PRICE AND QUALITY TRANSPARENCY
Just Published: Research Report on Preventing Anticompetitive Contracting Practices in Healthcare Markets
Amy Y. Gu, Managing Editor September 8, 2020
As unrelenting consolidation in healthcare provider and insurer markets continues, policymakers need additional options to protect the public from escalating healthcare prices and low-quality care. High healthcare prices result from multiple factors, including third-party payers dampening consumers’ price sensitivity, patients and providers demanding expensive healthcare technologies, and healthcare markets consolidating. While these factors are visible, dominant insurers and healthcare providers can also use terms in their insurer-provider contracts in anticompetitive ways that thwart competition and lead to higher prices or lower quality but remain hidden from public view. With support …
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Spotlight on State: Nevada
Kendall Kohlmeyer, Student Fellow September 4, 2020
This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week. See Nevada state page. The Nevada legislature convenes in odd-numbered years. For several years, Nevada law has required all healthcare plans to cover telehealth services for an insured to the same extent they would cover services provided by other means. This includes plans from managed care organizations (MCOs), health maintenance organization (HMOs), benefit contracts, and group …
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The Source Roundup: September 2020 Edition
Kendall Kohlmeyer, Student Fellow September 1, 2020
This month in health policy research, surprise billing and changes in market structures fuel concerns about competition and consumer choice. In addition, some studies on pharmaceutical costs produced hopeful reports. Healthcare Market Competition and Consolidation Consolidation Trends In a Health Affairs study, Consolidation of Providers into Health Systems Increased Substantially, 2016-18, Michael Furukawa et al. analyzed provider consolidation trends. The rate of physician affiliation with a health system increased by 11 to 51 percent in 2018. Based on the 556 health systems the authors identified, the median number of …
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Q&A: The What, When, Who and How of California’s New APCD: The Health Care Payments Data System
Mallory Warner, Health Policy Research Fellow August 17, 2020
Last month, we discussed California healthcare proposals that were postponed or cut due to budget constraints brought on by the pandemic-induced recession. California’s proposed all-payers claims database (APCD) project, the Health Care Payments Data (HPD) Program, was one proposal that survived. The passage of the HPD Program demonstrates the Legislature’s understanding that health care price transparency is important enough to withstand an extreme budget crunch. In this post, we take a look at the specifics of California’s new APCD and answer some important questions about its implementation and what it …
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Surprise Billing: Proposed Federal Solutions From Both Sides of the Aisle
Source Fellow August 11, 2020
By: Danika Rothwell, Student Fellow Paul DeWolfe needed back surgery. He knew the operation would be covered by his insurance and was careful to make sure the hospital he chose was in his insurer’s network. DeWolfe sat down and did the math. He figured his portion of the bill would cost roughly $3,000. When DeWolfe recovered from his procedure, he was shocked to receive a bill for $18,590.83.[1] Despite all his attentive preparation, some of the physicians who treated him at his in-network hospital were, in fact, out-of-network. This story …
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[Presentation] Nevada Patient Protection Commission Meeting
Jaime S. King, Executive Editor July 20, 2020
The Nevada Patient Protection Commission Presentation on drivers of healthcare costs and efforts to improve transparency in healthcare pricing Presentation: “Addressing High Health Care Prices: Transparency, Enforcement, and Legislation” Meeting Recording Meeting Minutes
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Podcast from Harvard Professor Anna Sinaiko Provides Insights on Healthcare Consumerism
Amy Y. Gu, Managing Editor June 16, 2020
Tune in to the latest podcast with Anna Sinaiko, PhD, Assistant Professor at the Harvard T. H. Chan School of Public Health, who discusses with Catalyst for Payment Reform (CPR) Executive Director Suzanne Delbanco past price and quality transparency efforts and benefit design programs. CPR, in partnership with The Source, recently released a Report Card on State Transparency Laws that assesses state efforts to help consumers access health care price information to facilitate consumer shopping (see Suzanne Delbanco’s op-ed in Governing). This latest podcast from CPR provides insights on patient preferences in …
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The Source Roundup: June 2020 Edition
Kendall Kohlmeyer, Student Fellow June 1, 2020
The Source continues to extend wishes of safety and good health to you and your loved ones during this uniquely challenging time. Despite the reality that much of the healthcare industry suffers financial catastrophe due to the pandemic, experts note improvements in some areas. Authors this month expect some advancements to last and suggest how the U.S. should use them to diminish costs. Changes in Telehealth Will Likely Outlast the Pandemic In JAMA’s Implications for Telehealth in a Postpandemic Future, Carmel Shachar and co-authors affirm positive outcomes that the …
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[Publication] Catalyst for Payment Reform and The Source Release 2020 Report Card on State Price Transparency Laws
Amy Y. Gu, Managing Editor May 5, 2020
[Press Release] BERKELEY, CA – May 5, 2020 – Around 40% of Americans could not cover an unexpected $400 expense in 2018, which is less than one-third of the average health insurance deductible for an individual that year. Health care costs and deductibles have since continued to rise, along with the need for American consumers to have access to price information. Catalyst for Payment Reform (CPR) looked for laws in each state that ensure such transparency and today, the grades are in. CPR developed the 2020 Report Card on State …
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The Source Roundup: May 2020 Edition
Source Fellow May 1, 2020
By: Swaja Khanna, Student Fellow With the coronavirus pandemic causing shelter-in-place restrictions around the world, we here at The Source hope you are staying safe and healthy as we catch you up on some of the articles and reports in health policy this month. In this edition of the Source Roundup, we cover articles and reports that discuss: (1) the cost of hospital care for COVID-19 for the uninsured, (2) how health costs may change in the pandemic, (3) surprise out-of-network billing from ambulance transportation, (4) in-network ASC episodes that …
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