Healthcare Prices and Cost In An Era Of Premium And Provider Price Increases, State Employee Health Plans Target Key Cost Drivers (Health Affairs Forefront) Sabrina Corlette, Karen Davenport Employer-sponsored health insurance premiums have outpaced inflation and are poised for significant rate hikes this year. State Employee Health Plans have been in a prime position to address health care costs. Administrators of these plans identified reference pricing, tiered network plans, and multi-payer purchasing initiatives as having promising results in addressing cost drivers. The Joint Distribution Of High Out-Of-Pocket Burdens, Medical Debt, …

California’s Medi-Cal program is the largest Medicaid program in the country. It is tasked with providing care for approximately 15 million enrollees, or one third of California’s population. To ensure affordability while maintaining quality and improving health care outcomes, CalAIM was created as California’s newest approach to reform Medi-Cal, including changes to managed care plans and reimbursement of behavioral health plans. Although many of these objectives under CalAIM are still in the initial implementation stages, the potential ramifications of this multi-year, billion-dollar investment in changing how millions of people receive …

Pennsylvania’s efforts to restore competition to the provider and insurance markets in the long-standing battle between University of Pittsburgh Medical Center (UPMC) and Highmark Health overcame mounting challenges and finally concluded with an unprecedented 10-year consent decree. The Source closely tracked the case as it unfolded over the past several months. In this post, we take a look back at the case’s long and winding road, which included three stops at the Pennsylvania Supreme Court, leading up to the new truce.   It’s Déjà Vu All Over Again It all began in …

By: Leah S. Gray, Student Fellow A Texas high school teacher recently made headlines after getting a $108,951 bill when a heart attack sent him to an out-of-network hospital. The ambulance rushed Drew Calver to the nearest emergency center, which his insurance did not cover, leaving him with an astronomical surprise medical bill. Unfortunately, surprise medical bills are becoming a ubiquitous part of health care in America. The question is: why? Most people have insurance, but insurance doesn’t cover everything. So when Calver was treated at an out-of-network facility, his insurance …

As the holidays faded, January rang in 2015 with a return to concern about health care costs and the role of the market in health care. A number of reports came out this month on national costs. First and foremost, Health Affairs published National Health Spending in 2013: Growth Slows, Remains in Step with the Overall Economy in its January, 2015 issue. This annual report highlights national spending from the most recent data from CMS Office of the Actuary. In 2013, the U.S. spent $2.9 trillion on health care, about …