Research Roundup - October 2015

State News

California

Narrow Networks: Does Limited Choice of Hospitals Affect Quality in Covered California?

By Bruce Spurlock | California HealthCare Foundation | October 2015

Health insurance network size does not significantly correlate with performance, however, the lowest-performing hospitals were in small networks, according to a California HealthCare Foundation. The report found that quality varied by region more than network size.

Massachusetts

AG Says State Must Do More To Control Healthcare Costs

By Martha Bebinger | WBUR | Sept. 18, 2015

Massachusetts is unique in their commitment to tracking statewide health spending but the state will miss a self-imposed annual healthcare spending target, according to public radio station WBUR. A report from Attorney General Maura Healey finds little change in problems that have been contributing to high costs for years: some hospitals are paid a lot more than others, patients prefer the expensive hospitals and efforts to change the way we pay for healthcare have not yet done much to shift spending.

Michigan

Michigan ACOs Reaping Millions in Savings for Medicare

By Jay Green | Crains Detroit Business | Sept. 13, 2015
Michigan's 12 accountable care organizations (ACOs) fared better than national averages in saving Medicare money, generating profits of their own and improving quality, according to data for 2014 from CMS and interviews with ACO executives. The article does not assess why this group did so well.

Minnesota

With Hefty Health Insurance Hikes in Mind, Minnesota Officials Set Out to Get a Hold of Market

By Kyle Potter | Associated Press | Oct. 4, 2015

Consumers who purchase insurance through MNSure—Minnesota’s state-run insurance exchange—could experience rate hikes between 14 and 49 percent. In response, state regulators and lawmakers have begun looking into methods to reign in these price increases in an individual market that is smaller and more expensive than both regulators and insurance companies expected.

Vermont

Cost Containment: The Ultimate State Reform Effort

By Hamilton Davis | VTDigger.org | Oct. 12, 2015

Vermont has made a commitment to sustainable levels of health spending. This article describes the myriad efforts being made to  reform the delivery system require individual hospitals and doctors, to cooperate rather than compete with one another.The responsibility for controlling payment rates has been assigned by the Legislature to the Green Mountain Care Board and the state is seeking a waiver from the federal government to manage the flow of dollars from Medicare.

For more state news,  as well as background information on drug costs, delivery system reform, narrow networks and ACOs,  go to: https://www.healthcarevaluehub.org/

Recent Reports

Buyer Beware: A Mammogram’s Price Can Vary by Nearly $1,000, Study Finds

By Jordan Rau | Kaiser Health News | Oct. 7, 2015

As with other medical services, the cost of mammograms vary greatly, according to an analysis conducted by Castlight Health. Researchers looked at 179 metropolitan areas and found that mammogram prices varied four-fold or more in Atlanta, Houston, Los Angeles, Miami, Philadelphia and Seattle, among others. The study does not identify what may be causing the disparity in prices.

What Does a Deductible Do? The Impact of Cost-Sharing on Healthcare Prices, Quantities, and Spending Dynamics

National Bureau of Economic Research

Researchers studied a large employer that shifted from an insurance plan that provided free healthcare into a high-deductible insurance plan with a tool to help them shop for cost-efficient care.The paper shows that when faced with a deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used less healthcare. The sickest workers were most likely to forego care while still under the deductible.

Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax Exclusion

By Paul Ginsburg, et al. | National Institute for Healthcare Reform | October 2015

This analysis finds the Cadillac tax on high-cost health benefits is only slightly less progressive than capping the tax exclusion on the $250-billion annual tax break for employer health coverage because employers are likely to try and avoid paying either tax by restructuring health benefits.

For more  information on high deductible health plans and the cadillac tax, go to: https://www.healthcarevaluehub.org/

Commentary/ News

3 Keys to Shifting How We Pay for Healthcare

By Todd Rothenhaus and John Fox | Harvard Business Review | Sept. 24, 2015

Three principles of accountable care organizations can guide providers in their efforts to improve quality scores–all of which involve measurement. Evaluations of the Medicare ACO program reveal that population health and lower costs will take a long time to develop and require a steady, staged approach, as the the health system moves away from fee-for-service payments.

Shift from Fee-For-Service to Value-Based Models Slower than Expected

Ilene MacDonald | Fierce Health Finance | Sept. 30, 2015

Even with the new push by CMS to transition 30 percent of Medicaid payment to value-based care, a report from PwC’s Health Research Institute found that this transition is moving slower than expected. The report explains that providers are slow to transition and, although healthcare executives publicly support the move to value-based care, there is concern that it will impact revenue.

Why the Healthcare ‘Cadillac Tax’ Is Really Under Fire

By Maya MacGuineas | The Wall Street Journal | Oct. 2, 2015

The Cadillac Tax, a provision meant to help pay for the ACA and lower overall healthcare costs is now under scrutiny and potential repeal in Congress. The author of this op-ed argues that, while not perfect, the Cadillac Tax should remain unless a better alternative can be found that accomplishes the same goals.