

 This data brief, reports on five readmission rate measures for the Medicare Advantage (MA) population: 30-day all-cause hospital-wide readmissions and 30-day all-cause readmissions following acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. The results show that MA readmission rates have been declining over the past five years. &nb...

ABSTRACT One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. "Prospective" payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System an...

ABSTRACT Importance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have add...

This data brief examines the health care use and spending from 2010-2014 for people who are enrolled in consumer-driven health plans (CDHPs), and compares these trends to non-CDHP enrollees. Findings indicate that although fewer total dollars were spent on health care for CDHP enrollees, they had higher per capita out-of-pocket spending on deductibles, copays, and coinsurance.    Downloa...

ABSTRACT Importance: Patients' out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults. Objectives: To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, ...

ABSTRACT There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per a...

This data brief compares membership characteristics and health care service prices in non-ERISA and ERISA populations. The results suggest that non-ERISA data may be sufficient for policy relevant analyses, even when ERISA data is not available.    Download PDF File Here

The 2014 Diabetes Health Care Cost and Utilization Report examines how much is spent on health care for adults and children with diabetes, where those dollars are spent, and how that compares to people without diabetes. It is based on the health care claims of more than 40 million Americans younger than 65 covered by employer-sponsored insurance from 2012 to 2014.   Download Report Appendix K...

ABSTRACT: Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursem...

Children's Health Spending: 2010-2014 examines spending on health care for children covered by employer-sponsored insurance from 2010 to 2014. For the first time, HCCI analyzed children's health care spending trends at the state level, reporting on Arizona, Connecticut, Florida, Illinois, Maryland, Ohio, Texas, Virginia, and Wisconsin, as well as the District of Columbia.   Download Report Ap...

The National Chartbook of Health Care Prices – 2015 and accompanying Health Affairs article "Prices For Common Medical Services Vary Substantially Among the Commercially Insured" illuminates differences in price for over 240 common medical services in 41 states and the District of Columbia. Download Report   Download PDF File Here Among the commercially insured, wide variation in prices have ...

This data brief compares average state-level prices against quality measures for asthma, diabetes and hypertension care and finds that higher prices for medical services are not always indicative of higher quality of care.    Download PDF File Here

This issue brief examines health care spending on shoppable services in 2011. Contrary to expectations, giving consumers prices so they can shop for health care services may only have a modest effect on reducing health spending.   Key Findings: ​In 2011, about 43% of the $524.2 billion spent on health care services for commercially insured people was considered shoppable.About 15%—nearly...

This issue brief, in partnership with the National Academy for State Health Policy,  reports on reimbursement to primary care provides for health care services using telehealth.  Key findings include:  • Half of telehealth-related state policies were implemented in the last five years.• Although many states permit reimbursements for telehealth services, only seven&nbs...

Download Report The Healthy Marketplace Index is a series of metrics that measure the economic performance of health care markets across the country. The HMI was developed with support from the Robert Wood Johnson Foundation.    Download PDF File Here The Healthy Marketplace Index Report (HMI) shows the economic performance of more than 40 health care markets across the country. Dev...

 This data brief discusses patterns in the price and utilization indices reported in the 2015 Healthy Marketplace Index Report.   Download PDF File Here

Children's Health Spending: 2010–2013 shows that spending on healthcare for children (ages 0-18) covered by employer-sponsored insurance grew an average of 5.7% per year. The increase in spending in 2013 occurred despite a drop in the use of prescription drugs and visits to the emergency room, demonstrating that rising health care prices were an evident driver behind the spending increase in that ...

This issue brief examines health care spending for adults and children with diabetes relative to those without diabetes, both in terms of total per capita health care spending and out-of-pocket costs from 2009-2013.  Key Findings:  ​ In 2013, $14,999 was spent per capita on health care for people with diabetes.Per capita health care spending for children with diabetes rose 7% from 2...

This data brief looks at per capita out-of-pocket spending rates nationally and statewide and examines average differences in consumer prices for a set of five common medical procedures: office visit for the evaluation of a new patient, colonoscopy, cataract removal, lower leg MRI; and ultrasound for pregnancy nationally and in nine states: Arizona, Colorado, Florida, Georgia, Maryland, New Jersey...

ABSTRACT Objectives: Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome. Study Design: In this study, we discuss some of the issues around holdin...

This issue brief accompanies the 2013 Spending Cost & Utilization Report and examines trends in out-of-pocket expenditures per capita for the national, younger than age 65 population covered by employer-sponsored insurance for the period of 2011 through 2013.    Download PDF File Here

This issue brief is one of the first to examine health care trends for young adults (ages 19-25) with employer-sponsored insurance before and after implementation of Section 1001 of the Affordable Care Act that allows parents to include their adult children in family health plans.    Download PDF File Here

The 2007-2011 Vermont Health Care Cost and Utilization Report compares national and Vermont health care trends for the privately insured. The report finds that Vermonters with employer sponsored health insurance spent less on health care, but their spending grew faster than the national average. The report was prepared in cooperation with the Green Mountain Care Board. Download Repo...