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Tag: Cost of Affordable Healthcare

Health-Care Deductibles Climbing Out of Reach

Deductibles are an element of any insurance product, but as deductibles have grown in recent years, a surprising percentage of people with private insurance, and especially those with lower and moderate incomes, simply do not have the resources to pay their deductibles and will either have to put off care or incur medical debt.

The chart above, based on a Kaiser Family Foundation study published Wednesday, shows that about a quarter of all non-elderly Americans with private insurance coverage do not have sufficient liquid assets to pay even a mid-range deductible, which at today’s rates would be $1,200 for single coverage and $2,400 for family coverage. We found that more than a third don’t have the resources to pay higher deductibles. Among low- and moderate-income households, even fewer are able to meet deductibles. It’s no wonder that collections for medical debt represent half of all bill collections. The estimates are conservative because they assume that people have all of their liquid assets available to pay their health-care bills. But most people must tap into their liquid assets to meet other obligations, such as their rent or mortgage, car repairs, or educational costs.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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The Extreme Cost Variation in Healthcare

Today consumers are seeking to make more decisions on their healthcare needs based on costs and quality considerations. With the growth of consumerism in healthcare allowing people to shop their options, more individuals are learning that medical services and procedures have tremendous, seemingly random variation in costs.

Blue Cross Blue Shield, The Health of America Report is a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence that aims to mine a market-leading claims database to uncover key trends and provide insight into healthcare dynamics and ultimately support improved quality and affordability for Americans.

This report analyzed three years of independent Blue Cross and Blue Shield (BCBS) companies’ claims data for typical knee and hip replacement surgeries to further assess cost variations across the U.S. in 64 markets across the country. The report highlights typical knee and hip replacement procedures because they are among the fastest growing medical treatments in the U.S.

Key Findings

Some hospitals across the U.S. charge tens of thousands of dollars more than others for the same medical procedures, even within the same metropolitan market.
Their cost can vary by as much as 313%, depending on where the surgeries are performed.

A study published in the June 2014 issue of Journal of Bone and Joint Surgery, found that typical knee replacements more than tripled and that typical hip replacements doubled between 1993 and 2009.

In 2011 there were 645,062 typical hip replacements and 306,600 typical knee replacements performed in the U.S., according to a report from the American Academy of Orthopaedic Surgeons.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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New Payment Experiments Seek To Find The ‘Sweet Spot’

New payment experiments explore a key issue in the decades-long struggle over US health care spending, which is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments—lump-sum, per person payments to health care providers to provide all care for a specified individual or group—offers a stark example of how difficult it is for providers to assume meaningful financial responsibility for patient care.

This article chronicles the expansion and decline of the capitation model in the 1990s. We offer lessons learned and assess the extent to which these lessons have been applied in the development of contemporary forms of provider cost sharing, particularly accountable care organizations, which in effect constitute a search for the “sweet spot,” or appropriate place on a spectrum, between providers and payers with respect to the degree of risk they absorb.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Cost Variations Significant in Procedures Across the U.S

Today’s healthcare consumers have an increasing thirst for information that will empower them to make informed decisions about their care. The industry is in the midst of a transformation to meet the needs and expectations of today’s technologically savvy shoppers and through that process, a key obstacle has emerged: the unpredictable variation in costs of medical services and procedures and an accompanying lack of transparency.

This issue has obvious financial consequences for individuals and employers, as well as serious implications for the sustainability of the U.S. healthcare system. To help understand the depth of the issue, the Blue Cross Blue Shield Association and Blue Health Intelligence joined together to examine cost variation in one area of care: knee and hip replacement procedures.

The findings from this collaboration are contained in the first Blue Cross Blue Shield, The Health of America Report, “A Study of Cost Variations for Knee and Hip Replacement Surgeries in the U.S.” The study, which is based on independent Blue Cross and Blue Shield companies’ claims data*, revealed the cost of those procedures varies widely in markets across the country, with extreme variations emerging even within the same market. In fact, prices for identical procedures can quadruple in cost depending on which hospital a patient chooses.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Obamacare and Tax Complications

We’ve seen few administrative controversies with Obamacare’s second open-enrollment season, but as a Wall Street Journal article noted last week, the start of the 2014 tax-filing season could bring a new wave of public discontent.

This tax-filing season brings the first enforcement of the Affordable Care Act’s individual mandate–the complexity of which could become a boon for tax-preparation firms. The instructions for completing the mandate exemption form run 12 pages, list 19 types of exemptions (with multiple codes), and include worksheets that may require individuals to go to their state exchange’s Web site to find the monthly premiums that will determine whether they had access to “affordable” coverage.

This added documentation could confuse those used to filing short, simple tax returns. Potential bad outcomes include: filers could give up, and pay the mandate tax even though they qualify for an exemption; filers could feel compelled to hire a tax preparer to sort through the issues for them; or filers could complete the form incorrectly and find their refund held in limbo while the IRS works to resolve the errors.

Meanwhile, Americans who purchased insurance last year and obtained federal premium subsidies will have to reconcile their income and taxes owed with the subsidies they received—which were based on estimated income. The Journal article cited an H&R Block analysis that as many as half of the 6.8 million individuals who received subsidies will have to repay a portion of them.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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