All HCCI Reports
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Nov
19

Ouch!: New Data reveals ER spending increased by 51% from 2012 – 2019, with patient out of pocket payments increasing by 85%

Introduction Excessive emergency room (ER) spending and utilization have long been major areas of focus for health care stakeholders. The ER is an important source of health care for many individuals, especially those who lack a usual source of care, or those with work schedules that limit the ability to access care during "normal business hours." But an ER visit can be extremely expensive, and pa...
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Oct
15

Capping Out-of-Pocket Spending on Insulin would Lower Costs for a Substantial Proportion of Commercially Insured Individuals

Previous HCCI analysis documented rapid growth in insulin spending over the 2012-17 period. High out-of-pocket spending may deter adherence to insulin among individuals with diabetes, with potentially fatal effects. In this blog, we update our analysis of out-of-pocket insulin spending to 2019 using HCCI's unique commercial claims dataset, which includes prescription drug claims for 29 millio...
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Jun
11

Real World Consequences of the Qualifying Payment Amount in the No Surprises Act

The United States Congress passed the No Surprises Act last year, offering several protections to consumers. Beginning in 2022, providers can no longer bill patients for more than their insurance's in-network cost sharing. The law also bans balance billing except in situations where a patient is notified in advance and their written consent is obtained. Independent dispute resolution between insur...
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Apr
16

The Impact of COVID-19 on the Use of Preventive Health Care

Updated 4/16/2021 to include data through 12/30/2020. Since the original post on 9/9/2020, the data have been adjusted to account for claims submission lags. For more information, see Methods Note below. COVID-19 has had an extraordinary impact on the US health care system since its emergence in early 2020. One of the largest and most immediate impacts has been the death toll, with ...
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Apr
01

The Insanity of U.S. Health Care Pricing: An Early Look at Hospital Price Transparency Data

The numbers in this report have been updated to reflect the most recent pricing data made available by Sutter Health. While nearly all of the prices remained unchanged (93%), some, generally higher cost services were revised downward by Sutter. For example, in the initial report we found that C-section prices ranged from $7,634 to $89,244 across the Sutter system, whereas in the more recently avai...
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Mar
08

Daily Deaths During Coronavirus Pandemic by State

The staggering death toll of the novel coronavirus pandemic in the United States has been widely reported, surpassing 523,000 as of March 8, 2021. Over the course of the current pandemic a common method for measuring the probable number of deaths caused by COVID-19 has been comparing actual deaths in 2020 to the expected number of deaths in 2020 based on deaths in previous years. To add to the gro...
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Feb
24

Using Medicare Data to Improve Vaccine Targeting: Providers Serving Highest Risk Patients

As the production and distribution of SARS-CoV-2 vaccines ramps up in the United States, there is a need to ensure that communities at highest risk for severe COVID-19 morbidity and mortality are targeted. As of February 2021, the Pfizer/BioNTech and Moderna mRNA vaccines, which were approved by the U.S. Food and Drug Administration (FDA) under Emergency Use Authorization (EUA) in late 2020, remai...
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Feb
18

COVID-19 Disparities Persist in Community Health Centers' Vulnerable Populations

Community Health Centers (CHCs) serve over 29 million vulnerable patients, making the lack of data on COVID-19-related racial disparities in patients served in CHCs a critical knowledge gap in assessments of the pandemic's national impact. In rural and poor urban areas, CHCs may be the only accessible healthcare option. Even when other options exist, CHCs reduce barriers such as cost, lack of insu...
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Dec
09

How Differences Between Commercial, Medicare Professional Service Prices Could Result in Different Policy Impacts

 Introduction As rising health care costs force difficult choices for families, employers, and federal, state, and local governments, a range of policy proposals are emerging to address health care spending in the U.S. In this presidential election year, there has been heightened attention on lowering health care costs and making care more affordable, which will likely accelerate with the ele...
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Nov
12

Past the Healthy Marketplace Index, Volume II: Exploring Changes in Actual Prices Paid for Specific Services by Metro Area from 2013 to 2017

In the first brief of the Past the Healthy Marketplace Index series, we explored how prices compared across the country and found that, in 2017, health care prices for specific services varied by as much as 22-fold across metro areas and even up 40-fold within them. In this next brief, we looked at variation in price growth and examined if that variation was related to the substantial observed dif...
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Nov
12

Past the Healthy Marketplace Index, Volume I: Exploring Actual Prices Paid for Specific Services by Metro Area

How much people spend on health care from place to place reflects multiple, interwoven, and dynamic factors, such as the cost and use of services. Health care spending and its driving factors change over time, differ across geographies, and vary by type of service. The Health Care Cost Institute's (HCCI) Healthy Marketplace Index (HMI) provides a number of metrics illustrating how health care spen...
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Oct
14

Electronic Medical Record Data Suggest Disparities in COVID Incidence Persist Across Regions and Over Time

Since the onset of the COVID-19 pandemic, a growing body of research has found alarming disparities in rates of the virus among Black and Hispanic communities. For example, the CDC reports that "American Indian or Alaska Native, Non-Hispanic" people and "Hispanic or Latino" people each have 2.8 times as many COVID cases than white people, Black patients have 2.6 time as many, and Asian people have...
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Oct
14

The Impact of COVID-19 on Years of Life Lost

Summary: Since April, 1.9 million excess years of life have been lost, 13% above historical average. Over the course of the pandemic, we found age and sex contributions to excess YLL have shifted. Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. Since April, working age adults 20-64 have accounted for 47% of excess YLL, and males 20...
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Aug
13

Comparing Commercial and Medicare Professional Service Prices

People in the United States routinely cite health care and health care costs as top concerns.1,2,3,4 For the more than 160 million people who get insurance from their employer, the cost of health care is high, growing, and outpacing growth in wages.5,6,7 Across the country, health care costs show up in the form of higher premiums and higher out-of-pocket costs (for services that are both...
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Aug
13

Commercial Prices Relative to Medicare Vary Within Metro Areas Across Specialties and by Type of Service

Earlier HCCI research found that at the national level, commercial payers paid prices that were, on average, 122% of Medicare. However, we found that commercial professional service prices varied dramatically across states from 98% of Medicare in Alabama to 188% of Medicare in Wisconsin. There was similar variation within states, such as California, and also substantial variation within Metro Area...
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Jul
27

Analysis of Electronic Medical Record Data Shows Significantly Higher Rates of COVID-19 Infection among Hispanic and Black Patients

The COVID-19 pandemic has resulted in a previously unimaginable impact both in the United States and globally. It is increasingly clear as we enter the fifth month of the pandemic, with rising caseloads and deaths, that the United States will need to continue to address the COVID-19 pandemic for the foreseeable future. Each day, we learn more – about the virus clinically, about the people and...
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Jun
26

Charge Amounts for Professional Procedures to Commercial Insurance and Traditional Medicare

In the start of 2019, Centers for Medicare and Medicaid Services finalized federal policies that required hospitals to publish the amount they charge for common services, documents commonly referred to as chargemasters. While similar policies have been in place at the state level since the early 2000s, this was the first federal mandate to require this type of transparency. These policies have bee...
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Jun
19

ADRD Prevalence in Various Insurance Populations: A Collaboration with The Alzheimer’s Association

Alzheimer's disease and related dementias (ADRD) represent a significant and growing cost to the United States health care system. While the prevalence and cost of ADRD related to Medicare Fee-for-Service beneficiaries is documented in the Center for Medicare and Medicaid Services' Chronic Conditions Warehouse, less is known about the prevalence and cost of ADRD among individuals covered by employ...
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Jun
10

Consumer-Directed Health Plan Enrollment Rises in All Cities over 10 Years (2008 to 2017)

Recent analysis by HCCI finds that enrollment in consumer-directed health plans (CDHPs) increased dramatically since 2008. Nationally, nearly a third of commercially insured individuals were enrolled in a CDHP in 2017, up from 7.5% in 2008. Over ten years, enrollment in CDHPs doubled in 85 of the 88 metro areas studied. High-deductible health plans (HDHPs) have become increasin...
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Jun
02

Health Affairs Blog: Out-of-Network Spending: Why Growing Attention Is Focused On A Small Share Of Medical Spending

In HCCI's publication in Health Affairs Blog, we examine the cost and utilization of out-of-network care in commercial claims.  From the article:  "People receiving surprise bills, sometimes totaling tens of thousands of dollars, have been frequently chronicled by high-profile media stories and in academic research over the past several years. Previous research from the Health ...
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Jun
01

Health Affairs: Out-Of-Network Spending Mostly Declined In Privately Insured Populations With A Few Notable Exceptions From 2008 To 2016

In HCCI's publication in Health Affairs, we examined out-of-network spending in the privately insured population.  Abstract:  "While out-of-network or potential "surprise" billing has garnered increasing attention, particularly in emergency department and inpatient settings, few national studies have examined out-of-network care overall or in other settings. We examined out-of-network sp...
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May
28

How often do providers bill out of network?

In recent analysis, we document extensive variation across states and metropolitan areas in the frequency of out-of-network visits among individuals with health insurance provided by an employer. These differences raise the question of whether individual providers bill out of network at dissimilar rates. To explore whether a small group of providers are responsible for most out-of-network billing,...
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May
13

Use of Prenatal Care Varies among People with Employer-Sponsored Insurance

Prenatal care leads to healthier pregnancy, healthier pregnant people, and healthier babies. In fact, birthing parents who receive prenatal care are three times less likely to deliver low birthweight babies, and the baby is five times more likely to survive delivery. To explore the kind of prenatal care pregnant people receive, we looked at utilization of two prototypical prenatal services – labor...
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May
13

Understanding Variation in Spending on Childbirth Among the Commercially Insured

Childbirth is the most frequent reason for an inpatient admission in the United States, and Cesarean-section (C-section) is the most common operating room procedure in an inpatient hospital stay. Among people who get insurance through an employer, the combination of labor, delivery, and newborn care makes up nearly one in six dollars spent on inpatient care. Childbirth accounts for an estimated fo...
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May
13

Most Postpartum Spending Occurs Beyond 60 Days After Delivery

The postpartum period is a vulnerable time for both birthing parent and newborn and is critically important to their health and well-being. The American College of Obstetricians and Gynecologists (ACOG) recommends ongoing, comprehensive care, including physical, social, and psychological services, during the postpartum period. In large part because of an increasing maternal mortalit...
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