Publications
HCCI’s external researcher publications powered by #HCCIdata

Jul
29

Health Care Spending in New York Growing Faster Than Rest of U.S.

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 ...
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Apr
01

Health Care Spending and Utilization in Public and Private Medicare

Abstract:We compare health care 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 health care spending. Adjusting for enrollee mix, health care spending per enrollee in MA is 9 to 30 percent lower than in Traditional Medicare (TM), depending on the way we define "comparable" enrollee...
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Feb
27

BMC Public Health: Area-Level Deprivation and Preterm Birth: Results from a National, Commercially-Insured Population

AbstractBackground: Area-level deprivation is associated with multiple adverse birth outcomes. Few studies have examined the mediating pathways through which area-level deprivation affects these outcomes. The objective of this study was to investigate the association between area-level deprivation and preterm birth, and examine the mediating effects of maternal medical, behavioural, and psych...
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Feb
04

Health Affairs: Variation In Health Spending Growth For The Privately Insured From 2007 to 2014

ABSTRACTWe examined the growth in health spending on people with employer-sponsored private insurance in the period 2007–14. Our analysis relied on information from the Health Care Cost Institute data set, which includes insurance claims from Aetna, Humana, and UnitedHealthcare. In the study period private health spending per enrollee grew 16.9 percent, while growth in Medicare spending per fee-fo...
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Feb
04

Health Affairs: Medicare Advantage And Commercial Prices For Mental Health Services

​Abstract:In 2014, insurers paid an average of 13–14 percent less for in-network mental health services in their commercial and Medicare Advantage plans than fee-for-service Medicare paid for identical services—despite paying up to 12 percent more than Medicare when the same services were provided by other physician specialties. However, patients went out of network more frequently for mental heal...
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Feb
04

Health Affairs: Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14

Abstract:Evidence suggests that growth in providers' prices drives growth in health care spending on the privately insured. However, existing work has not systematically differentiated between the growth rate of hospital prices and that of physician prices. We analyzed growth in both types of prices for inpatient and hospital-based outpatient services using actual negotiated prices paid by insurer...
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Jan
01

Medical Care: Competition in Outpatient Procedure Markets

 AbstractBackground: More than half of all medical procedures performed in the United States occur in an outpatient setting, yet few studies have explored how competition among ambulatory surgery centers (ASCs) and hospitals affects prices for commercially insured outpatient services.Objectives: We examined the association between prices for commercially insured outpatient procedure...
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Dec
13

American Academy of Pediatrics: Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder

ABSTRACT  BACKGROUND: The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers.METHODS: We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending...
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Nov
01

American Academy of Actuaries: Estimating the Potential Health Care Savings of Reference Pricing

Executive Summary:High and rising health care prices play a major role in the persistent increases in health care spending. This study, undertaken by the American Academy of Actuaries Health Practice Council, explores the potential for reference pricing to counter high health care prices and contain health care spending growth. Reference pricing is a system in which an insurer selects a price it i...
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Nov
01

International Journal of Radiation Oncology: Impact of Medicare Advantage Enrollment on Utilization of Intensity-Modulated Radiation Therapy and Cost of Care for Cancer Treatment

Abstract:Intensity-modulated radiation therapy (IMRT) is an important driver of rising costs in oncology care, but the level of evidence supporting its routine use varies across disease sites, including breast, lung, and prostate. While Medicare Advantage (MA) plans have incentives to reduce health care spending, the effect of MA enrollment on utilization of high-cost medical services and quality ...
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Oct
01

Health Affairs: Assessing The Impact Of State Policies For Prescription Drug Monitoring Programs On High-Risk Opioid Prescriptions

 ABSTRACT:Policies and practices have proliferated to optimize prescribers' use of their states' prescription drug monitoring programs, which are statewide databases of controlled substances dispensed at retail pharmacies. Our study assessed the effectiveness of three such policies: comprehensive legislative mandates to use the program, laws that allow prescribers to delegate its use to offic...
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Sep
14

American Journal of Health Economics: Why Don't Commercial Health Plans Use Prospective Payment?

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...
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Sep
11

Journal of General Internal Medicine: First Opioid Prescription and Subsequent High-Risk Opiod Use, a National Survey of Privately Insured and Medicare Advantage Adults

​BACKGROUND: National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription.OBJECTIVE: To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription.DESIGN: Retrospec...
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Sep
04

The Quarterly Journal of Economics: The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured

​Abstract: We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three a...
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Sep
01

The Society of Actuaries: Predicting High-Cost Members in the HCCI Database

Abstract:Using the Health Care Cost Institute (HCCI) database, which contains claim information on approximately 47 million members annually over a seven-year time period, we examined which characteristics best predict and describe high-cost members. We found that cost history, age, gender and prescription drug coverage are all predictors of future high costs, with cost history being the most pred...
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Sep
01

JAMA Pediatrics: Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

ABSTRACTImportance: 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 addr...
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Apr
01

American Journal of Obstetrics & Gynecology: Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women

ABSTRACTBackground: Laparotomy followed by inpatient hospitalization has traditionally been the most common surgical care for hysterectomy. The financial implications of the increased use of laparoscopy and outpatient hysterectomy are unknown.Objectives: The objective of the study was to quantify the increasing use of laparoscopy and outpatient hysterectomy and to describe the financial implicatio...
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Oct
01

NBER: Why Don't Commercial Health Plans Use Prospective Payment?

ABSTRACTOne 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 and...
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Sep
01

JAMA Internal Medicine: Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults

ABSTRACTImportance: 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, re...
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Oct
01

JAMA Oncology: Association Between Quality of Care for Breast Cancer and Health Insurance Exchange Coverage An Analysis of Use of Radiation Therapy After Breast-Conserving Surgery

ABSTRACTResearch comparing quality of cancer care by insurance categories concluded that cancer patients without insurance or with Medicaid experienced inferior quality of care compared with those with private insurance. A new insurance category created from the Affordable Care Act (ACA) is insurance purchased from the Health Insurance Marketplace (also known as the exchange). The present stu...
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Jun
11

INQUIRY The Journal of Health Care Organization, Provision, and Financing: How do the Hospital Prices Paid by Medicare Advantage Plans and Commercial Plans Compare with Medicare Fee-for-Service Prices?

ABSTRACTThe prices that private insurers pay hospitals have received considerable attention in recent years, but most of that literature has focused on the commercially insured population. Although nearly one-third of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan, little is known about the prices paid to hospitals by the private insurers that administer such plans. More inf...
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Aug
01

Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays

ABSTRACTThere 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 ad...
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Jun
25

Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial Plans

ABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program...
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May
23

Health Services Research: Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs

 ABSTRACTObjective: To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all.Data Sources: Commercial health insurance claims data, 2009–2013.Study Design: Retrospective analyses using two‐stage residual inclusion instrumen...
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May
01

NBER: The Price Ain't Right? Hospital Prices and Health Spending on the Privately Insured

ABSTRACT: We use insurance claims data covering 28 percent of individuals with employer-sponsored health insurance in the US to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor of three across...
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