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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...

HCCI's research on  ER facility prices was cited by the New York Post in a recent article. From the article: "While Jordan's case is extreme, the typical tab for an emergency room visit is still hard to fathom. The average visit costs $1,917, according to the Health Care Cost Institute, which looked at data from 2016. A different study from Johns Hopkins Bloomberg School of Public H...

HCCI's research on rising insulin list prices was recently cited by The New York Times in its reporting on Express Scripts' new plan to offer a $25 cap for month insulin. From the article: "Consumers whose drug benefits are managed by Express Scripts could see their out-of-pocket costs for insulin limited to $25 a month under a plan announced on Wednesday. The move is aimed at addressing rising an...

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 ...

Watch the Webinar HCCI recently held a webinar to discuss the 2017 Annual Health Care Cost and Utilization Report.    Download PDF File Here

The 2017 Health Care Cost and Utilization Report shows that spending per privately insured person grew by 4.2 percent, the second year in a row of spending growth over four percent. Price increases were the primary driver. The report covers the period 2013 through 2017 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedH...

HCCI's recent report on rising insulin prices was cited in support of congressional  inquiries into drug pricing. This included a letter from U.S. Senator Tim Kaine (D-VA) to executives at Eli Lilly, Novo Nordisk, and Sanofi requesting information on insulin pricing.  Additionally, HCCI's research on emergency care was cited in a letter from U.S. Senators Bill Cassidy (R-LA)&nb...

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 insure...

 HCCI's recent report on trends in rising insulin prices received additional media coverage in the last week in outlets including NBC, CBS, CNN, The New York Times, The Hill, U.S. News & World Report, and USA Today.  From CNN: "Congress and the Trump administration continue to push for a drug pricing plan and were given more ammunition Tuesday in the form of a report documenting...

​HCCI's latest research on rising insulin prices was recently featured in Reuters. HCCI's report detailed both use and price trends of insulin used by those with type 1 diabetes from 2012 to 2016. Per Reuters article: "A person with type 1 diabetes incurred annual insulin costs of $5,705, on average, in 2016. The average cost was roughly half that at $2,864 per patient in 2012, according to a...

HCCI's claims data was recently used to support investigations by Sarah Kliff into emergency room pricing in San Francisco. From Vox:   "Data from the non-profit Health Care Cost Institute shows that the average price at other San Francisco-area emergency rooms is $2,000 — less than half the city hospital's price. "A privately insured patient does not seem to be getting a very good ...

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...

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 ...

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...

HCCI's 2016 Annual Report was cited in the WSJ: The HCCI findings are "pretty compelling," said Paul Ginsburg, a professor at the University of Southern California. "Higher prices from providers is the most important element in rising premiums in the past few years."  Employer-Provided Health Insurance Approaches $20,000 a Year - WSJ The average cost of health coverage offered by employers ro...

​HCCI data was featured in The Wall Street Journal showing that insurers pay higher prices for some services performed on an outpatient basis that could also be performed in doctors offices. Read the Article

Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition - WSJ Hidden provisions in contracts between health-care providers and insurers allow hospitals to hide prices from consumers, add fees and discourage use of less-expensive rivals. https://www.wsj.com/articles/behind-your-rising-health-care-bills-secret-hospital-deals-that-squelch-competition-1537281963?mod=hp_lea...

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 a...

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...

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...

The 2016 Health Care Cost and Utilization Report shows that spending per privately insured person grew by 4.6 percent, faster than in previous years. Price increases were the primary driver. The report covers the period 2012 through 2016 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedHealthcare.​  The data in the report can al...

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...

 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 ...

Laurie Cook went shopping recently for a mammogram near her home in New Hampshire. Using an online tool provided through her insurer, she plugged in her ZIP code. Up popped facilities in her network, each with an incentive amount she would be paid if she chose it. Paid? To get a test? It's part of a strategy to rein in health care spending by steering patients to the most cost-effective providers ...