ER visits continue, despite insurance

ER visits continue, despite insurance

Emergency rooms and hospitals are among the most expensive places to get health care. One of the big selling points for Obamacare was the idea that if people get insurance, they’ll have better preventive care and end up in the ER a lot less.

Today we have new data that buries that idea.

Though people with insurance are taking advantage of more preventive care, they’re also still going to the ER. A prior study, done by the same economists, found when you give people insurance, they use more health care services — more doctor’s visits, flu shots, prescriptions, even hospitalizations.

Dr. Renee Hsia, of the University of California San Francisco Emergency Department, said she treats many insured patients.

“We have noticed that as our patient population gets older and frailer and we have more complex diseases, there are higher-acuity things presenting to the ED,” she said.

Hsia said other reasons the insured keep showing up include patients’ doctors sending them to the ER, or people can’t get a primary care appointments quickly.

Harvard economist Kate Baicker, one of the co-leads on the paper, said people need to be clear about the impact of insurance.

“Insurance makes the emergency department affordable,” she said. “People didn’t go [when they were uninsured] because of the big bill they got when they showed up. Now that it’s more affordable, people go more.”

Based on their findings, Baicker said insurance also improves people’s financial security and reduced their rate of depression.

Clinton vs. Trump: 5 critical election issues

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/hillary-vs-trump-5-critical-election-issues?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=25102016

While Hillary Clinton vows to forge ahead with Obamacare if she is elected president, Donald Trump would scrap it altogether. The end results would be two very different forms of healthcare, and industry leaders have much to consider.

Brill“Many different factors are weighing on managed care executives such as the costs of pharmaceuticals, diagnostics and devices; the impact of consolidation amongst hospitals, physicians, health plans; and the losses in the exchange marketplace,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, which partners with stakeholders to improve coverage of value-driven care. “With each of these factors, plans can, at least at a high level, make some educated guesses about the relative risk of each factor and impact to the bottom line.”

The election results, however, are much less certain, which from a risk perspective, weighs heavily on the minds of healthcare executives, Brill says. “How can you plan for business knowing that whatever you are doing currently could be upended in the beginning of November?”

To help provide some clarity, Managed Healthcare Executive identified five of the top industry issues, reviewed the candidates’ platforms for each, and asked industry experts to weigh in.

Narrow networks: savings at what cost?

Narrow networks: savings at what cost?

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You probably chafe a bit every time you learn that a certain doctor or hospital isn’t part of your insurance network. Narrowing the scope of your network helps insurers save money. They can drive hard bargains with doctors and hospitals to get lower prices and walk away from higher-priced ones.

Increasingly, insurers are offering narrow network plans. Would you enroll in one? So long as quality doesn’t suffer, consumers should welcome the lower premiums they may offer.

Researchers at the Leonard Davis Institute at Penn analyzed the relationship between network size and premiums for plans offered in the Affordable Care Act marketplaces. Plans with very narrow networks (covering care by less than 10 percent of physicians) charged 6.7 percent lower premiums than plans with much broader networks (covering care by up to 60 percent of physicians). This translates into an annual savings for an individual of between $212 and $339, depending on age and family size. For a young family of four, the savings could reach nearly $700 per year.

“Marketplace consumers are looking for value,” said Daniel Polsky, the University of Pennsylvania health economist who led the study. “That level of savings could be a very good deal for consumers, but whether these plans provide value depends on how they are achieving those savings.”

One way plans might save money could make it harder for patients to get care — so that they get less of it. Narrow network plans may do this if they don’t cover enough nearby providers, with the ones they do cover too busy to take new patients in a timely fashion. Clearly this would be especially problematic if appointments with one’s preferred primary care doctor are hard to obtain.

Are today’s narrow network plans actually doing this? Until recently, we had no data to answer this question. But two studies published earlier this year — one focused onMassachusetts, the other on California — provide some insight.

21 statistics on high-deductible health plans

http://www.beckershospitalreview.com/finance/21-statistics-on-high-deductible-health-plans.html

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Hospital and health system executives are well aware of the affects high-deductible health plans have had on hospital finances, from patient collections to bad debt. To help quantify the impact of increasing patient financial obligations on the business of healthcare, here are 21 statistics to know about high-deductible health plans.

Medicare shouldn’t pay more for drugs when others pay less

https://www.statnews.com/2016/10/18/medicare-drug-prices/?_hsenc=p2ANqtz–zfLIsv2nEEzVlLISqrp28lPm5ANNScP2_qYXJZI-DenazQvHTSROulTck5xdVsR5KMAzBoOaUWrYMEPSR1ZxAyLybMQ&_hsmi=36101369

Hillary Clinton and Donald Trump don’t see eye-to-eye on much. But they do agree that drug costs are spiraling out of control at the public’s expense. Both the Democratic and the Republican candidates for president have said that Medicare should be able to negotiate drug prices, something that currently isn’t allowed by law. Letting Medicare do that — which the Department of Veterans Affairs and other countries have been doing for years — has the potential to transform health care.

Most developed nations, including Canada and the United Kingdom, negotiate with pharmaceutical companies to determine how much they will pay for medications. In the US, health care is covered by many different payers, with Medicare being the largest by far. The federal government never gave Medicare the power to negotiate drug prices. Instead, that’s done by the many private insurers that manage Medicare drug plans.

Giving Medicare the power to negotiate drug prices would immediately save billions of dollars. The implications would also reach far beyond the 37 million Americans covered by the Medicare drug benefit (Part D), because commercial insurers often follow Medicare’s lead.

 

 

Specialty Drug Costs Soar 30% For California Pension Fund

Specialty Drug Costs Soar 30% For California Pension Fund

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Specialty drug costs jumped 30 percent last year to $587 million for the California Public Employees’ Retirement System, one of the nation’s largest health care purchasers.

Though they amount to less than 1 percent of all prescriptions, specialty drugs accounted for more than a quarter of the state agency’s $2.1 billion in total pharmacy costs. Those overall drug costs have climbed 40 percent since 2010.

The new figures show just how much financial pressure many employers and government agencies face from rising drug costs and why it’s become such a hot topic in California politics and on the presidential campaign trail.

Hepatitis C drugs drove much of the increase for the state retirement system during 2015, as did two rheumatoid arthritis drugs. Drugs for cancer and multiple sclerosis were also among the top 10 specialty drugs for CalPERS.

CalPERS spent the most, $94.5 million, on Harvoni, a hepatitis C drug. It is sold by Gilead Sciences Inc., whose steep prices have drawn public outrage and government scrutiny. The agency spent an additional $16.6 million on Sovaldi, another Gilead drug for hepatitis C.

Apart from specialty medications, CalPERS’ highest-cost drugs were Lantus, for diabetes; Advair, an asthma inhaler; and Crestor, a cholesterol medicine. Painkiller OxyContin rounded out the top 10 at $14.3 million, according to state data.

More than 5 percent of CalPERS’ total drug spending — $118 million — went for Humira and Enbrel, two anti-inflammatory biotech drugs that don’t face competition from lower-priced generics.

POLITICO-Harvard poll: Americans blame drug companies for rising health costs

http://www.politico.com/story/2016/09/americans-blame-drug-companies-for-rising-health-cost-poll-228866?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=35091656&_hsenc=p2ANqtz-8PbV9cRcxweGuejnRZArmy5BpOsVlplZlnpP5Tlh3Bb4D0hvTxsoCG-nghADRTV3uBXXBbgZHO8RPcxFGbLEAOLxGfVw&_hsmi=35091656

A pharmacist is pictured. | Getty

The poll found 43 percent of Americans are “very or somewhat” worried about medical costs in the coming year, and the top concern (31 percent) is their out-of-pocket costs.

Hillary Clinton’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

http://www.commonwealthfund.org/Publications/Issue-Briefs/2016/Sep/Clinton-Presidential-Health-Care-Proposal

Image result for Impact of Hillary Clinton Proposed Reforms on the number of people with insurance coverage

Issue: Presidential candidate Hillary Clinton has proposed modifications to the Affordable Care Act to limit consumers’ out-of-pocket health spending.

Goal: We analyzed four of these policies—cost-sharing tax credits to offset spending above 5 percent of income; reduced premium contributions for marketplace enrollees; a fix to the ACA’s “family glitch,” which leaves some families with expensive employer coverage; and the introduction of a public option on the marketplaces.

Methods: RAND’s COMPARE microsimulation model.

Key findings and conclusions: These policies would increase the number of insured individuals by 400,000 to 9.6 million, and decrease consumers’ health spending relative to current law. Cost-sharing tax credits have the biggest effect—increasing coverage by 9.6 million and decreasing average spending by up to 33 percent for those with moderately low incomes. However, the policies with the largest coverage gains also increase the federal deficit, with impacts ranging from –$0.7 billion to $90 billion.