Research Roundup - April 2016


Covered California Imposes New Quality, Cost Conditions on Plans

By Anna Ibarra and David Gorn | California Healthline | April 8, 2016

Moving into a realm usually reserved for healthcare regulators, Covered California unveiled sweeping reforms to its contracts with insurers, seeking to improve the quality of care, curb costs and increase transparency for consumers, according to California Healthline. Among the biggest changes: Health plans will be required to dock hospitals at least 6 percent of their payments if they do not meet certain quality standards, or give them bonuses of an equal amount if they exceed the standards. 

California’s Largest Healthcare Purchasers Seek Public Input on How to Reduce Unncecessary Care

Center for Healthcare Decisions | April 14, 2016

Once people understand the magnitude of unnecessary, harmful or wasteful care, they are much more willing to support interventions to stem unneeded care through greater physician oversight and possibly increased patient cost sharing, according to a new report from the nonprofit Center for Healthcare Decisions. The report informs the work of the Statewide Workgroup on Reducing Overuse, a collaboration of California’s three largest healthcare purchasers -- Medi-Cal, Covered California and CalPERS -- committed to improving the quality and affordability of health insurance. [Link]


Colorado's Proposed Universal Healthcare Would be Bigger than McDonalds

By David Olinger | The Denver Post | April 8, 2016

An independent analysis of Colorado's proposed universal health care system by the Colorado Health Institute estimates it would cover 83 percent of residents and create a massive new entity that would dwarf most U.S. corporations. ColoradoCare would create a new system that would replace both Medicaid and private insurance. It would be funded by a payroll tax, with employers contributing two-thirds and employees one-third. [Link]


Florida Implements Law Protecting Consumers from Surprise Medical Bills

By Ashlee Keiler | Consumerist | April 14, 2016

Florida is now the second state behind New York to shield consumers from expensive surprise medical bills, as Governor Rick Scott signed legislation that would protect patients from balance-billing in both emergency and non-emergency hospital situations, according to The Consumerist. The measure aims to put a stop to unfair and expensive surprise out-of-network charges that affect nearly 30 percent of privately insured Americans. [Link]


Bill to Rein in Drug Costs Spurs Controversy

By Robert Weisman | Boston Globe | April 11, 2016

The lead sponsor of a Massachusetts bill calling for some of the nation’s most sweeping steps to control prescription drug costs scrapped a controversial provision that would have capped prices on treatments for critical illnesses such as hepatitis C. “It’s nearly impossible for policy makers, regulators and regular consumers to know the true markup on drug prices,” the Hub’s Lynn Quincy said, suggesting the factors that go into calculating drug prices have long been “shrouded in secrecy” in the United States. [Link]

New Hampshire

Transparency is Key in Controlling Health Care Costs

By Roger Sevigny | Concord Monitor | March 29, 2016

New Hampshire is considered a national leader in health cost transparency. has put a spotlight the extreme price variation patient face for the same healthcare service. It has prompted insurance companies to design new health plans that pass savings on to members who get care in reduced cost settings. This not only helps consumers but also employers seeking ways to hold down the cost of employee coverage. Now, uncertainty over the U.S. Supreme Court’s Gobeille v. Liberty Mutual decision could threaten the state’s transparency efforts. [Link]

New York

New Report Examines Factors Contributing to Performance of New York’s ACOs

By Greg Burke and Suzanne Brundage | United Hospital Fund | April 18, 2016

A new United Hospital Fund report examines the performance of New York’s accountable care organizations in the second year of the federal Medicare Shared Savings Program, finding that they lag the national experience on cost savings but outperform it on quality results. [Link]


Oregon Hospitals Are Banking Windfall Profits, While Providing Less Charity Care

By Nigel Jaquiss | Willamette Week | April 14, 2016

With the Affordable Care Act’s expansion of coverage, hospitals in Oregon are earning huge profits, allowing them to invest aggressively across the state.  At the same time, critics contend hospitals are abusing their nonprofit status by falling short of their commitment to provide community benefits such as charity care. [Link]  

Recent Reports

Cost Sharing Increasing Rapidly Over Time

By Gary Claxton, et al. | Kaiser Family Foundation | April 12, 2016

Rising cost-sharing for people with health insurance has drawn a good deal of public attention in recent years. For example, the average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015, according to a Peterson-Kaiser Health System Tracker brief. [Link]

States Taking Lead in Healthcare Cost Control

By Shannon Muchmore | Modern Healthcare | April 11, 2016

Some state-level efforts to reduce healthcare costs without sacrificing quality are working and should be replicated by others states, especially because local government is more poised to make changes than the federal government, according to a report released Monday. The Center for American Progress studied successful state initiatives like bundled payments, all-payer claims databases and cost-growth goals. The authors say states are in the best position to try these methods because reform is more politically feasible and programs can be tailored to a state's specific demographics. [Link]

Patients’ and Consumers’ Use of Evidence Featured in April Edition of Health Affairs

Health Affairs | April 2016

The April edition of Health Affairs examines patients’ and consumers’ use of evidence to inform healthcare decisions. The edition includes studies about the role of evidence in healthcare decisions, the barriers associated with collecting and using data and opportunities to engage with patients as consumers. [Link]

Care Redesign Survey: Why Population Health Management Is Undervalued

By Amy Compton-Phillips | New England Journal of Medicine | Aug. 31, 2016

In the first NEJM Catalyst Care Redesign survey, clinicians, clinical leaders, and healthcare executives cite “investing in behavioral health services alongside physical health services” as the clinical practice change most likely to improve the health of communities. [Link]


Are Out-of-Pocket Medical Costs Too High?

Views from Lynn Quincy and Grace-Marie Turner | Wall Street Journal | April 11, 2016

In this special Wall Street Journal debate feature, Lynn Quincy argues that consumers bear too much of the cost of health care and that there are more consumer-friendly ways to address high underlying healthcare costs. Turner, president of the Galen Institute, says that when consumers assume more out-of-pocket costs it can spur innovation and bring down costs overall. [Link]

Beyond Workout Apps: The ROI of Well-crafted Wellness Programs

By Katherine Moody | FierceHealthPayer | March 31, 2016

Both health insurers and employers have a stake in driving down healthcare costs for their member populations--especially among patients with expensive-to-treat chronic conditions. Increasingly, businesses are turning to payers to design wellness programs to aid in the effort.But it's not as simple as handing out activity trackers or launching a member wellness portal. Every company is different, and there are many ways to measure success. [Link]

Payment Reform Landscape: Where We Started on Transparency Tools and Where We Need to Go

By Suzanne Delbanco and Lea Tessitore | Health Affairs Blog | March 31, 2016

Modern technology is abundant, providing many with access to a wealth of knowledge and resources. With high expectations regarding the availability of information, consumers are baffled why something as seemingly simple as comparing providers on price and quality is so difficult. As an increasing number of consumers enroll in high-deductible health plans and tiered networks and assume more financial responsibility for their care, the lack of adequate tools is an obstacle to effectively managing healthcare and associated costs. [Link]

Six Years Later: The Affordable Care Act and Public Health Transformation

By LaMar Hasbrouck | NACCHO | April 1, 2016

This month marks the sixth anniversary of the passage of the Patient Protection and Affordable Care Act (ACA). The law has brought about significant change to the healthcare and public health landscape, fundamentally shifting how we as a nation think about the meaning and value of health. [Link]

Rewarding High Quality: Practice Models for Value-Based Physician Payment

Alliance of Community Health Plans | April 2016

A new brief from Alliance of Community Health Plans examines how community health plans are designing value-based alternative payment models. It highlights specific, replicable strategies designed to reduce the total cost of care and improve health by rewarding providers for quality and specific health outcomes. The brief provides examples from plans for each strategy and includes detailed case studies on new payment models that reduce cost while maintaining a commitment to high-quality care. [Link]

Consumers Must Have a Voice in Healthcare Mergers

By Frances Padilla | CT Post | March 25, 2016

Many Connecticut residents still don’t know that by the end of this year, Anthem Insurance Co. and Cigna may merge, forcing us all into a dire situation, according to Frances Padilla of the  Universal Health Care Foundation of Connecticut. Mergers are justified on the basis of increased efficiency and opportunity for innovation, but past experience doesn’t uphold those claims. They should be carefully questioned, because they can be expected to increase health insurance premiums, and cause deductibles, co-pays, and co-insurance out-of-pocket costs to spike. [Link]