Research Roundup - March 2016


California Regulators Approve Health Plan Merger

By Bertha Coombs | CNBC | March 22, 2016

State regulators in California approved the merger between Centene and Health Net. While the merger was approved with key conditions that Consumers Union and others sought to protect consumers, it will require strong oversight to ensure the health plans meet their commitments. [Link]


Bill on Healthcare Transparency Headed to Governor

By Charles Elmore | Palm Beach Post | March 18, 2016

Personal stories from across Palm Beach County and the state clearly resonated, consumer advocates said — and set the stage for Florida lawmakers’ last-minute passage of what one group calls a national model for protection against surprise medical charges. “I do think it’s a great model for other states,” said Chuck Bell, programs director for Consumers Union, the Yonkers, N.Y.-based advocacy arm of Consumer Reports. “We need a healthcare system where consumers are not being used as pawns.” [Link]


Hospitals May be Required to Show Service Charges

By Will Greenberg | NPR | March 16, 2016

The Michigan legislature is considering a bill that would require hospitals to use their chargemaster information to inform patients of what they charge before a procedure. The Michigan Health and Hospital Association says they support price transparency but do not think the charge master would be helpful in informing patients how much they will pay for care. [Link]

Recent Reports

The Value of Value-Based Insurance Design: Savings From Eliminating Drug Co-Payments

By Daniel Maeng, et al. | American Journal of Managed Care | Feb. 16, 2016

The concept of value-based insurance design (VBID) has gained popularity. This study examined  the introduction of the $0 co-pay drug program on patient adherence to medication therapies and subsequent use of acute care, such as hospitalization and emergency department visits. Unlike many prior VBID studies, researchers found total healthcare spending (medical plus prescription drug spending) among the employees under the VBID program was lower by $144 per member per year. The estimated return on investment (drug acquisition cost and the forgone co-pay) over a 5-year period was $1.80 savings for each dollar invested. The authors note that the VBID program was implemented in conjunction with a  wider employee wellness program targeting. [Link]

Physicians, Accountable Care and Drugs

By Alan Weil | Health Affairs | March 2016

As purchasers increasingly seek value from the healthcare system, quality data are the linchpin. Centers for Medicare and Medicaid Services’ (CMS)  goal of moving 90 percent of payments in Medicare to a value basis by 2019, and Medicare’s new Merit-Based Incentive Payment System (MIPS) will rely upon as-yet-defined measures of physician quality to determine payment levels. To increase standardization and reduce the reporting burden, the Core Quality Measures Collaborative, a partnership between private insurers and CMS, released seven sets of measures to be used by public and private payers. [Link]

Medical Bills Still Take A Big Toll, Even With Insurance

By Alison Kodjak | NPR | March 11, 2016

A recent poll conducted by the Robert Wood Johnson Foundation and Harvard's T.H. Chan School of Public Health found that 26 percent of people  say healthcare expenses have taken a serious toll on family finances. This article is one of many that argues that even people with medical insurance are still struggling to pay medical bills. [Link]

Trends in Prescription Drug Spending

ASPE | March 8, 2016

The U.S. Assistant Secretary for Planning and Evaluation issued a report that found that about 30 percent of the rise in prescription drug spending from 2010 to 2014 can be attributed to the changes in the composition of drug prescribed toward higher priced products or price increases. Other factors that contributed to greater drug spending include overall inflation (30 percent), an increase in prescriptions per person (30 percent) and population growth (10 percent). [Link]

Commentary/ News

Liberty Mutual: A Blow to Healthcare Transparency

By Charles Ornstein | ProPublica | Mar 1, 2016

The U.S. Supreme Court dealt a blow to nascent efforts to track the quality and cost of healthcare, ruling that a 1974 law precludes states from requiring self-insured health plans submit their healthcare claims to databases called APCDs. The arguments were arcane, but the effect is clear: We’re a long way off from having a true picture of the country’s healthcare spending, especially differences in the way hospitals treat patients and doctors practice medicine. [Link]

CMS Plans Network-Breadth Rating System for Plans

By Leslie Small | FierceHealthcare | March 7, 2016

Although the federal government has stepped back from its proposal to implement additional network adequacy regulations for Affordable Care Act plans, it will move forward with its initiative to provide shoppers with information about health plans' network breadth, according to the final notice for2017 Benefit and Payment Parameters. The issue of network adequacy has caught the attention of regulators and consumer advocates alike as narrow-network plans become more common on the ACA exchanges. [Link]

Breaking Good? The Arc of Antitrust Policy in the Health Sector

By Barak Richman | Health Affairs Blog | March 15, 2016

It appears that 2016 will likely be another year of massive consolidation in the healthcare sector.  Against this backdrop, it is timely and revealing to examine the current state and trajectory of antitrust law as it intersects and shapes healthcare policy. [Link]

Finding Value in Unexpected Places—Fixing the Medicare Physician Fee Schedule

By Robert Berenson and John Goodson | New England Journal of Medicine | March 9, 2016

With rising healthcare spending found throughout the U.S., the federal government has put greater focus on value-based care reimbursement than ever before. Healthcare providers and payers are seeking ways to move beyond fee-for-service payment and adopt quality value-based care reimbursement instead of quantity-based fee-for-service - this includes the Medicare Physician Fee Schedule. [Link]