Prior authorization and opioid abuse

An interesting article by Cochran et al. (2017) examines whether health plan prior authorization rules can help prevent opioid abuse.  The authors use Pennsylvania Medicaid data from 2010 to 2012.  The data included both fee-for-service and managed care enrollees. The authors measured opioid abuse based on diagnosis codes for opioid use disorder (304.0, 304.00, 304.01,…

Interpreting evidence on value

Value is the latest jargon to hit the health care sector.  One potential way value could manifest itself is through value-based insurance design (VBID).  Under VBID, patients would pay lower copayments for treatments that are highly effective and/or low cost would pay higher payments for treatments that have low effectiveness or high cost to the…

Avoiding unnecessary care: Does insurance coverage matter?

Consumer Reports‘ “Choosing Wisely” initiative aims to identify high-cost, low-value treatments that can often be avoided.  One question remains is why do providers still offer these services?  Do payer coverage policies or reimbursement rules affect these choices? A paper by Colla et al. (2017) attempts to answer that question.  The authors used commercial payer claims data…

The Changing US Health Insurance Market

An interesting paper by Graves and Nikpay (2017) look at the evoluation of the health insurance market before and after Obamacare.  The authors find We found that the ACA’s unprecedented coverage changes increased transitions to Medicaid and nongroup coverage among the uninsured, while strengthening the existing employer-sponsored insurance system and improving retention of public coverage.…

The last Obamacare sign up?

Today is the last day to sign up for Obamacare for 2017.  If President Trump has his way, it could be the last day to sign up for Obamacare ever.  In fact, Marketplace reports that Trump administration decided to pull ads promoting last-minute sign-ups, although it reversed that decision shortly after. The media put forth mixed estimates…