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Tag: cost of healthcare

Compare Prices: Insurers Reveal What Healthcare Providers Are Paid

Healthcare consumers have a new tool to compare prices using data from some of the largest U.S. health insurers, but comparison shopping will remain a challenge for most.

On Wednesday the Health Care Cost Institute, a not-for-profit healthcare research organization, launched the first of two websites conceived to help consumers navigate prices for medical services. The website—named Guroo—allows consumers to search for average prices for 70 services across more than 300 hundred cities, 41 states, coastal California and the District of Columbia.

Prices are drawn from medical claims for 40 million Americans covered by Aetna, Assurant Health, Humana and UnitedHealthcare.

Consumers will be able to identify the low, average and high prices within each market, and they will see prices for all of the services to treat certain conditions, including office visits, laboratory and diagnostic tests, and other services in addition to the procedures themselves.

“HCCI is going to use this data to ultimately create a national source of truth for consumers,” said Tom Beauregard, executive vice president of UnitedHealth Group.

The new website comes amid a wave of healthcare price transparency tools developed by entrepreneurs, health insurers and states to give patients and employers more ability to shop around. Pricing tool Castlight Health went public roughly one year ago with a hugely successful initial public offering. (Wall Street has lost some of its enthusiasm recently, although the company has been adding customers and narrowing its losses.) A dozen states operate all-payer claims databases. Regulators, too, may use price data to challenge hospitals and doctors to justify wide differences in price.

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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Health Care Prices: Organizations to Watch

Health care costs have increased three times faster than wages over the past decade. Just like any marketplace, prices for medical procedures, equipment and treatments vary dramatically among providers. An appendectomy can cost anywhere from $1,529 to $186,990. A hip replacement could run from $11,100 to $125,798. But trying to determine the actual price you’ll pay — or the one you should be paying — can be daunting for the average consumer. And once that pricing information is available, how can we aggregate and utilize it to make health care more affordable for everyone? Here, we’ve broken down the issue of health care price transparency and profiled fourteen exciting, effective and innovative organizations that support it in different ways.

“In 2014, we make purchasing decisions for every other commodity based on transparent price and quality information. Why not healthcare, too?” — Dr. Neel Shah, Costs of Care

American Board of Internal Medicine Foundation (ABIM) — Choosing Wisely
California Health Care Foundation (CHCF)
Castlight Health
Catalyst for Payment Reform
Clear Health Costs
Change Healthcare
Costs of Care
Council for Affordable Health Insurance (CAHI)
Emergency Care Research Institute (ECRI)
FAIR Health
Healthcare Bluebook
Health Care Cost Institute (HCCI)
Health Care Incentives Improvement Institute
Health Care Financial Management Association (HFMA) – Price Transparency Task Force

Read the full article here.

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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.

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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Applying Lean IT to Healthcare

The healthcare sector is going through fundamental technology-enabled changes in the way care is delivered, how providers interact with their patients, and how payments are made. To take advantage of digital technology and create more effective systems that help health professionals deliver better care, providers are moving rapidly toward becoming digital enterprises. For example, they are borrowing lessons from e-commerce leaders on how to acquire and retain patients through data analytics and from manufacturing entities on managing patient throughput and optimizing clinical supply chains. Providers are also leveraging apps on smartphones to engage patients remotely in new ways that improve outcomes, and they are using digital tech­nologies to support clinical decisions and streamline hospital operations. In this way, the adoption of more sophisticated analytics has simplified processes and significantly reduced manual workloads.

The pressure of enabling the digital enterprise is landing squarely on the shoulders of the IT department, and this presents tough challenges in a sector that has traditionally lagged behind others in the adoption of information technology. For example, according to Gartner, IT spending as a portion of revenue is 6.3 percent in banking and financial services and 4.2 percent in healthcare. Despite this history, IT departments are now being asked to deliver the core digital platforms that will enable far-reaching changes for healthcare providers. At the same time, in the spirit of doing more with less, these IT departments are being asked to improve service levels and increase IT efficiency.

IT departments will need to take a comprehensive view of how to meet the demands of all core IT functions rather than undertake discrete initiatives. IT leaders will have to address topics such as IT-infrastructure architecture and services, cybersecurity, advanced analytics and data management, and the rationalization of application port­folios. IT departments must carefully juggle a “two-speed IT infrastructure”—balancing the acceleration of new digital capabilities against the maintenance of legacy systems (see “A two-speed IT architecture for the digital enterprise”).

All this will require a more efficient and effective IT workforce. That’s why the appli­cation of lean principles is one important element for healthcare providers across the globe pursuing digitization.

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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Funding Woes Imperil Future of State-Run Exchanges

Starting this month, state-run insurance exchanges are legally required by the healthcare reform law to be financially self-sustaining. But that mandate is being ignored across the country, and there do not appear to be any immediate consequences for the states.

Many of the 16 states and the District of Columbia that run their own marketplaces will continue to rely on leftover federal funds to pay for operations this year. The Obama administration issued a guidance last year that states can continue to use federal grant dollars this year if the CMS grants permission. Some uses of the funds are prohibited, such as for rent and software maintenance.

So far, the CMS has dispensed more than $4 billion in grants to help launch state-run exchanges. In December, the agency issued its final round of grants, roughly $265 million to 10 states with existing state-run marketplaces, to assist with technology development and enrollment efforts. Despite the influx of federal funds, many state-based exchanges are facing projected deficits this year and in future years.

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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