Subscribe to Weekly Health Care News
Weekly access to breaking news, exclusive reports and events. No spam here.
As health care costs continue to consume an increasingly large share of the federal budget and impact Americans’ personal finances, it is important to understand the various drivers of those costs. The literature documents how higher levels of concentration (lack of competition) among commercial payers and providers contributes to higher premiums for commercial health plans. Less well understood, however, is the relationship between the concentration of Medicare Advantage (MA) plans in a market and MA premiums. Our paper uses a fixed-effects, multivariate regression to evaluate the association of both MA plan concentration and health system concentration on MA premiums. We found that increased concentration (lower competition) in the MA insurance market was associated with higher MA premiums and that if all beneficiaries were in markets at least as competitive as the average market today, they would pay nearly $200 million less in annual premiums. We also found that the highest premiums were in markets that lacked competition among MA payers and hospital markets, suggesting the interaction between MA insurer concentration and hospital system concentration matters. Our findings suggest that maintaining or increasing current levels of competition is necessary for controlling MA premiums.
In 2014, Affordable Care Act (ACA) federal requirements went into effect that dramatically changed the regulatory framework for the individual market in most states. The ACA also applied separate regulatory changes to the group market, with the small group market having to undergo more adjustments than large group, but in general these reforms had less of a disruptive impact than in the individual market. This paper compares average claims expense across the individual and group markets by analyzing total incurred medical claims, both before and after the ACA’s requirements went into effect, from 2010 to 2016. Because we examined the years 2010 to 2016, this paper does not take into account recent changes that may affect costs and premiums in 2018 and beyond. We find that at the national level, individual market costs are coming into increasing alignment and achieving parity with costs in the group markets. Our findings suggest the ACA’s 2014 regulations brought the individual market into greater cost parity with the more mature group market. If costs in the individual market rise beyond the point of parity with the group market, then the increases may be more indicative of the structure and makeup of the market than with just underlying health care costs.
By 2030, it is estimated that the United States will lack between 40,800 and 104,900 physicians. Moreover, there is a maldistribution of physicians across and within states. To address these projected shortages, some states, depending on their current environment, could bolster their supply of physicians by increasing their existing medical school enrollment or building new medical schools. We used data from the Medicare Physician Compare database to examine state retention of their medical school graduates and how a variety of factors, such as physician age, specialty, and gender, were related to a physician’s likeliness of practicing in their medical school state. We also analyzed the relationship between state retention of physicians and number of physicians per capita. We found that on average, states retain 38 percent of their medical school graduates and physicians who pursue a non-primary care specialty are more likely to leave their medical school state. We also observed a significant negative correlation between state retention and number of physicians per capita. Additional medical schools may not sufficiently address some state’s physician shortage unless other measures are also pursued, such as increasing residency positions. As states assess their physician supply and medical school graduate retention, there is also an opportunity for states to incorporate more value-based care training into the curriculum of both their existing and new medical schools. States may also consider encouraging the use of physician and non-physician care teams as an additional strategy to addressing their primary care physician shortage.
The Comprehensive Care for Joint Replacement (CJR) bundled payment model is a Centers for Medicare and Medicaid Services (CMS) initiative that is designed to incent hospitals to reduce the widespread cost variation in hip and knee replacements, and post-operative hospital readmissions throughout the United States. Originally announced in 2015 and revised in 2017, hospitals in
34 markets will be required to participate in the model, including being subject to downside risk, beginning January 1, 2018.
Bundle payment models, including the Bundled Payments for Care Improvement Initiative (BPCI), are an important part of the episode-based health care value transformation. However, they are also under increased scrutiny, in part due to strong concerns among some Republicans regarding mandatory models as well as the idea that they do little to curb the volume […]
Emergency medical services (EMS) evoke images of EMTs and paramedics responding to medical crises and transporting patients to the hospital rather than thoughts about value-based care and changes in health care delivery and payment models. EMS leaders are trying to change that paradigm through a movement dubbed “EMS 3.0.” EMS 3.0 aims to make emergency […]