Unbiased Analysis of Today's Healthcare Issues
Many of the provisions of the Affordable Care Act include provisions requiring health insurers to do certain things. Variability of premiums are regulated, certain services are mandated (e.g., free annual check-up) and minimum benefits packages are set on the health insurance exchanges. One seemingly innocuous provision of the ACA is that children are allowed to remain…
Are high deductible health plans (HDHP) the holy grail for reducing cost? If so, how do consumers go about reducing cost, by reducing all utilization or shopping around for better prices? This is the research question that Ben Handel presented at 2016 ASSA meetings. He uses data from a large firm with 35,000-60,000 employees and…
In September 2015, 267 economists from 44 countries, led by Lawrence H. Summers of Harvard University, signed the Economists Declaration on Universal Health Coverage, which calls on global policymakers to prioritize a pro-poor pathway to universal health coverage as an essential pillar of sustainable development. The full text is here. An excerpt is below: Universal…
With the ACA and now MARCA, Congress is moving full steam ahead with payment reform. An article by Paul Ginsburg and Gail Wilensky (2015) consider some of the implications of these reform efforts. This belief – that a set of metrics can be developed or delivery systems specified that could lead to the delivery of…
A Robert Wood Johnson commentary by Katherine Hempstead provides insight into the evaluation of PPO offerings in health insurance exchange. Since last year there has been a significant reduction in the number of PPOs offered in the Affordable Care Act (ACA) marketplaces. A prior analysis showed that of the 131 carriers offering silver PPO products…
In 2013, Medicare launched the Bundled Payments for Care Improvement (BPCI) initiative. There were 4 models included in the program: Model 1 (least comprehensive): includes Part A services for the index hospitalization alone, and thus most closely resembles current fee-for-service payment. Model 2 (most comprehensive): encompasses Part A and Part B services for the index hospitalization, readmissions, and all other post…
Although the ACA certainly expanded health insurance coverage, mostly through subsidies, creation of insurance exchanges, and Medicaid, small businesses generally did not expand coverage. A RWJ report from Lucia et al. (2015) used MEPS-IC data to track insurance offering among businesses with fewer than 50 workers. Part of the reason is the rise of health insurance…
That was Amitabh Chandra’s comment on Hillary Clinton’s plan to reign in drug prices and I don’t disagree. According to the N.Y. Times, her plan: …includes regulating the percentage of revenues pharmaceutical companies must spend on research and development, instituting a cap on the cost of many out-of-pocket drugs for chronic and serious health conditions, and allocating…
Bundled Payments for Care Improvement (BPCI)A helpful post from Steven A. Farmer, Meaghan George and Mark B. McClellan explains. Comprehensive Care for Joint Replacement (CCJR) is a bundled payment structure for hip and knee replacements. CMS notes that: 2013, there were more than 400,000 inpatient primary procedures in Medicare, costing more than $7 billion for hospitalization alone.…
In recent years, payers have moved towards shifting more financial risk to providers. One of the most significant ways financial risk is passed to providers is through the creation of Accountable Care Organizations (ACOs). The biggest ACO program is Medicare’s Shared Savings Program (MSSP). Are ACO’s improving quality and reducing cost? A paper by Schulz,…