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.
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.
Nathan Smith is a senior analyst based in Salt Lake City. As a senior analyst, Nathan works directly with the research and development team managing data-related client work and internal research tasks. Using CMS Limited Data Set (LDS) 2013 claims data, I examined the distribution of all Medicare fee-for-service (FFS) costs. The LDS claims file […]
Each year CMS releases its Limited Data Set (LDS) claims data for all Medicare beneficiaries. Medicare claims data provides a wealth of information that can be used to inform researchers, policy makers, and commercial entities about health care trends throughout the country and in particular locales. I used the 2013 Medicare denominator data file to […]
Last October I wrote a blog examining the average number of days that opioids were prescribed per medicare beneficiary at the state level. There is continual interest in understanding and reducing the abuse of prescription pain medicines.1 Use of opioids to manage pain has been increasing steadily since the early 90s,2 and increased use is […]
Opioids are a class of drug primarily used in the treatment of pain. According to the NIH, The number of people both using and abusing opioids has increased significantly since 1999. Scientific research has revealed several deleterious effects associated with opioid prescription drug abuse. The primary concern with increased opioid prescribing is the high probability […]