Summary: “The Milliman Medical Index (MMI) was released earlier today, and like every year since 2001, the index was up,” Dan Munro wrote in Forbes. “This year’s MMI — which calculates the total cost of employer-sponsored PPO coverage for an average American family of four — is $25,826. That’s the total average cost for employer-sponsored coverage, but the MMI is further divided into two core components: the individual employee expense and the employer portion. This year’s employee expense–which includes premium contributions (typically through payroll) plus out-of-pocket expenses–combined to equal $11,033. In lockstep with the MMI generally, the employee portion has continued its upward climb as well.” Dan Munro, “Annual Healthcare Cost For Family Of Four Now At $25,826,” Forbes.
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Summary: “Rising cost-sharing for people with health insurance has drawn a good deal of public attention in recent years,” Gary Claxton, Larry Levitt and Michelle Long wrote in the Peterson-Kaiser Health System Tracker. “For example, the average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015. While we can get a sense of employees’ potential exposure to out-of-pocket costs by looking at trends in deductibles, many employees will never reach their deductibles and other employees may have costs that far exceed their deductibles. In addition to deductible payments, some employees also have copayments (set dollar amounts for a given service) or coinsurance payments (a percentage of the allowed amount for the service). To look at what workers and their families actually spend out-of-pocket for services covered by their employer-sponsored plan, we analyzed a sample of health benefit claims from the Truven MarketScan Commercial Claims and Encounters Database to calculate the average amounts paid toward deductibles, copayments and coinsurance. We find that, between 2004 and 2014, average payments for deductibles and coinsurance rose considerably faster than the overall cost for covered benefits, while the average payments for copayments fell. As can be seen in the chart below, over this time period, patient cost-sharing rose substantially faster than payments for care by health plans as insurance coverage became a little less generous.” Gary Claxton, Larry Levitt and Michelle Long, Payments for cost sharing increasing rapidly over time,” Peterson-Kaiser Health System Tracker.
Summary: “Estimates of annual health spending for a comprehensive set of medical conditions are presented for the entire US population and with totals benchmarked to the National Health Expenditure Accounts,” Charles Roehrig writes in Health Affairs. “In 2013 mental disorders topped the list of most costly conditions, with spending at $201 billion. Cost of Health Care Health Economics Health Spending The National Health Expenditure Accounts (NHEA), maintained by the Centers for Medicare and Medicaid Services, provide official estimates of annual health spending in the United States. The NHEA covers spending by the entire US population broken out by type of service and source of payment, but not by medical condition. For many years the Agency for Healthcare Research and Quality (AHRQ) has produced estimates of spending by medical condition from its Medical Expenditure Panel Survey (MEPS), but they are limited to the civilian noninstitutionalized population and include double counting of spending that involves multiple conditions. The Commerce Department’s Bureau of Economic Analysis recently released the Health Care Satellite Account, which promises to be an ongoing source of spending by medical condition, without double counting, for the civilian noninstitutionalized population.2,3 Estimates of health spending by medical condition for the entire US population, without double counting and benchmarked to the NHEA, were first developed in a 2009 study published in Health Affairs that covered the period 1996–2005. This article updates those estimates through 2013, using similar data and methods. The inclusion of institutionalized populations has a significant impact on total spending and brings mental disorders to the top of the list of medical conditions with the highest estimated spending: $201 billion in 2013.” Charles Roehrig,
Mental Disorders Top The List Of The Most Costly Conditions In The United States: $201 Billion, Health Affairs.
Summary: Massachusetts continues to be interesting, not only in prices of health care, but also in other regards. High-price providers still compel attention from regulators, but nothing ever seems to change, as we see in a Health Affairs blog post by David Seltz, David Auerbach, Kate Mills, Marian Wrobel, and Aaron Pervin. “The two highest-priced hospitals in the state, Brigham and Women’s Hospital and Massachusetts General Hospital (both part of Partners HealthCare System) together accounted for 20 percent of privately-insured births in the state,” the authors write. “C-section rates did not systematically vary between high- and low-priced hospitals, nor did rates of neo-natal injury or obstetrical complications. … Higher hospital relative prices were not generally associated with higher quality or other common measures of value. However, higher prices were associated with hospital system size and affiliation with certain systems, such as the Partners system. Finally, the [state Health Policy Commission] reported that not only has the extensive price variation found by the [attorney general’s office] in 2010 persisted through 2014, but that patient care is also highly concentrated among higher-price hospitals and physician groups. This concentration of care among higher-priced providers has generally increased from 2010 to 2014.” David Seltz, David Auerbach, Kate Mills, Marian Wrobel, and Aaron Pervin, Addressing Price Variation In Massachusetts, Health Affairs.
Summary: “Amy Moses and her circle of self-employed small-business owners were supporters of President Obama and the Affordable Care Act,” Elisabeth Rosenthal writes in The New York Times, looking at the A.C.A. landscape. “They bought policies on the newly created New York State exchange. But when they called doctors and hospitals in Manhattan to schedule appointments, they were dismayed to be turned away again and again with a common refrain: ‘We don’t take Obamacare,’ the umbrella epithet for the hundreds of plans offered through the president’s signature health legislation. “Anyone who is on these plans knows it’s a two-tiered system,” said Ms. Moses, describing the emotional sting of those words to a successful entrepreneur. ‘Anytime one of us needs a doctor,’ she continued, ‘we send out an alert: “Does anyone have anyone on an exchange plan that does mammography or colonoscopy? Who takes our insurance?” It’s really a problem.’ The goal of the Affordable Care Act, which took effect in 2013, was to provide insurance to tens of millions of uninsured or under-insured Americans, through online state and federal marketplaces offering an array of policies. By many measures, the law has been a success: The number of uninsured Americans has dropped by about half, with 20 million more people gaining coverage. It has also created a host of new policies for self-employed people like Ms. Moses, who previously had insurance but whose old plans were no longer offered. Elisabeth Rosenthal, “Sorry, We Don’t Take Obamacare,” The New York Times.
Summary: We won the audience People’s Choice at the Consumer Shark Tank pitchfest at the 2016 Datapalooza in Washington, put on by the Department of Health and Human Services. It’s kind of a big deal to be in a ballroom with more than 1,000 people and on the livestream! Thanks to all who made this possible, including the Shark Tank judges, the Consumer’s Circle reps who chose the contestants, and to my co-presenters, @SympleApp and @MedicarePath, which won the judge’s award. Here’s the story, in tweets.
Summary: “Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013, according to a study published Monday,” Lena Sun writes in The Washington Post. “Topping the list is Gunderson Lutheran Medical Center in La Crosse, Wis., which earned $302.5 million in profit from patient-care services that year, according to researchers from the Johns Hopkins Bloomberg School of Public Health and Washington and Lee University. Other nonprofits in the top 10 include the Stanford Hospital in Palo Alto, Calif., which took in nearly $225 million, and the University of Pennsylvania’s hospital in Philadelphia, which earned $184.5 million. “Most hospitals lose money, but there are a few very profitable ones and we need to pay attention to why they are making so much” and how it affects consumers, said lead author Gerard Anderson, a Hopkins health policy professor. In the study published in Health Affairs, Anderson and co-author Ge Bai, an assistant accounting professor at Washington and Lee, analyzed only net income for patient-care services for fiscal 2013, the most recent year for which data were available.” Lena Sun, “These hospitals make the most money off patients — and they’re mostly nonprofits,” The Washington Post.
Summary: How do people use our data? Listen: “We recently spent much time trying to find the cost of a fairly routine thyroid ultrasound as we now have a high deductible insurance plan,” said the note to us. “It was extremely frustrating. Even Aetna could not give us expected costs or alternate locations for the test. In fact the Aetna website is out of date as it lists closed facilities and sites no longer in our plan. Using the ClearHealthCosts website (found via WHYY’s Pulse) we were able to drop our cost from $1325. at the local hospital off site radiology lab (the lab could not answer whether the rate was the negotiated rate, nor could Aetna), to $120 w/insurance and $150 cash, no insurance at a lab about 30 minutes away. The lab listed on the ClearHealthCosts website confirmed the costs listed were accurate. … We are convinced that this type of transparent system will be the only way to drive down healthcare costs.”
Summary: “Huge variations exist in the prices of some of the most common medical procedures across state lines, according to a report by major insurers released Wednesday, but some experts say the data is of little use to consumers who rarely know what they owe until the bills arrive,” Jayne O’Donnell writes today in USA Today, quoting liberally from our CEO, Jeanne Pinder. “The insurer-funded Health Care Cost Institute (HCCI) won’t disclose which hospitals or doctors are the high-price culprits and instead are releasing how much states’ average prices differ from national average. California, for example, has average prices that are the same as the U.S. averages for dozens of the most common procedures, including pregnancy ultrasounds and cataract surgery. But Clearhealthcosts.com, which compiles prices in 10 metro areas using data from consumers, doctors and hospitals and its own staff members’ research, finds a huge price disparity within a 100-mile radius of San Francisco for some procedures. The cash price for a lower-back MRI without dye ranges from $475 at the Castro Valley Open MRI to a whopping $6,221 at the University of California, San Francisco at Mt. Zion. Patients pre-paying or paying on the day of service at UCSF, however, get 40% off.” Jayne O’Donnell, USA Today, “Huge health care price differences even within same area, by state.”
Summary: “Her name is passed from one desperate family to another like an amulet,” Eric Boodman writes over at StatNews. “In phone conversations and online chat rooms, she’s mentioned at moments when the devout might call on a patron saint. A baby born with a deformed skull? ‘Call Laurie.’ An impossibly expensive cancer treatment? ‘Call Laurie.’ Laurie Todd isn’t a doctor, or a lawyer, or a hospital chaplain. She’s a 66-year-old former massage therapist. Most of the time, she sounds cheerful and efficient. But if someone tries to pull the wool over her eyes, her voice gets low and a little bit threatening. ‘Do you know what I do for a living? she asks. ‘I’m known as the Insurance Warrior.’ ” Eric Boodman, “Insurance Warrior” helps patients get pricey therapies covered.