Research Roundup - July 2015

State News

More than 220,000 Oregonians Face Higher Prices for 2016 Health Coverage

By Nick Budnick, The Oregonian | July 1, 2015

Oregon was the first state to announce 2016 rates for people who aren't covered by their employers or government programs. Premium rates approved by the Oregon Insurance Commission ranged from 8.3 percent to 37.8 percent - some of the highest rates seen around the country.

Connecticut Health Insurers Lower Rate Hike Requests

By Arielle Levin Becker, Hartford Courant | July 10, 2015

The four companies selling individual health plans through Connecticut's health insurance exchange have revised their proposals for 2016 rates, seeking lower increases than initially proposed. In filings with state regulators, the companies cited varying reasons — ranging from lower claims costs to the expectation of using a narrower network of healthcare providers. For example, Anthem Blue Cross and Blue Shield cut its proposed average increase from 6.7 percent to 4.7 percent. The Connecticut Insurance Department is expected to issue decisions on the potential rate hikes by the end of August.

Narrow Networks in Colorado: Balancing Access and Affordability

Mara Baer et al., Colorado Health Institute | June 2015

Health policy discussions in Colorado and across the nation are increasingly turning to the subject of  the adequacy of the narrower networks that are becoming increasingly prevalent. This new report provides background on this issue and lists key criteria for policymakers in Colorado.

South Carolina: Evolution and Initial Experience of a Statewide Care Transitions Quality Improvement Collaborative: Preventing Avoidable Readmissions Together

By R. Neal Axon, et al., Population Health Management | July 8, 2015

This  study finds healthcare providers in South Carolina have significantly reduced hospital readmissions and improved care transition quality through a statewide initiative. The initiative addressed conditions that carry a high risk of readmission, including pneumonia, congestive heart failure, chronic obstructive pulmonary disease and myocardial infarction. During the intervention period, the rate of 30-day readmissions decreased significantly for participants between 2011 and 2013.

NY Medicaid Program Pushes Value-Based Purchasing Trend

Law360 | July 7, 2015

New York has adopted an ambitious plan for value-based purchasing in its Medicaid program, placing the state at the forefront of the national movement to find new reimbursement models. Under the plan being reviewed by the Centers for Medicare & Medicaid Services, over the next five years New York aims to have 80 to 90 percent of Medicaid payments made through alternative payment models that entail shared risk tied to cost savings and quality measures.

Delaware Becomes Latest State to Regulate Telemedicine Practices

By Adam Rubenfire, Modern Healthcare | July 7, 2015

Delaware has become the 29th state to require health insurers to pay for telemedicine after the state's governor approved an updated law regulating the virtual services. The law was seen as necessary because some healthcare providers using telemedicine have at times had claims denied because the services were performed remotely. There is ongoing debate about the actual cost-saving benefits of telehealth.

Massachusetts Insurers Asked to Improve Health Cost Websites

Felice Freyer, Boston Globe | July 14, 2015

The state’s three biggest health insurers are doing a mediocre job of meeting a state requirement to give consumers estimates of what their care will cost, according to an evaluation released by the advocacy group Healthcare for All.

Recent Reports

Healthcare Costs for U.S. Households Closing in on $25,000

By Ron Shrinkman, FierceHealthFinance | May 21, 2015

The cost of providing healthcare for a typical family of four with a PPO plan is now approaching $25,000, an increase of 6.3 percent from 2014 and well above growth in the consumer price index for medical services. According to the the report from actuarial firm Milliman, prescription drug costs drove most of this year's increase, spiking up 13.6 percent.

Healthcare Prices Remain a Secret in Most States

By Bruce Japsen, Forbes | July 8, 2015

The third annual report from the Healthcare Incentives Improvement Institute and Catalyst for Payment Reform shows little progress is being when it comes to disclosing healthcare price information to the public--45 of 50 states received failing grades in making price information easily available..  States with higher grades generally share information about inpatient and outpatient services via a website that can be accessed by anyone.

Study: Out-of-pocket health costs rose slightly in 2014

By Sarah Ferris, The Hill | July 7, 2015

Out-of-pocket healthcare costs have increased modestly over the last year, according to a new study – a sign that prices are not skyrocketing under ObamaCare as some critics had predicted.

The total amount of money that a patient spent per visit increased 3.5 percent over the last year, according to data from a study published Health Affairs and sponsored by the Robert Wood Johnson Foundation. That amounts to about $1 per visit, including copayments and deductibles.

Analysis of 2016 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces

Cynthia Cox, et al., Kaiser Family Foundation | June 23, 2015

This brief presents an early analysis of changes in the premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 10 states, plus D.C. In most of these 11 major cities, costs for the lowest and second-lowest cost silver plans – where the bulk of enrollees tend to migrate – are changing relatively modestly in 2016, although increases are generally bigger than in 2015.

Commentary/News

With Merging of Insurers, Questions for Patients About Costs and Innovation

By Reed Ableson, The New York Times | July 5, 2015

As larger insurance companies buy out their smaller competitors, questions arise around the ability for these large insurers to negotiate rates with healthcare providers. The answers depend largely on how successfully the other insurers, particularly those that were created or attracted by the Affordable Care Act, can compete with these much larger companies.

Save Medicare, Starting with Your Hips

By Peter Orszag, Bloomberg View | July 9, 2015

HHS Secretary Sylvia Burwell proposed fixed Medicare payments for all the costs associated with hip and knee replacements in 75 metropolitan areas. There is wide variations in the amount that Medicare pays for these procedures and by bundling payments HHS hopes to reward value and reduce unnecessary tests and services.

Consumers Demand Price Transparency, but at What Cost?

By Beth Kutscher, Modern Healthcare | June 23, 2015

Consumers are demanding an increase in healthcare cost transparency, but there may be limits to how the information can help them. “There can be adverse effects of price transparency,” David Newman, the executive director of Healthcare Cost Institute, said at the annual meeting of the Healthcare Financial Management Association. Newman claimed that in markets where pricing is very transparent, pricing tends to narrow and the average cost can rise.

Medicare Plans to Pay for Voluntary End-Of-Life Counseling

By Krishnadev Calamur, NPR| July 8, 2015

Medicare says that starting Jan. 1, 2016, it plans to pay doctors to counsel patients about end-of-life care. Counseling would be voluntary for the patients and would allow terminal patients to talk through their medical options and outline their end-of-life plan.

Providers Add Population Health Management to Chronic Care Equation

By Zack Budryk, FierceHealthcare |July 6, 2015

Shifts to value-based payments have forced providers to focus on preventive care and early detection for chronic conditions. In many cases, this means providers now try to address socio- demographic factors such as food and housing access, tobacco use, substance abuse, and transportation access to manage population health. Hospitals in New Jersey and Pennsylvania have programs that focus on integrating population health and have found that readmission rates have been significantly reduced for patients in the programs.