Insurance

High-Deductible Health Plans Linked to Lower Health Care Utilization

High-Deductible Health Plans Linked to Lower Health Care Utilization

Emergency department visits declined by 14% among study participants were switched to a high-deductible health plan.

Prior Authorization Equals Current Frustration: Challenges in Practice

Prior Authorization Equals Current Frustration: Challenges in Practice

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Insurance companies believe that if there are enough hurdles to jump over — and if the hurdles are high enough — patients and physicians might stop running.

Trends in Spending Following ACA Implementation Examined

Trends in Spending Following ACA Implementation Examined

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Overall, implementation of the Affordable Care Act has been associated with reduced out-of-pocket healthcare spending.

The CVS/Aetna Merger: What It Means for the Future of Primary Care

The CVS/Aetna Merger: What It Means for the Future of Primary Care

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In the new partnership, Aetna will have access to data on pharmaceutical usage patterns that will allow the company to carefully parse the insurance risks it takes on.

Balancing Sustainability and Access to Care in Concierge Medicine

Balancing Sustainability and Access to Care in Concierge Medicine

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One of the major pitfalls of concierge medicine is that physicians must limit their practice to guarantee the accessibility offered by the model in exchange for the retainer.

Physicians Must Report on 1 Patient and 1 Measure for MACRA

Physicians Must Report on 1 Patient and 1 Measure for MACRA

Physicians must report on at least 1 patient and 1 measure by December 31, 2017 and submit the report to Medicare no later than February 28, 2018.

Requiring Insurers to Participate in Marketplace Could Improve Access

Requiring Insurers to Participate in Marketplace Could Improve Access

If the government required insurers that participate in Medicare or Medicaid to participate in the marketplaces in the same geographic area, there would be potential to improve access.

Observation Care Costs Increased Among Commercially Insured Patients

Observation Care Costs Increased Among Commercially Insured Patients

The cost of observation care has increased for commercially insured patients, but it is still lower than spending for short-stay hospitalizations

Value-Based Payment Modifier Program Not Linked to Differences in Practice Performance

Value-Based Payment Modifier Program Not Linked to Differences in Practice Performance

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The Value-Based Payment Modifier is not associated with differences in performance between practices serving higher-risk and lower-risk patients.

Cancer Survival Improvements Limited to Patients With Medicare, Private Insurance

Cancer Survival Improvements Limited to Patients With Medicare, Private Insurance

Improvements in cancer survival were limited to patients with private or Medicare insurance.

Medicaid's Best-Price Rule May Not Be Such a Big Problem

Medicaid's Best-Price Rule May Not Be Such a Big Problem

Researchers note that the best-price rule may be an impediment to some novel pricing arrangements in the private sector, but there are ways to avoid or mitigate its impact.

Insurers Can Reduce Provider Prices in Highly Concentrated Provider Markets

Insurers Can Reduce Provider Prices in Highly Concentrated Provider Markets

In highly concentrated markets, hospital admission, cardiologist, radiologist, and oncologist visit prices were lower.

Prior Authorizations Addressed by New AAFP Policy

Prior Authorizations Addressed by New AAFP Policy

Coalition urges insurers to apply reform principles to current prior authorization programs.

Decline of Uninsured Rates in Adults Starting to Slow Down

Decline of Uninsured Rates in Adults Starting to Slow Down

The uninsured rate was 9% in 2016, compared with 9.1% in 2015.

Higher Quality Products Associated with Vertical Integration Insurance

Higher Quality Products Associated with Vertical Integration Insurance

There was a slight increase in the percentage of insurance products offered by hospitals and health systems from 2011-2015.

Television Advertising During ACA Enrollment Decreased Uninsurance Rates

Television Advertising During ACA Enrollment Decreased Uninsurance Rates

Counties exposed to higher volumes of local insurance ads had a larger drop in uninsurance.

Uninsurance Rates Reach 8.8% of Americans in 2016

Uninsurance Rates Reach 8.8% of Americans in 2016

In first nine months of 2016, 12.3% of adults aged 18 to 64 and 5% of children were uninsured.

Opinions on Disability Benefits Varies Among Physicians

Opinions on Disability Benefits Varies Among Physicians

An international study finds a wide variance in how medical professionals determine benefit recipients.

ACA Increased Coverage Access for Chronically Ill Patients

ACA Increased Coverage Access for Chronically Ill Patients

However, nearly 1 in 7 of those with a chronic disease still lack coverage.

Outcomes-Based Pricing Suggested for Expensive, Novel Drugs

Outcomes-Based Pricing Suggested for Expensive, Novel Drugs

Strategy would encourage manufacturers and insurers to share accountability for clinical outcomes

Health Care Cost Rising Significantly for Privately Insured Americans

Health Care Cost Rising Significantly for Privately Insured Americans

Prescription drugs are the fastest growing expense, report shows.

Major Unexpected Costs After In-Network ED Visits

Major Unexpected Costs After In-Network ED Visits

Although a hospital may be in an insurance network, the treating physician may not be.

Medicare Part D Reduces Cost Burden of Prescription Drugs for Diabetes

Medicare Part D Reduces Cost Burden of Prescription Drugs for Diabetes

There was a decrease in the proportion of Part D beneficiaries who experienced coverage gap to 40.9% in 2011.

Majority of Health Professions View Insurance as Solution for Obesity

Majority of Health Professions View Insurance as Solution for Obesity

Approximately 57% of health professionals perceive improved coverage as a solution to improve outcomes in obese patients.

Similar Rates in Employer-Sponsored Insurance Observed in 2013 and 2014

Similar Rates in Employer-Sponsored Insurance Observed in 2013 and 2014

This report shows that only 3.5% of employers dropped coverage and 1.1% added coverage from 2013 to 2014.

Narrow-Network Plans Have Lower Monthly Premiums Than Larger-Network Plans

Narrow-Network Plans Have Lower Monthly Premiums Than Larger-Network Plans

Study shows that small-network plans have less expensive monthly premiums when compared to larger-network plans.

Stable Premiums for Health Care Coverage Seen in 2016

Stable Premiums for Health Care Coverage Seen in 2016

Family premium were 3% higher in 2016, but overall, there were no changes in share of firms offering health benefits.

Copay Assistance Programs Believed To Do More Harm Than Good in Health Care Markets

Copay Assistance Programs Believed To Do More Harm Than Good in Health Care Markets

Despite offering assistance to those who cannot afford expensive medications, copay assistance programs create broader problems for patients.

Considerable Variation Seen in Medicare Payments for Perioperative Complication Patients

Considerable Variation Seen in Medicare Payments for Perioperative Complication Patients

A large variation in Medicare payments across hospitals for patients rescued from perioperative complications has been reported.

Premium Rates Under ACA Expected to Rise in 2017, Experts Say

Premium Rates Under ACA Expected to Rise in 2017, Experts Say

Experts say increases in premium rates under ACA will most likely affect people who get modest subsidies or no financial assistance.

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