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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
11

ER facility prices grew in tandem with faster-growing charges from 2009-2016

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...
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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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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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May
30

ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)

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...
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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
23

Health Payer Intelligence: Pros and Cons of High Cost Sharing for Employer Health Plans

 By Thomas BeatonEmployer-sponsored health plans that include high cost sharing expectations can help control spending for plan sponsors, but could create longer-term health risks for employee beneficiaries. Striking the right balance between lowering costs and enabling healthy decision-making can be a challenge for employers and payers looking to design cost-effective plans. How can plan spo...
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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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Apr
30

Business Wire: Vitals Reduced Medical Spending for Employers by $56M. Three people every hour shop and save on their health care

 Vitals today released its 2018 Book of Business report. The annual summary reports the metrics associated with shopping activity and savings achieved by employers and employees using Vitals SmartShopper.SmartShopper is a high-tech, high-touch health care program that allows consumers to shop for and choose better-value medical care. Over the past four years, SmartShopper has generated over $...
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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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Mar
01

Medical Care: The Differential Effects of Insurance Mandates on Health Care Spending for Children’s Autism Spectrum Disorder

ABSTRACTObjectives: There is substantial variation in treatment intensity among children with autism spectrum disorder (ASD). This study asks whether policies that target health care utilization for ASD affect children differentially based on this variation. Specifically, we examine the impact of state-level insurance mandates that require commercial insurers to cover certain treatments for ASD fo...
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Mar
01

Obstetrics & Gynecology: Rate of Pelvic Organ Prolapse Surgery Among Privately Insured Women in the United States, 2010-2013

AbstractOBJECTIVE: To analyze utilization of, and payments for, pelvic organ prolapse procedures after the 2011 U.S. Food and Drug Administration (FDA) communication regarding transvaginal mesh.METHODS: This is a retrospective cohort study examining private claims from three insurance providers for inpatient and outpatient prolapse procedures from 2010 to 2013 in the Health Care Cost Institute. Pr...
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Feb
15

RevCycle Intelligence: Hospital Cost-Shifting Increases Private Payer Payments by 1.6%

Healthcare organizations that faced Medicare reimbursement reductions under the Affordable Care Act engaged in hospital cost-shifting that resulted in 1.6 percent higher average payments from private payers, a new working paper from the National Bureau of Economic Research uncovered.Researchers reported that hospitals penalized under the Hospital Readmission Reduction Program (HRRP) and the Hospit...
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Feb
09

Health Affairs: Health Spending Growth Is Accelerating; Prices Are In The Driver’s Seat

 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 f...
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Feb
01

New England Journal of Medicine: Consistently High Turnover in the Group of Top Health Care Spenders

 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 ac...
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Feb
01

Top Spenders Among the Commercially Insured Increased Spending Concentration and Consistent Turnover from 2013 to 2015

 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...
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Jan
30

CNN Money: Jeff Bezos, Warren Buffett, and Jamie Dimon want to fix health care

By: Chris Isidore Amazon is partnering with Buffett's Berkshire Hathaway and JPMorgan Chase, the nation's largest bank, to try to address one of the nation's thorniest and priciest problems -- soaring health care costs.The three companies unveiled an as yet unnamed company to give their U.S. workers and families a better option on health insurance. The statement said the new company will be "...
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Jan
24

Wall Street Journal: Health-Care Costs Rose for Americans With Employer-Sponsored Insurance

By: Jeanne WhalenSpending on health care accelerated in 2016 for Americans who get insurance through work, even as use of most health-care services declined or remained flat. The reason, according to a new report: price increases.Rising prices for prescription drugs, surgery, emergency-room visits and other services drove a 4.6% increase in total spending per person, versus 4.1% in 2015 and less t...
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Dec
04

ER spending increased 85%, driven by price increases for the most severe cases (2009-2015)

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...
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Dec
01

Health Affairs: Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

ABSTRACT:  Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received cons...
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Nov
20

New England Journal of Medicine: The Value of Health Insurance through Price Discounts

 NEJM CATALYST:"As context for the ongoing health care reform debate, we analyzed Health Care Cost Institute (HCCI) data. HCCI is a nonpartisan, nonprofit organization aimed at providing complete and accurate information about health care utilization and costs in the United States.Our goal was to demonstrate the value of insurance through these discounted rates. We did so by calculating media...
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Oct
01

Health Affairs: Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

ABSTRACT: Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for m...
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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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Sep
01

Women's Health Issues: Maternal Medical Complexity Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section

ABSTRACTBackground: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured.Objective: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending dur...
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Sep
01

Psychiatric Services: Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States

ABSTRACT: Objective: This study characterizes telehealth claims for mental health and substance abuse (MH/SA) services by using national private claims data.Methods: Telehealth-related mental health service claims were identified with private claims data from 2009 to 2013. These data—provided by the Health Care Cost Institute—included claims from Aetna, Humana, and UnitedHealth for ...
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