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Is Health Care Shoppable?

"The fact that patients struggle to shop in this favorable setting makes it unlikely that greater cost sharing and price transparency will lead them to shop for more complex services. A more promising avenue may be to harness the power exerted by referring physicians and help them to help their patients select better value providers."

High Deductibles May Encourage Smarter Patient Decisions About Low-Value Care Use

"Over the three years after a firm began offering a health plan with a deductible of at least $500, its spending for a set of 24 low-value outpatient services fell by an average of 13.7% compared to firms that never offered such a plan.... The percent reductions in spending were significantly larger for low-value services than for all outpatient care and all laboratory services, suggesting some ability and willingness of patients to selectively curtail low-value care."

Improving Payment Accuracy in Health Insurance Marketplaces

"Despite real differences in how the three study countries administer risk adjustments, ... even the sophisticated risk adjustment methods they currently use fail to accurately compensate health plans for the risks represented by specific enrollees.... This study demonstrated the important payment improvements that can be achieved across the board by reinsuring against losses for the small portion of enrollees whose care is grossly undercompensated and suggests this reinsurance will not weaken plan incentives to effectively manage care for these very high cost patients."

Creating Sustainable Local Health Information Exchanges - Can Barriers to Stakeholder Participation be Overcome?

Excerpt: Findings from a study of stakeholder perspectives on participation in four HIEs by the Center for Studying Health System Change (HSC) and the National Institute for Health Care Management (NIHCM) Foundation suggest, however, that barriers to achieving data exchange remain high. Concerns about loss of competitive advantage and data misuse impede provider and health plan willingness to contribute patient data. Additionally, uncertainty about who benefits from HIEs is affecting stakeholder willingness to fund the exchanges.

Better Prediction of Rising Health Spending to Improve Cost Containment

"Spending patterns over two years were best described by classifying patients into five groups: minimal users comprised 11 percent of the population; low-, moderate- and high-cost patients accounted for 15, 25, and 41 percent, respectively; and patients with rising costs were 8 percent of the population.... Across patients with similar baseline spending, the odds of subsequently incurring rising spending were higher for patients using fewer medications, having fewer office visits, seeing a larger number of different physicians and using tobacco. These factors suggest patients to target for intervention."

After Changing Insurance Carriers, Do Patients Change Physicians and Use Emergency Departments More?

"For patients initially covered by private insurance, changing carriers was associated with a nearly 50 percent increase in new [primary care physician] visits while visits to new specialists fell slightly. The overall decline in new specialist visits was caused by lower use among patients who faced higher deductibles after changing plans. These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year."

How Do Providers Respond to Reference Pricing?

"There was no evidence that providers responded to the changing incentives by lowering prices only for patients facing reference pricing.... There also was no evidence that providers attempted to compensate for lower facility prices by raising other fees, by charging higher prices to other insurers for these services or by letting quality decline.... Significant changes in provider pricing behavior in response to reference pricing are unlikely unless these programs are coordinated across many large employers and purchasers."