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Aug
31

Wall Street Journal: The Math Behind Higher Health-Care Deductibles

 By. Melanie Evans, Yaryna Serkez, and Merrill Sherman More U.S. workers are taking a bigger out-of-pocket hit from their employer-provided health plans. Blame high deductibles.High-deductible plans required patients to spend $2,200 to $4,300, on average, in 2016 before insurance kicked in, and amounts can be significantly more. Employers have embraced high deductibles to cut the amount ...
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Aug
01

Health Affairs: Medicare Competitive Bidding Program Realized Price Savings For Durable Medical Equipment Purchases

ABSTRACT:From the inception of the Medicare program there have been questions regarding whether and how to pay for durable medical equipment, prosthetics, orthotics, and supplies. In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items. Previously, CMS had used prices in an administrati...
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May
04

Academic Emergency Medicine: Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women

ABSTRACTObjectives: Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department (ED) use among a national sample of commercially insured pregnant women.Methods: We conducted a retrospective cohort study using multipayer med...
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Apr
04

Congressional Budget Office Working Paper Series: An Analysis of Private-Sector Prices for Hospital Admissions

ABSTRACT: Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this paper, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them wit...
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Feb
28

Non-Shoppable Health Care Services: Inpatient Hospitalizations

This data brief reports on spending and utilization in populations likely unable to shop for a hospital prior to seeking care, comparing spending and length-of-stay for individuals who were admitted through the emergency department (ED) to that of individuals who needed ambulance services the day of their admission through the ED.    Download PDF File Here
Feb
19

Health Services Research: Payer Type and Low‐Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

ABSTRACTObjective: To compare low‐value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low‐value care.​Data Sources: 2009–2011 national Medicare and commercial insurance administrative data.Design: We created claims‐based algorithms to measure seven Choosing Wisely‐identified low‐value services and examined the cor...
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Jan
01

JAMA Internal Medicine: A Perspective on Out-of-Pocket Spending

To the Editor Understanding out-of-pocket spending is critical to understanding health care costs in the United States. We applaud the efforts of Adrion et al as an important contribution to understanding the out-of-pocket spending of the commercially insured population younger than 65 years. The commercially insured comprise over 50% of the nonelderly US population and, as demonstrated by Ad...
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Nov
23

CNBC: Health-care spending increased at a faster pace in 2015 as prices rose

By: Dan ManganSpending on health care for people who have private insurance accelerated last year, ending a two-year period of more modest spending growth, a new study finds.In 2015, overall spending for people with private health insurance increased by 4.6 percent, according to the Health Care Cost Institute report. Most of that increase, again, was due to higher prices for prescription drugs and...
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Nov
22

2015 Health Care Cost and Utilization Report

The 2015 Health Care Cost and Utilization Report shows that spending per privately insured averaged $5,141 in 2015, up $226 from the year before.Key Findings ​Health care spending averaged $5,141 per individual in 2015, up $226 from the year before.Out-of-pocket spending rose 3.0 percent in 2015, to an average of $813 per capita.Spending on prescription drugs grew faster than spending on any ...
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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
14

Washington Post: How companies are quietly changing your health plan to make you pay more

 By: Carolyn JohnsonWhile politicians have been embroiled in a fiery debate over President Obama's signature health-care law, a quiet but profound shift is fundamentally reshaping how health insurance works for the roughly 155 million Americans who receive coverage through their employers.A national survey of employer health benefits released Wednesday shows how much deductibles — the health-...
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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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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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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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Jul
01

Necessary versus Sufficient Claims Data

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
Jun
20

Star Tribune: The dollars pile up with diabetes

By: Christopher Snowbeck Per capita spending on patients with diabetes hit $16,021 in 2014, which was an increase of about 6 percent or $897 from the previous year, according to a report released Monday.The average person in an employer plan during 2014, meanwhile, wracked up $4,396 in medical spending, which was up 3 percent compared with the previous year.The numbers come from the Health Ca...
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Jun
20

2014 Diabetes Health Care Cost and Utilization Report

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 AppendixKe...
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Jun
03

Journal of Telemedicine and Telecare: Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States

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...
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May
05

Healthzette: The Health Savings We’re Missing - Cost transparency tools exist ... yet we're not using them

 By: Kristen Fischer We have the tools to shop around and save on health care costs — but we aren't using them. A new Harvard Medical School study reveals that consumer access to price transparency tools doesn't make them any more popular or likely to decrease health care spending.Do we not want to save money, especially in a health care climate in which out-of-pocket costs are soaring? ...
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Apr
21

National Chartbook of Health Care Prices 2015

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 ...
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Mar
01

Spending on Shoppable Services in Health Care

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 $...
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Oct
29

2014 Health Care Cost and Utilization Report

The 2014 Health Care Cost and Utilization Report tracks changes in health care prices, utilization, and spending for people younger than 65 covered by employer-sponsored health insurance (ESI). The 2014 Health Care Cost and Utilization Report shows that spending per privately insured person grew 3.4% in 2014, with more dollars going to brand-name drugs than in prior years.   Download Report A...
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Jul
08

Children's Health Spending: 2010-2013

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 ...
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Oct
23

2013 Health Care Cost and Utilization Report

The 2013 Health Care Cost and Utilization Report shows that spending per privately insured grew 3.9% in 2013, as falling utilization offset rising prices. The 2013 Health Care Cost and Utilization Report tracks changes in health care prices, utilization, and spending for people younger than 65 covered by employer-sponsored health insurance (ESI).   Download Report Appendix Tables Key Fin...
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Oct
01

Out-of-Pocket Spending Trends 2013

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