Reference Pricing: Will Price Caps Help Contain Healthcare Costs?

Many employers have begun to adopt a strategy known as “reference pricing” to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the “reference price,” they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge.

Quality Care: Getting More Bang for the Buck?

Health care policy leaders are counting on public and private initiatives, such as paying for performance, to improve value in the health care equation in which cost and quality at times seem to be at odds.

Health Care Consolidation

The pace of health care consolidation is accelerating. Over half of hospitals were exploring a possible merger in 2013, and half were also planning to purchase physician practices. The dollar value of those acquisitions declined, however, as recent purchases have been less about megamergers and more about smaller entities as the newer targets of acquisition.

Streamlining Cost Sharing in Medicare: The Impact on Beneficiaries.

Recent proposals to combine the two main parts of Medicare would mean streamlining deductibles and other cost-sharing for beneficiaries. But health care policy experts are cautioning that such a change is complicated and requires analysis. A July 22 briefing explored the impact on beneficiaries.

Medicare for the 21st Century

The federal government currently spends about 15 percent of its budget on Medicare, and the program faces substantial growth in beneficiaries as baby boomers continue to age into eligibility. A June 3 briefing, “Medicare for the 21st Century,” addressed the sustainability of Medicare under its current design.

Price and Quality Transparency: Tools for Informing Health Care Decisions

The Patient Protection and Affordable Care Act (ACA) calls for increased consumer involvement in health care decision-making. Transparency in price and quality as a tool for consumer engagement is a critical component of that process. One does not buy food, clothing or housing without comparison shopping. Yet in health care, equally important and typically a large part of the family budget, consumers have not had the tools to compare prices and quality of the product they are buying. The data are spotty and the little data that are available are not consumer friendly.

The Sustainable Growth Rate: Seeking a ‘Doc Fix’

The public is keeping a close eye on federal budget deficit reduction efforts this year, including potential automatic spending cuts initially mandated by the Budget Control Act of 2011. Yet one component of the debate has been largely ignored - the Sustainable Growth Rate (SGR). Indeed, because of the SGR, physicians in January 2013 faced a 26.5 percent cut in Medicare reimbursement rates. Last-minute congressional intervention delayed the cut until January 2014 as part of the American Taxpayer Relief Act of 2012. Without intervention, physicians will receive a 25 percent reimbursement cut in January 2014. At the same time, according to the most recent Congressional Budget Office (CBO) estimates, if Congress and the president agree to permanently eliminate the SGR, the deficit will grow by another $138 billion over 10 years. The cost of repealing the SGR has fallen significantly since last year, spiking a new interest in permanently fixing the problem.

The Doc Fix: What Happens Next?

Proposals to fix the Sustainable Growth Rate (SGR) abound and there is agreement that policy makers must take action, but the question of how to reach a permanent solution remains. The SGR originated as part of the Balanced Budget Act of 1997 to control federal Medicare spending. Congress began overriding the SGR in 2002 and has continued to delay scheduled physician reimbursement cuts ever since. Medicare physician payments were maintained at their current rates in 2012 as a result of The Middle Class Tax Relief and Job Creation Act of 2012. Most recently, Congress extended payment rates until January 2014 as part of the “fiscal cliff” negotiations.

Approaches to Bending the Health Care Cost Curve

Health spending in the U.S. climbed to $2.7 trillion and constituted 17.9 percent of the nation’s gross domestic product (GDP) in 2011. A recent report released by actuaries at the Centers for Medicare and Medicaid Services (CMS) found that health spending as a share of GDP remained steady at 17.9 percent from 2009 through 2011. Despite that stability, some analysts warn that, as the economy improves and the population ages, cost increases could again accelerate. Effects of cost constraining provisions in the Patient Protection and Affordable Care Act (PPACA) are largely unknown, since major provisions will not be implemented until 2014.

Raising Medicare’s Eligibility Age: A Complex Proposition

With Americans living longer, some policymakers are proposing to gradually raise Medicare’s eligibility age from age 65 to 67 as part of a broader package to reduce the federal debt. The later starting point is projected to reduce federal spending by $113 billion over the next decade, according to the Congressional Budget Office, which estimates that most people would gain insurance coverage through other sources.

Health Care on the Brink of the Fiscal Cliff

As Washington attempts to steer clear of the “fiscal cliff,” it is important that policymakers, stakeholders and the public have a clear understanding of the components of this key policy crossroads and the likely consequences of inaction – on everything from expiring tax cuts to debt ceiling increases to scheduled budget reductions. The goal of a Nov. 16 briefing was to foster that understanding.

The Right Care at the Right Time: Are Retail Clinics Meeting a Need?

Urgent care centers and retail clinics are rapidly emerging within the health care system — a partial response to rising health care costs and a possible flood of new demand for care as the Patient Protection and Affordable Care Act is fully implemented. The number of patient visits to retail health clinics grew by 1,000 percent in just the last two years, according to a RAND Health study.

Health Care Costs: What Can Be Done?

Though there is still disagreement about the extent to which various cost drivers contribute to the troubling trajectory of health care spending in the United States, there are success stories. This briefing took a look at some of the innovative strategies in both the public and private sectors that have bent the cost curve downwards and some that may hold promise for lowering the rate of growth of national health care spending. The briefing also featured Dr. Paul Ginsburg presenting a paper that was commissioned especially for this series. The paper examines a range of policy strategies that might promote changes in health financing and delivery that would encourage higher quality and more efficient care delivery.

Health Care Costs: The Role of Technology and Chronic Conditions

This is the second event in a three-part series of discussions on costs, the factors driving them up and what (if anything) can be done about them. The series marks the Alliance for Health Reform’s 20th year of promoting informed and balanced discussion of health policy issues.

Health Care Costs: The Role of Prices and Volume

This was the first event in a three-part series of discussions on costs, the factors driving them up and what (if anything) can be done about them. The series marks the Alliance for Health Reform’s 20th year of promoting informed and balanced discussion of health policy issues.