PRICE AND QUALITY TRANSPARENCY
The Source Roundup: May 2019 Edition
Tiffany Wang, Student Fellow May 1, 2019
Happy May! We hope you’re enjoying the longer, sunnier days of spring. In this edition of The Source Roundup, we survey articles and reports that discuss 1) health system consolidation’s impact on healthcare prices and quality, 2) the new federal price transparency rule, and 3) cost-containment strategies from various fronts. More Evidence of Hospital Market Concentration’s Negative Impact on Competition and Healthcare Costs Two articles this month reinforced the principle that protecting access to affordable healthcare requires strong antitrust enforcement policies to ensure adequate competition among hospitals and hospital systems. …
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Better Data for Better Results: AB 1122’s Super User Pilot Project and Other 2019 Bills That Improve Health Care Transparency
Sammy Chang, Health Policy Researcher April 30, 2019
As California continues its implementation of an all-payer claims database, we take a look at other bills the Legislature introduced to further the aim of better understanding the factors and activities that drive health care costs and quality. SB 343 subjects the Kaiser Permanente system to the same reporting requirements as other plans and hospitals. SB 612 and AB 929 mandate public disclosure of cost reduction and quality improvement activities. Additionally, AB 1122 proposes a pilot project that utilizes existing data sets to identify a new data set: high health …
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The Source Roundup: April 2019 Edition
Source Fellow April 1, 2019
By: Erin Sclar, Student Fellow Spring is finally here! With it, we review articles and reports about 1) single payer health plans and universal health care, 2) the causes, effects, and possible solutions to rising prescription drug pricing, and 3) health care costs and price transparency. Single Payer Health Plans and Universal Health Care The terms “single payer health plans” and “universal health care” are becoming increasingly familiar as the 2020 elections approach. But the meanings of these terms, and the specific policies and proposals associated with them, are often …
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The Source Roundup: March 2019 Edition
Source Fellow March 1, 2019
By: Leah S. Gray, Student Fellow Happy March! This month we take a look at articles that examine 1) state health system reform efforts, 2) protections against surprise medical bills, 3) effects of market concentration on cost and quality, and 4) ways to control rising costs for health care and pharmaceuticals. States are taking the lead in health system reform While the federal health policy debate has remained rather stagnant, states have stepped up protect their citizens from rising health care costs. North Carolina is poised to make rapid, unprecedented …
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2019’s AB 1611 is California’s Latest Attempt in Its Long, Litigious History to Eliminate Balance Billing
Sammy Chang, Health Policy Researcher February 28, 2019
This has happened before. In 2014, San Francisco General Hospital Medical Group acknowledged in a settlement with the California Department of Managed Health Care (DMHC) that it had balance billed patients with Blue Shield PPO plans for emergency services between January 2009 and March 2014. The group claimed to have balance billed these patients because it did “not realize that Blue Shield of California PPO plans were subject to DMHC jurisdiction.” Because legislative and judicial authority prohibit balance billing of emergency services for enrollees that are part of a DMHC-regulated …
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Right-to-Shop Programs: Encouraging Patients to Shop for High-Value Health Care
Katie Gudiksen, Senior Health Policy Researcher February 11, 2019
With the share of Gross Domestic Product spent on health care reaching crisis levels,[1] experts on both sides of the political spectrum are demanding better value for the dollars spent on health care. Programs that give patients incentive to choose better value health care get widespread support from both political parties. In the past few years, many states considered enabling or implementing right-to-shop or savings reward programs, in which an insurer creates an incentive program that gives patients financial rewards for choosing providers with lower than average costs. How …
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Recapping the 2017-2018 California Legislative Session (Part 2): Incremental Steps Made in Scrutinizing Market Changes and High Health Care Costs
Sammy Chang, Health Policy Researcher January 29, 2019
As California begins its 2019-2020 legislative cycle, we look back at the 2017-2018 bills that will affect California health care costs and markets. Previously, we mentioned that last session’s health care bills coalesced around four themes: targeting high costs of prescription drugs, attempting to implement single payer, regulating competition, and limiting high health costs. In Part 1 of our review, we covered how the legislature banned pharmacy gag clauses and limited out of pocket expenses but failed to implement single payer. This time, we’ll look at 2017-2018 bills that sought …
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Beyond Price Shopping: How Stakeholders Utilize All-Payer Claims Databases to Address Rising Health Care Costs
Tiffany Wang, Student Fellow and Megan O'Leary, Student Fellow January 22, 2019
Since 2005, Americans have identified the availability and cost of health care as one of their top concerns. Health care costs have risen due to various factors, such as reliance on fee-for-service payment systems, lack of patient engagement, and lack of coordination and management. In recent years, state legislatures have focused on increasing price transparency in the hopes that it will drive down health care costs by encouraging consumer price shopping. One means of promoting price transparency is through the use of database tools, such as state-mandated all-payer claims databases …
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AB 1810: California’s Rough Road to an APCD Becomes Smoother
Sammy Chang, Health Policy Researcher November 27, 2018
California’s AB 1810, among its many provisions, authorizes the creation of an all-payer claims database (“APCD”) via a one-time $60 million appropriation to California’s Office of Statewide Health Planning and Development (“OSHPD”).[1] An APCD is a database that collects medical, pharmacy, and dental claims and administrative data from public and private payers. An APCD is the best way to provide price transparency, as they allow comparison of the costs of medical procedures across different health facilities. For more information, see the Source’s issue brief on All-Payer Claims Databases and California …
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Surprise Balance Billing: The New Fight for Consumer Protection in Health Care
Source Fellow October 22, 2018
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 …
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