Research Roundup - May 2016

Massachusetts

Addressing Price Variation in Massachusetts

By David Seltz, et al. | Health Affairs Blog | May 12, 2016

A Health Affairs blog post analysed current price variation among providers and ongoing efforts within the state to decrease this unwanted variation. While Massachusetts is a leader throughout the  country in taking the necessary steps to curb rising healthcare costs, more work needs to be done to reduce this variation. [Link]

Missouri

Missouri Throws First Big Wrench into Aetna-Humana Deal

By Bob Herman | Modern Healthcare | May 25, 2016

Missouri insurance officials have issued a preliminary order against the merger of Aetna and Humana, the first state to find serious antitrust problems with the massive transaction, according to Modern Healthcare. However, Aetna and Humana have 30 days to “submit a plan to remedy the anti-competitive impact of the acquisition.”

Coalition Cheers Health Insurance Rate Review Bill Passage

By Rachel Herndon | The Missouri Times | May 10, 2016

Both chambers of the Missouri legislature overwhelmingly passed a health insurance rate review bill, according to The Missouri Times. The advancement was cheered by Missouri Health Care for All, who believe the bill will bring more transparency to insurance premiums. The law gives the Missouri Department of Insurance a chance to determine if a rate hike is unreasonable ahead of time, notify the insurer and request a change. If the insurer moves forward with a rate that has been deemed unreasonable, the agency can make the determination public. But it cannot reject those increases, according to St. Louis Public Radio.

New York

Consumer Perspectives on Healthcare Decision Making

By Linda Weiss, Maya Scherer and Anthony Shih | New York Academy of Medicine | April 2016

Increased access to health care data, growing concerns regarding cost, and shifts to greater patient responsibility for medical expenditures have catalyzed attention to “transparency,” to give patients access to health care information that they can use to assess—and make decisions on—the cost and quality of care. This report from the New York Academy of Medicine examines patient and consumer perspectives on making decisions about health and healthcare, using information gathered during a series of New York state focus groups.

Recent Reports

Comparing the Power of Market Concentration in New York and California

By Richard Scheffler, et al. | Health Affairs | May 2016

This Health Affairs article examines market concentration and rising costs in the New York and California markets. The study found that increased hospital concentration is associated with an increase in premiums in both states. The results showed a difference in health plan concentration exhibiting a positive correlation in premium growth in New York but a negative association in California.

Consumer Cost Sharing Increased Modestly in Marketplace Plans

By Jon Gabel, et al. | Commonwealth Fund | May 2016

Cost-sharing—such as copays and deductibles—in health care plans offered in the Affordable Care Act’s marketplaces increased modestly between 2015 and 2016, a Commonwealth Fund–supported study finds.The study found that cost-sharing increased for out-of-pocket limits, annual deductibles and certain brand-name drugs. However, copays for primary care office visits remained constant and copayments for generic drugs dropped by more than 3 percent.

Estimation of Potential Savings Through Generic Drug Substitution

By Michael Johansen and Caroline Richardson | JAMA Internal Medicine | May 9, 2016

This study estimates excess expenditure due to branded drug overuse when a lower-cost generic in the same class with the same indication was available between 2010 and 2012. The “excess expenditure” in the U.S. was $10.9 billion for statins, $6.12 billion for proton pump inhibitors, and $5.53 billion for angiotensin receptor blockers.

What to Look for in 2017 ACA Marketplace Premium Change

By Gary Claxton and Larry Levitt | Kaiser Family Foundation | May 5, 2016

Insurers are in the process of filing proposed premiums for ACA-compliant nongroup plans that will be available inside and outside of Marketplaces in 2017. This analysis from Kaiser Family Foundation assesses the key factors that will influence the health insurance rate changes that insurers will request this year.

Interactive Healthcare Quality-Spending Tool

Commonwealth Fund | May 2016

Healthcare quality and spending are national concerns, but care is delivered locally. The Commonwealth Fund updated its Quality-Spending Interactive tool that shows the “relative value” of care—the quality achieved per amount spent— at the state and local level.

For more on drug costs, rate review and market concentration, please visit www.healthcarevaluehub.org

Commentary/ News

Hospital Consolidation Could Make Your Hospital Stay $2,000 More Expensive

By Renae Merle | The Washington Post | May 13, 2016

Consolidation in the healthcare industry is accelerating and has helped drive up prices in parts of the country, Edith Ramirez, chair of the Federal Trade Commission, said in a speech Friday, according to The Washington Post. “I remain very concerned about the rapid rate of consolidation among healthcare providers,” Ramirez said. Last year, the number of hospital mergers increased 18 percent compared with the previous year, she said. In areas where there is a hospital monopoly, prices are 15 percent higher than those in areas with four or more competitors, and the average inpatient stay in those places is almost $2,000 higher, Ramirez said.

Merger Indigestion: Big Hospital Mergers Failing to Deliver Promised Results

By Melanie Evans | Modern Healthcare | April 23, 2016

Hospital operator mergers have created big—sometimes behemoth—health systems that will provide the scale necessary to achieve operating efficiencies and compete for more cost-conscious consumers, according to Modern Healthcare. So they say. But some of the biggest mergers in recent years have so far failed to deliver.

A Simple Way for the Government to Curb Inflated Drug Prices

By Zain Rizvi, Amy Kapczynski and Aaron Kesselheim | The Washington Post | May 12, 2016

“When a pharmaceutical company has a patent on such a drug, it holds the same privileged position as the last landowners along a proposed train route. Because only the manufacturer can sell the drug, the only available ‘route’ to treatment runs through its intellectual property.” In this Washington Post op-ed and accompanying Health Affairs, authors argue whether land acquisition or critical drugs, the government can use its power of eminent domain to acquire what’s needed for a reasonable price.

Where U.S. Cities Are Redefining Healthcare

By Jen Kinney | Next City | May 18, 2016

This commentary calls upon U.S. healthcare institutions to broaden their definition of healthcare. It highlights a new Urban Institute feature spotlighting three programs in U.S. cities that take into account housing, employment and parental education as aspects of health, including Baltimore, Md., and Newport News, Va.