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Building a Better "Cadillac"

January 4, 2017

The excise tax on premiums paid for high-cost employer-sponsored plans, also known as the Cadillac tax, is an important provision of the Affordable Care Act (ACA) and should be retained even if the larger law is repealed because it will not only help control the growth of health care spending but also will provide revenues needed to pay for any potential ACA replacement, according to a new paper (PDF) by experts at the Urban Institute and the Center for Health Policy at Brookings. However, the tax should be improved to increase political acceptability and to correct genuine shortcomings in the current law.

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.

Bundling Payment for Episodes of Hospital Care: Issues and Recommendations for the New Pilot Program in Medicare

July 18, 2011

Outlines the 2010 healthcare reform's provision to launch a pilot project for bundling Medicare payments around hospitalization episodes of care, the rationale for hospital episode bundling, and guidance on designing an effective pilot program.

Individual Insurance: Health Insurers Try to Tap Potential Market Growth

November 5, 2009

Examines the challenges the current individual health insurance market poses for insurers and consumers, the market's growth potential, market and regulatory conditions across states, and trends in marketing strategies. Considers policy implications.

Efficiency and Quality: Controlling Cost Growth in Health Care Reform

May 31, 2009

Outlines options for slowing the growth of healthcare spending, including improving the Medicare fee schedule, payment for episodes of care, multi-provider episode payments, the tax treatment of private insurance, and comparative effectiveness research.

Making Medical Homes Work: Moving From Concept to Practice

December 11, 2008

Explores practical considerations for implementing a medical home program of physician practices committed to coordinating and integrating care based on patient needs and priorities, such as how to qualify medical homes and how to match patients to them.

High and Rising Health Care Costs: Demystifying U.S. Health Care Spending

October 16, 2008

Reviews the data used to measure U.S. healthcare costs and examines long- and short-term trends, whether costs are too high, how they compare to those of other developed nations, and what factors are driving the growth. Includes policy implications.

A Health Plan Work in Progress: Hospital-Physician Price and Quality Transparency

August 28, 2008

Assesses health plans' efforts to provide consumers with price and quality comparisons on hospitals and doctors in twelve metropolitan areas. Looks at the plans' motives and strategies, as well as the limitations, risks, and challenges of transparency.

Growth Rates in Health Care Costs Are High and Stable

November 26, 2006

Highlights findings from a study of growth rates in health insurance premiums and healthcare spending in 1995-2006, factors behind the trends, and changes in the components of healthcare costs.

Employment Changes Play Major Role in Access to Employer Health Coverage

May 11, 2006

Highlights findings on the factors that drive short-term changes in employer-sponsored health insurance coverage, including the rising cost of health insurance and changes in employment rates and availability of better jobs during macroeconomic cycles.

Physician Acceptance of New Medicare Patients Stabilizes in 2004-05

January 1, 2006

Measures access to physicians by Medicare beneficiaries in recent years, in relation to the decline in the number of U.S. physicians accepting patients during the late 1990s. Explores factors that determine why a physician accepts new patients.