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Spending per person in employer-sponsored plans reaches all-time high of $6,335 Health care spending for the average New Yorker with employer-sponsored health insurance is increasing faster in New York State than the rest of the country, according to a new analysis released today by the New York State Health Foundation (NYSHealth) and the Health Care Cost Institute (HCCI). Per-person spending grew...

Committees in both the House and Senate have advanced legislation that includes measures to address "surprise bills." A surprise bill results when a person unknowingly receives medical care from a provider that is not part of their insurer's network. Both pieces of legislation set a benchmark for out-of-network payments. Those benchmarks are determined based on the median in-network amount paid by...

Among people who get health insurance from their employers (56% of the population in 2017), prescription opioid use peaked in 2010/2011 and declined every year from 2012 to 2017. In a new study using the Health Care Cost Institute's commercial claims data from 2008 to 2017, we observed a decline regardless of how utilization was measured. We also found that utilization trends were driven by three ...

The Health Care Cost Institute (HCCI) is proud to present five posters at the AcademyHealth 2019 Annual Research Meeting in Washington, D.C. These posters, which cover HCCI research on a wide variety of topics, focus on health care spending and utilization trends among the commercially insured population. If you are attending the conference, please check out the schedule below to meet our staff an...

 On January 1, 2017, the Medicare program started reimbursing providers for a new procedure code for clinical visits for cognitive assessments and care planning services (CPT code G0505). This newly-billable service is intended to improve the care of patients with Alzheimer's disease and related dementias and hopefully increase early detection and diagnosis. A G0505 visit includes a complete ...

To better understand differences in spending and use across types of health plans, we examine individuals enrolled in consumer-directed health plans (CDHPs) and individuals enrolled in non-CDHP health plans. CDHPs are a type of HDHP that typically include a health savings account (HSA) or a health reimbursement arrangement (HRA). We analyzed a sample of over 10 million individuals under the age of...

As policymakers, employers, and patients increasingly struggle with rising health care costs, there is a lack of clarity around the actual price of health care services and why those prices are so different. Recent efforts have focused on greater price transparency as a way to impact growing prices. A range of proposals from both Congress and the White House seek to shed more light on the confusin...

Where people receive health care matters, especially in terms of costs. The same services may have a much higher price tag when performed in one setting rather than another, but this price difference is rarely publicized to patients. To understand what settings people used and how prices differed, we looked at the utilization and average price paid from 2009 to 2017 for a set of services commonly ...

 Out-of-network billing practices have increasingly garnered attention as individuals with commercial health insurance continue to experience "surprise billing." A surprise medical bill commonly describes a charge to a patient for care delivered by an out-of-network (OON) professional who works within an in-network facility. We used the Health Care Cost Institute's (HCCI) vast commercial...

We used health care claims data to investigate trends in total health care spending on individuals with type 1 diabetes between 2012 and 2016. We found a rapid increase in total health care spending, driven primarily by gross spending on insulin that doubled over the period. During that time insulin use rose only modestly. While the composition of insulins used shifted, the price of all types of i...

Office visits to primary care physicians (PCPs) declined 18 percent from 2012 to 2016 for adults under 65 years old with employer-sponsored health insurance, while office visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. Comparing 2012 to 2016, there were 273 fewer office visits per 1,000 insured individuals to primary care physicians over that span, while v...

Recently, the Health Care Cost Institute (HCCI) published its Healthy Marketplace Index (HMI) – Price Index report, examining relative health care prices in 112 different metropolitan areas. This report is the first in a new series of releases from the HMI project, funded by the Robert Wood Johnson Foundation, which compares commercial health care markets across the country. We found widespread va...

ABSTRACT Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories of health services, although the ...

HCCI often reports the prices of health care services, defined as the average amount a provider is paid for a given service based on negotiations with health care insurers. These prices typically represent a portion of charges, which are the amounts health care providers bill for the procedures they perform. The charge amount is often the starting point for negotiations between insurers and provid...

HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER CPT codes were higher in 2016 than in 2009, th...

In a recent issue brief, HCCI found that the already high cost of care for people with multiple sclerosis (MS) rose dramatically over the past several years. The primary driver was the increasing cost of a small group of prescription drugs called Disease Modifying Therapies (DMTs). To illustrate the role prescription drug prices play in driving overall health care spending for people with MS, we d...

This issue brief investigates how the cost of prescription drugs affects the total cost of care for people with multiple sclerosis (MS). It decomposes total health care spending by category, specifically separating out spending on specialty drugs used to treat MS, called Disease Modifying Therapies (DMTs). The issue brief subsequently examines whether changes in spending on DMTs are due to changes...

This issue brief compares trends in health care spending from 2012 to 2016 for adults with employer-sponsored insurance who were diagnosed with hypertension to those not diagnosed with hypertension. It also considers how changes in prescription drug spending compare to changes in prescription drug use for adults with a hypertension diagnosis.   Excel Data Tables Machine-Readable Data   D...

It is well documented that Americans spend a lot on health care, but this issue is often discussed in terms of share of GDP, billions of dollars, or an astoundingly high hospital bill. These numbers can be hard to relate to; it's hard to imagine billions of dollars, let alone a share of the national economy. A pricey bill may get our attention, but can seem like a special case that doesn't relate ...

 HEALTH AFFAIRS BLOG: "Perhaps nothing illustrates the intractability of America's struggle with health spending more than the recent announcement by Amazon, JP Morgan, and Berkshire Hathaway that they were founding a new entity to address health care costs for their employees. Despite lacking any concrete details this announcement managed to wipe billions of dollars in market capitalization ...

 NEJM CATALYST: "The concentration of most U.S. health care spending in a small proportion of individuals is well documented. The notion that high health care spending only affects a small portion of people in a given year is particularly relevant to the ongoing policy debate about how to make health insurance affordable for all, while accommodating people with complex health care needs and a...

 This issue brief explores the distribution of health care spending among commercially insured individuals, with a focus on the top 5 percent of spenders and turnover within that group from year to year. It considers the share of spending incurred by this group of top spenders, how those dollars are distributed among the health care service categories, turnover within the group of top spender...

Past literature has found links between higher opioid use and local economic conditions for people enrolled in public health programs, but there has been little discussion of whether this relationship occurs among the privately insured. Using HCCI claims data and county level income data from the US Census Bureau, we examined how a county's median household income relates to long-term opioid use a...

HEALTH AFFAIRS BLOG: "As policymakers consider actions to address challenges with the Affordable Care Act and ongoing growth in health spending, the importance of understanding local health care market dynamics is more important than ever. Traditionally, policy makers and other stakeholders have evaluated commercial health care markets' total spending and often attributed high spending to high pri...

Medical bills from the Emergency Room (ER) are a mystery to many patients in the US health system. From incredibly high, varying charges to surprise bills resulting from in/out of network confusion, many Americans have no idea what to expect when it comes to the cost of this necessary service. Recently, Vox reporter, Sarah Kliff, has begun collecting ER bills in an attempt to "bring transparency t...