Unbiased Analysis of Today's Healthcare Issues
Many people might know that generally the answer is commercial health plans have the most generous reimbursement compared to government plans. However, a key question is how much more do they pay? Commercial vs. Medicare rates A January 2022 report by the Congressional Budget Office finds that commercial payers reimburse hospitals at 223% of Medicare…
In a February 10th speech, President Biden wanted to end surprise bills for patients. Specifically he said: No more surprise billing. No more. In fact, he proposed the No Surprises Act. Key questions you may have include: what is a surprise bill? are there any exceptions to this rule? Kaiser Health News has a nice…
According to a recent paper by Kim and Koh (2022), the answer is ‘yes’. Using data from BRFSS and PSID, the authors use a difference-in-difference strategy which identifies the impact of health insurance on subjective well being using two policy changes: (i) the Massachusetts health insurance mandate implemented in July 2007 and (ii) the Affordable…
Should your employer offer you a single health plan type or is it better to be offered a menu of health insurance options that vary by generosity level. At first glance, the answer seems that more choice is better; different individuals may have different risk preferences; some may prefer higher premiums and more generous coverage…
For any patients–but especially those with neurodevelopmental illnesses such as schizophrenia–have a consistent ‘medical home’ is vital for continuity of care. However, having consistent access to provider who know your medical history may be challenging if you frequently switch health insurance. “Insurance churn” is defined a patients who either transition between health plans or transition…
This is a few years old, but still very relevant. It’s from a speech by former FDA Commissioner Scott Gottlieb on March 7, 2018 titled “Capturing the Benefits of Competition for Patients“ Patients shouldn’t be penalized by their biology if they need a drug that isn’t on formulary. Patients shouldn’t face exorbitant out of pocket…
Health Care Payment Learning and Action Network (HCP LAN) is dedicated to moving the health care system from volume-based, fee-for-service reimbursement, to alternative payment models (APM). While there are a large number of different types of APMs, broadly, all of them shift more financial risk to providers while also linking reimbursement to quality of care.…
Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, some health plans impose a utilization management tool known as “prescriber requirements” where only certain types of physicians may prescribe a drug. While this may be useful for some complex…
If you are on Medicare, how much will you pay for insulin? The answer is in the graph below (via MedPAC’s Payment Basics) Seem confusing? Well it is. Medicare Part D beneficiaries have a deductible, then the standard coverage phase with 25% cost sharing, then a coverage gap where beneficiaries pay 25% of cost (manufacturers…
Cost sharing is just that, sharing in the cost of providing a health care service. While health insurers often pay for a large share of health care cost (for those covered), individuals also contribute through deductibles, copayments and coinsurance. The goal of cost sharing is to reduce moral hazard. Moral hazard occurs when the price…