Peer Reviewed Journals
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NBER: Why Don’t Commercial Health Plans Use Prospective Payment?
Tags: Commercially Insured, Geographic Variation, Inpatient Spending, Market Concentration, NBER, Peer Reviewed Journals
Read more: NBER: 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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JAMA Pediatrics: Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder
Read more: JAMA Pediatrics: Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum DisorderABSTRACT Importance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have…
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JAMA Internal Medicine: Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults
Read more: JAMA Internal Medicine: Out-of-Pocket Spending for Hospitalizations Among Nonelderly AdultsABSTRACT Importance: Patients’ out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults. Objectives: To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, region, and type of…
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Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays
Tags: Commercially Insured, Health Affairs, Inpatient Spending, Medicare, Medicare Advantage, Outpatient Spending, Peer Reviewed JournalsRead more: Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare PaysABSTRACT There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012….
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Journal of Telemedicine and Telecare: Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States
Read more: Journal of Telemedicine and Telecare: Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United StatesABSTRACT: Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursements to non-telehealth…
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American Journal of Managed Care: Overcoming barriers to a research-ready national commercial claims database
Read more: American Journal of Managed Care: Overcoming barriers to a research-ready national commercial claims databaseABSTRACT Objectives: Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome. Study Design: In this study, we discuss some of the…
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Health Affairs: Health Spending Slowdown Is Mostly Due To Economic Factors, Not Structural Change In The Health Care Sector
Tags: Affordable Care Act, Commercially Insured, Health Affairs, Market Concentration, Peer Reviewed JournalsRead more: Health Affairs: Health Spending Slowdown Is Mostly Due To Economic Factors, Not Structural Change In The Health Care SectorABSTRACT: The source of the recent slowdown in health spending growth remains unclear. We used new and unique data on privately insured people to estimate the effect of the economic slowdown that began in December 2007 on the rate of growth in health spending. By exploiting regional variations in the severity of the slowdown, we determined…
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Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five
Read more: Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-FiveABSTRACT Little is known about the trends in health care spending for the 156 million Americans who are younger than age sixty-five and enrolled in employer-sponsored health insurance. Using a new source of health insurance claims data, we estimated per capita spending, utilization, and prices for this population between 2007 and 2011. During this period…