External Research
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Medical Care: Competition in Outpatient Procedure Markets
Read more: Medical Care: Competition in Outpatient Procedure MarketsAbstract Background: More than half of all medical procedures performed in the United States occur in an outpatient setting, yet few studies have explored how competition among ambulatory surgery centers (ASCs) and hospitals affects prices for commercially insured outpatient services. Objectives: We examined the association between prices for commercially insured outpatient procedures and competition among ASCs and…
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American Academy of Pediatrics: Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum Disorder
Read more: American Academy of Pediatrics: Insurance Mandates and Out-of-Pocket Spending for Children With Autism Spectrum DisorderABSTRACT BACKGROUND: The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers. METHODS: We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and…
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American Academy of Actuaries: Estimating the Potential Health Care Savings of Reference Pricing
Read more: American Academy of Actuaries: Estimating the Potential Health Care Savings of Reference PricingExecutive Summary: High and rising health care prices play a major role in the persistent increases in health care spending. This study, undertaken by the American Academy of Actuaries Health Practice Council, explores the potential for reference pricing to counter high health care prices and contain health care spending growth. Reference pricing is a system…
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International Journal of Radiation Oncology: Impact of Medicare Advantage Enrollment on Utilization of Intensity-Modulated Radiation Therapy and Cost of Care for Cancer Treatment
Read more: International Journal of Radiation Oncology: Impact of Medicare Advantage Enrollment on Utilization of Intensity-Modulated Radiation Therapy and Cost of Care for Cancer TreatmentAbstract: Intensity-modulated radiation therapy (IMRT) is an important driver of rising costs in oncology care, but the level of evidence supporting its routine use varies across disease sites, including breast, lung, and prostate. While Medicare Advantage (MA) plans have incentives to reduce health care spending, the effect of MA enrollment on utilization of high-cost medical…
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Health Affairs: Assessing The Impact Of State Policies For Prescription Drug Monitoring Programs On High-Risk Opioid Prescriptions
Tags: Commercially Insured, Geographic Variation, Health Affairs, Opioids, Peer Reviewed Journals, UtilizationRead more: Health Affairs: Assessing The Impact Of State Policies For Prescription Drug Monitoring Programs On High-Risk Opioid PrescriptionsABSTRACT: Policies and practices have proliferated to optimize prescribers’ use of their states’ prescription drug monitoring programs, which are statewide databases of controlled substances dispensed at retail pharmacies. Our study assessed the effectiveness of three such policies: comprehensive legislative mandates to use the program, laws that allow prescribers to delegate its use to office staff,…
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American Journal of Health Economics: Why Don’t Commercial Health Plans Use Prospective Payment?
Read more: American Journal of Health Economics: Why Don’t Commercial Health Plans Use Prospective Payment?Abstract: One of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. “Prospective” payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the…
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Journal of General Internal Medicine: First Opioid Prescription and Subsequent High-Risk Opiod Use, a National Survey of Privately Insured and Medicare Advantage Adults
Read more: Journal of General Internal Medicine: First Opioid Prescription and Subsequent High-Risk Opiod Use, a National Survey of Privately Insured and Medicare Advantage AdultsBACKGROUND: National guidelines make recommendations regarding the initial opioid prescriptions, but most of the supporting evidence is from the initial episode of care, not the first prescription. OBJECTIVE: To examine associations between features of the first opioid prescription and high-risk opioid use in the 18 months following the first prescription. DESIGN: Retrospective cohort study using data from a large commercial insurance…
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The Quarterly Journal of Economics: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured
Read more: The Quarterly Journal of Economics: The Price Ain’t Right? Hospital Prices and Health Spending on the Privately InsuredAbstract: We use insurance claims data covering 28% of individuals with employer-sponsored health insurance in the United States to study the variation in health spending on the privately insured, examine the structure of insurer-hospital contracts, and analyze the variation in hospital prices across the nation. Health spending per privately insured beneficiary differs by a factor…
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The Society of Actuaries: Predicting High-Cost Members in the HCCI Database
Read more: The Society of Actuaries: Predicting High-Cost Members in the HCCI DatabaseAbstract: Using the Health Care Cost Institute (HCCI) database, which contains claim information on approximately 47 million members annually over a seven-year time period, we examined which characteristics best predict and describe high-cost members. We found that cost history, age, gender and prescription drug coverage are all predictors of future high costs, with cost history…
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Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial Plans
Tags: Commercially Insured, Medicare Advantage, Out-of-Network, Peer Reviewed Journals, Physician Spending, PricesRead more: Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial PlansABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries’ health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare’s fee-for-service (FFS) program…