The Source Blog

Happy May! April produced a number of articles and reports on interesting aspects of healthcare issues. As always, healthcare cost was at the forefront of the scene. Also discussed were pharmaceutical cost, the intersection of quality and cost, cost-sharing, the likelihood of a single-payer healthcare system in the United States, the effects of the ACA’s Medicaid expansion, and the ins and outs of the new Medicare payment system. HEALTHCARE COST Health Affairs published an article entitled Study of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients’ Out-Of-Pocket […]

Happy Spring! A common theme among the healthcare articles and reports, published in March, was payment reimbursement systems (fee-for-service versus value-based systems) and Accountable Care Organizations (“ACOs”). In addition, typical healthcare topics were also reported on. These include healthcare cost|insurance cost|healthcare competition|and suggested improvements for the United States healthcare system. As a bonus, a few articles and reports focused on healthcare cost and competition issues in other countries. FEE-FOR-SERVICE REIMBURSEMENT MODEL Health Affairs posted an article entitled Fee-For-Service, While Much Maligned, Remains the Dominant Payment Method for Physician Visits. The article’s […]

UPDATE: March 23, 2016: California state regulators approved the Centene and Health Net merger—subject to strong conditions. Centene announced that it received approval from the California Department of Managed Health Care (“DMHC”), on March 22, 2016, and approval from the California Department of Insurance (“CDI”), on March 23, 2016. Both state agencies placed significant—and expensive—conditions on the merger. DMHC provided an extensive list of undertakings. In addition to typical closing requirements, DMHC is requiring Centene to satisfy unique conditions. The San Francisco Business Times reported that DMHC’s conditions carry a “total […]

Today, the Supreme Court decided Gobeille v. Liberty Mutual Insurance Co. in favor of Respondent, Liberty Mutual. The Court held that ERISA does, in fact, pre-empt Vermont’s all-payer claims database (“APCD”) statute as the statute applies to ERISA plans. Earlier, we included this case brief on the Source Blog. THE MAJORITY OPINION Justice Kennedy authored the majority opinion. He was joined by Justices Roberts, Thomas, Breyer, Alito, and Kagan. In its majority opinion, the Court acknowledged that Section 1144(a) of ERISA—that “any and all state laws insofar as they may […]

Although February’s literature was light in quantity, it was high in quality. The bulk of February’s articles and reports focused heavily on marketplace competition, healthcare consolidation, healthcare cost, pharmaceutical price reform initiatives, bundled payments, and high-deductible health plans. MARKETPLACE COMPETITION The Commonwealth Fund published an issue brief entitled Implementing the Affordable Care Act: Promoting Competition in the Individual Marketplace. In its brief, the Commonwealth Fund explores how the ACA has influenced individual healthcare marketplaces in Kansas, Nevada, Rhode Island, and Washington.[1] To understand the impact the ACA has had in […]

As expected, a large number of articles and reports were published in January. Most heavily discussed was healthcare cost, which came up in many contexts, including: national spending slowdowns, comparatively among different countries’ healthcare systems, pharmaceutical drugs, healthcare services, the effect provider education has on cost, how cost intersects with quality, “cost-effectiveness,” and high-cost/high-need patient populations. Another hot topic was healthcare consolidation. One article discussed the general history and trajectory of healthcare consolidation (spoiler alert: it isn’t slowing down anytime soon) and the California Health Care Foundation published a mini-series […]

Happy New Year! As 2015 wrapped up, many interesting and comprehensive healthcare studies, on a variety of topics, yielded results that will likely propel healthcare research, policy, and legislation in the new year. At the heart of these studies were the ACA, healthcare cost and value, cost transparency, and hospital competition. Enjoy! ACA Positive ACA Effects Health Affairs published Affordable Care Act Provision Lowered Out-Of-Pocket Cost And Increased Colonoscopy Rates Among Men In Medicare. The authors, two economists, analyzed colonoscopy rates pre- and post-ACA. The authors found that, post-ACA, annual […]

OVERVIEW The reach of All Payers Claims Database (“APCD”) legislation is currently being tested in Gobeille v. Liberty Mutual Insurance Company, Docket No. 14-181, which is presently before the U.S. Supreme Court. The case stems from Liberty Mutual’s refusal to comply with Vermont’s reporting requirements under that state’s APCD statute, which the insurer argues is preempted by The Employee Retirement Income Security Act of 1974 (“ERISA”)—a notoriously broad statute that preempts any state law that “relates to” a self-insured plan. FACTS Pursuant to Vt. Stat. Ann. Tit. 18, Section 9410, […]

Introduction: What is an All-Payer Claims Database? An All-Payer Claims Database (“APCD”) is an electronic system that aggregates claims and administrative data from public and private payers. APCDs allow states to monitor utilization and healthcare charges across all payers, and, as such, are key tools for policymakers to identify and respond to systematic trends among (nearly) all delivery settings. According to the APCD Council (a collaboration between the University of New Hampshire and the National Association of Health Data Organizations), 18 states have existing APCDs.[1] Further research by the Source […]

We hope you all had a great Thanksgiving, full of friends, family, and cheer! November yielded some interesting articles and perspectives on health care markets and consolidation, price transparency, payment reform, prescription drug pricing, more ACA litigation, and health care spending. Enjoy! HEALTH CARE MARKETS/CONSOLIDATION Multiple articles discussed the effects of health care markets and consolidation on various health care entities. Early in November, the Alliance for Health Reform published an article entitled Health Care Consolidation. The article uses numbers and statistics to paint a vivid picture of the increase in […]