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50 Things to Know About Healthcare Costs

"The difference between costs, charges and payments ... Healthcare spending on the rise ... Cost of hospital services ... Costs broken down by hospital type and state ... Spending on prescription drugs and physician services is growing ... Out-of-pocket healthcare costs are increasing ... A breakdown of out-of-pocket healthcare costs ... Employer healthcare costs ... Influence of the 'Cadillac tax' on employer healthcare costs."

DOL Settles Unprecedented Lawsuit Against United Healthcare for Violations of the Mental Health Parity and Addiction Equity Act

"[T]wo settlement agreements filed on August 11 provide that United Healthcare Insurance Co., United Behavioral Health, and Oxford Health Insurance Inc. will together pay more than $15.6 million to settle allegations they violated the federal mental health parity law.... The enforcement actions reflect the first instance in which DOL has initiated litigation to enforce MHPAEA against a health insurance issuer, health plan, or administrative service provider in the 13 years since the initial passage of the statute.' [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)]

OIG Approves Per-Click Fee Arrangement for Online Healthcare Directory

"OIG approved a technology company's proposal to make its online healthcare directory search results visible to federal healthcare beneficiaries in locations where the company charges the healthcare professionals a per-click or per-booking fee to be included in the directory.... [OIC Advisory Opinion 19-04] provides valuable insight regarding how OIG evaluates the fraud and abuse risks posed by online scheduling tools, as well as demonstrates OIG's recognition of the increasing importance of technology in the delivery of healthcare."

Regulators Use 'Carrots and Sticks' to Incentivize Healthcare Sector Cybersecurity Compliance

"In light of ... growing threats and potential disruptive impacts on the healthcare industry, HHS' 2024 agenda continues to encourage compliance with cybersecurity and privacy regulations through a variety of mechanisms. As of the first quarter of 2024, specific efforts include issuance of updated guidance from HHS and the National Institute of Standards and Technology (NIST), changes to existing regulations, and leveraging investigatory and enforcement authorities."

10 States with Highest, Lowest 2017 Employer Healthcare Spending

"Alaska saw the highest average annual healthcare spending for individuals with employer-sponsored insurance in 2017, while Hawaii saw the lowest, according to an interactive state tool from the Health Care Cost Institute."

DOL Settles Unprecedented Lawsuit Against United Healthcare for Alleged Violations of MHPAEA (PDF)

"The enforcement actions reflect the first instance in which DOL has initiated litigation to enforce MHPAEA against a health insurance issuer, health plan, or administrative service provider in the 13 years since the initial passage of the statute.... [I]ssuers and health plans should carefully review both the consistency of the factors they use to determine which benefits should be subject to a given [non-quantitative treatment limitations (NQTL)] type as well as the ratio of mental health/substance use disorder benefits subject to an NQTL type compared to the application of the same NQTL to medical-surgical benefits in the same classification." [Walsh v. United Behavioral Health and UnitedHealthcare Ins. Co., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021); Walsh v. UnitedHealth Group Inc. and Oxford Health Ins. Inc., No. 21-4519 (E.D.N.Y. settlement agreement filed Aug. 11, 2021)]

10 Characteristics of Effective Healthcare Price Transparency Tools

"[1] The product is easy to use.... [2] The tool should allow people to understand their share of the cost, the total cost and spending and utilization to date.... [3] The product shows quality measures consumers care about, based on the latest information.... [4] The product lets people perform a side-by-side price and quality comparison.... [5] The tool helps people understand and identify value.... [6] The product should include information on pharmacy and ancillary services, as well as information to help older patients and those with chronic conditions.... [7] The tool should help consumers avoid unneeded care.... [8] The product should encourage people to use it.... [9] The product should integrate well with other products.... [10] The tool should give employers useful information about utilization and savings."

Cadillac Tax Could Jeopardize the Viability of Employer-Based Healthcare Plans

"To date, the 'Cadillac Tax' provision, which is one of ACA's principal 'Pay Fors,' has been largely ignored. While its 2018 implementation date may appear distant, it is time for employers to act to lower costs and avoid the tax."

Blues Plans Dive Into Care Delivery

"In recent years, BCBS plans opened medical clinics that exclusively serve their members. Premera Blue Cross partnered with Seattle-based Kinwell Medical Group in 2022 to open primary care clinics for its members in Washington state. Back in 2016, Florida Blue and Alignment Healthcare opened six clinics for their members in Florida. This year, BCBS Arizona launched a new primary care company, Prosano Health Solutions.... In October, BCBS North Carolina announced it intends to purchase 55 North Carolina locations of FastMed, a national chain of urgent care clinics."

Weight Loss Drug Coverage Gets More Complicated

"[A] federal lawmaker warned weight loss drugs have the potential to bankrupt the healthcare system, and new research from Blue Cross Blue Shield found nearly six in 10 patients taking the drugs don't reach a meaningful health benefit.... Weight loss medications such as Ozempic and Wegozy can cost upward of $10,000 a year. In 2022, Medicare spent $5.7 billion on the medications, up from $57 million in 2018 ... If half of Americans with obesity took weight loss drugs, it would cost $411 billion annually[.]"