New laws and rules requiring greater transparency into the behaviors and reimbursements of insurers have given employees and employers a clearer picture of where their healthcare dollars are going.  For example, the “Transparency in Coverage” rule, implemented in October 2020, required health plans and insurers to post rates they negotiate with providers and develop price transparency tools related to cost-sharing.  The “Consolidated Appropriations Act”, passed in 2021, requires Third Party Administrators (TPAs) to provide notice of other compensation they receive to plan sponsors and restricts “gag clauses” that would otherwise …

By: Swaja Khanna, Student Fellow Happy November! We hope you are enjoying football season and preparing for turkey! In this edition of the Source Roundup, we cover five academic articles and reports from October. The topics this month include (1) the popularity of telemedicine for employers and employees, (2) an integrated health care system that combines ACO and bundled payment, (3) health spending growth in the coming years, (4) Maryland’s new initiative reduced hospital utilization and costs, and (5) how to remedy recent generic drug price hikes.   Telemedicine Is …

Rising prescription drug prices concern nearly all Americans, with 80% reporting that drug prices are “unreasonable”. The problem of rising drug expenditures is particularly acute for state Medicaid programs, which provide health coverage for low-income and disabled Americans. Medicaid serves nearly one in five Americans including many with chronic conditions, and purchases about 10% of total prescription medications dispensed in the U.S.[1] Furthermore, Medicaid’s nationwide drug spending increased almost 50% between 2013 and 2016 (from $22.4 billion to $33.4 billion).[2] In a survey of Medicaid programs, 36 states reported increased cost containment efforts for prescription drugs …

Last month, we reviewed how the California Assembly is trying to understand cost drivers of healthcare overall. As California has the highest retail drug spending with prescription drug expenditures outpacing overall healthcare spending, high drug pricing has become a specific concern for the Legislature.[1] For the past few years, the Legislature has used bills[2] (like SB 17 (2017)), resolutions (like SJR 29 (2015)), and informational hearings to better understand and control high drug pricing. For example, the Assembly Health Committee (“Committee”) began a series of hearings to understand prescription drug …

By Guest Blogger: Amanda Goltz, MPA, Industry Consultant In the avalanche of media coverage, conference sessions, and social media posts around why the $2.7 trillion healthcare industry is one of the slowest to adopt widespread innovation, there’s plenty about the barriers to change, but not a lot of what truly drives the few widespread changes that actually have happened. We understand that the third party payer system distorts business models, the practice of medicine is an art as much as a science, fee for service rewards process, not outcomes, and that …