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Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

May 2, 2014

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated $18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the $40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment.

Long Island Follows Bumpy New York Road to National Health Reform

September 11, 2013

At first glance, New York and the Long Island metropolitan area appear well positioned for smooth implementation of the federal Patient Protection and Affordable Care Act (ACA) of 2010, according to a new Center for Studying Health System Change (HSC) study of Long Island's commercial and Medicaid insurance markets (see Data Source). Key ACA reforms—expanded Medicaid eligibility, premium rating restrictions in the nongroup, or individual, and small-group markets, minimum medical loss ratios (MLRs)—have long been features of New York's broad public health insurance programs and highly regulated health insurance market. Once the ACA became law, there was little doubt that New York would embrace reform. Yet, partisan gridlock in Albany has made for a rough road to health reform for New York. After many months of wrangling with the state Legislature, Gov. Andrew Cuomo (D) resorted to authorizing the state health insurance exchange by executive order in 2012, giving New York's exchange a later start than in many states. Another threat to successful implementation is the state's commitment to stringent insurance regulations that exceed ACA requirements, most notably in small-group and nongroup community rating. Most respondents expected stricter state regulations to keep New York nongroup premiums very high and lead many healthier state residents to continue staying out of the nongroup risk pool. However, when 2014 premiums were released in July, the approved rates were lower than most had expected. What remains uncertain is how sustainable these rates will be over time—specifically, whether they will remain sufficiently low to attract and retain a sizable pool of younger, healthier enrollees.

San Francisco Bay Area: Health Care Providers Shift Allegiances as Regional Networks Emerge

December 1, 2012

CHCF is updating a series of market studies in six areas: Fresno, Los Angeles, Riverside/San Bernardino, Sacramento, San Diego, and the San Francisco Bay Area. These regional market reports highlight variations in health care affordability, access, and quality of care across the state. The reports are published as part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's medical system.Key findings from the San Francisco Bay Area issue brief include:Although two hospital systems account for half of inpatient discharges, as a result of geographic barriers, much of health care delivery occurs within local submarkets.Health care providers weathered the economic downturn comparatively well, with hospital systems showing strong financial performance. However, county hospitals and smaller safety-net hospitals continued to struggle. Health reform and other developing trends are expected to tamp down revenues in coming years. Substantial seismic construction projects underway raise concerns that hospitals may not be able to pay debt obligations in the face of declining income.Bay Area providers and health plans are aggressively aligning. Health plans and providers formed narrow-network accountable care organizations (ACOs) in 2011. Safety-net providers are working to coordinate care through the medical home model, while a surge of physicians and hospitals have collaborated to expand geographic reach.

Limited Options to Manage Specialty Drug Spending

April 26, 2012

Outlines rising trends in costs of and spending on specialty drugs; health plans' efforts to curb specialty drug spending, including patient cost sharing and utilization management; and efforts to integrate medical and pharmaceutical coverage.

Employer-Sponsored Health Insurance: Down, But Not Out

October 31, 2011

Presents findings from twelve metropolitan areas about employers' efforts to control employee healthcare costs in response to the recession and national healthcare reform by firm size. Projects employer trends through 2014, including greater cost sharing.

Key Findings From HSC's 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

May 31, 2011

Presents findings about hospital payment rate increases, hospital-physician alignment, and insurance premiums, funding for safety-net providers, and their implications from HSC's site visits to twelve nationally representative metropolitan communities.

Workplace Clinics: A Sign of Growing Employer Interest in Wellness

December 13, 2010

Examines the increasing employer demand for workplace clinics, clinic management models, types of services, challenges, regulations, and the clinics' potential impact, including their ability to raise productivity and help contain healthcare costs.

Designing Effective Health Care Quality Transparency Initiatives

July 22, 2009

Profiles two well-designed healthcare quality transparency initiatives from California and Massachusetts. Examines key design and implementation elements, including provider engagement, reliable data, consumer-friendliness, and feedback to providers.

Financial and Health Burdens of Chronic Conditions Grow

April 2, 2009

Points to rising rates of chronic conditions and obesity; growing numbers of patients with problems paying medical bills, even with insurance; and contributing factors such as declining private coverage and delays in accessing care. Outlines implications.

Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice

December 31, 2008

Examines how consumers choose physicians, specialists, or medical facilities, including the use of physician referrals, word-of-mouth recommendations, health plan information, and the Internet. Explores implications for consumer-directed health care.

Checking Up on Retail-Based Health Clinics: Is the Boom Ending?

December 15, 2008

Outlines trends in the growth of retail-based clinics providing basic care at pharmacies and other retail settings. Examines who uses them, where, for what services, and why; insurance coverage and reimbursement rates; and variations in state regulation.

Striking Jump in Consumers Seeking Health Care Information

August 21, 2008

Examines shifts in how Americans seek health information from sources other than their doctors. Looks at growing Internet use and information-seeking for others, education as a factor, and the impact of information-seeking on perceptions of health issues.