August 2016 Nearly every health care reporter comes across this challenge daily: how to account for costs? Whether writing about the uninsured, drug prices, insurance plans or the business of heath care, journalists are constantly wading through complex web of pricing and related issues. Consumer Union’s Lynn Quincy discussed how to navigate the challenge of health care costs, from finding transparent information on costs and quality to understanding the wide price variations for seemingly similar care.
June 2016 For journalists reporting on how payers, providers and patients are promoting discussions about treatment options and costs, AHCJ hosted a webinar with Robert W. Carlson, M.D., chief executive officer of the National Comprehensive Cancer Network.
November 2015 On Nov. 18, the Health Care Incentives Improvement Institute (HCI3) published methodology that will allow consumers, health plans, provider organizations and others to better calculate complication rates for individual physicians. This has the potential to empower consumers, payers, and providers to do their own evaluations of physicians based on doctors’ rates of potentially avoidable complications.
François de Brantes, HCI3’s executive director, explained the methodology and previewed the results of the organization’s third annual State Report Card on Transparency of Physician Quality Information.
September 2015 As executive director of the nonprofit Health Care Incentives Improvement Institute, François de Brantes has been working with health plans and providers to implement bundled payment programs since 2007. Bundled payment initiatives from CMS have been criticized for not taking full advantage of this innovative payment model. In the private sector, however, health insurers, hospitals, and physicians are demonstrating how to fully develop bundled payment programs and make the operational adjustments needed to ensure their long-term success.
In this webcast, de Brantes discussed how providers and payers are getting good results from bundled payment programs and expanding many of these initiatives.
August 2014 In this webcast, Mark Fendrick, M.D., the director of the Center for Value-Based Insurance Design (VBID) at the University of Michigan, explained the concept of VBID and discussed why legislation is needed to allow the federal Centers for Medicare & Medicaid Services to start a VBID demonstration project for members of Medicare Advantage plans. Insurance core topic leader Joe Burns discussed story ideas and resources for reporting with Fendrick.
Fendrick explained the principals of VBID and why this strategy is important for consumers. Most health insurers do not use VBID when implementing cost-sharing strategies with consumers. Instead they use what Fendrick called a “one-size-fits-all approach,” such as high copayments and high-deductible health plans.
December 2013 Come Jan. 1, the newly insured will be like most Americans using the health care system today: They will lack the information they need about the cost of health care services and about how much of the total cost is their responsibility.
Two experts shared information on efforts to increase transparency in health care costs, tips on stories reporters should be covering and an extensive list of resources on the topic.
October 2013 This AHCJ webcast explored how the launch of health insurance exchanges across the country will affect rural Americans. Nearly one in five uninsured Americans live in rural areas, and a greater proportion of rural residents lacks health insurance compared with the proportion of urban residents without health care coverage. One of the goals of the Affordable Care Act is to help make health insurance coverage affordable and accessible for the approximately 60 million Americans who live in rural areas.
Introduction to Hotspotting
The Camden Coalition explains that health care hotspotting is the strategic use of data to reallocate resources to a small subset of high-needs, high-cost patients.
We know that a small number of individuals drives much of the cost in the American health care system. The system struggles to help extreme patients, or outliers – the small number of patients with complex, hard-to-manage needs and chronic conditions. These outliers are known as super-utilizers. Over time, their chronic conditions worsen, leading to ever more expensive, invasive and risky treatment. Super-utilizers are the patients our standard systems have failed.
Hotspotting uses data to discover the outliers, understand the problem, dedicate resources, and design effective interventions. It is a movement for a new system of multi-disciplinary, coordinated care that treats the whole patient and attends to the non-medical needs that affect health: housing, mental health, substance abuse, emotional support.
Health Care Consolidation: What You Need to Know
The Alliance for Health Reform hosted a discussion about health care consolidation on Dec. 15, 2015. A top Federal Trade Commission official, along with key experts, met with reporters to discuss the recent surge in health care consolidation; the driving forces behind this trend; and the implications for policymakers and enforcers.
In 2014, there were a total of 1,299 mergers and acquisitions in the health care sector – a record number, up from 1,035 the year before. That includes a recent spike in pharmaceutical transactions, including inversions, which base U.S. drug companies overseas.
Speakers will provide the latest information about the roles of the Department of Justice and the Federal Trade Commission; efforts by policymakers; the scope and extent of consolidation among doctors, hospitals, insurers and pharmaceutical companies; and implications for consumers and other stakeholders.
Deborah Feinstein, director of the Federal Trade Commission’s Bureau of Competition
Andrea Murino, partner and co-chair of Goodwin Procter’s antitrust practice
George Slover, senior policy counsel at Consumers Union
Alan Weil of Health Affairs and Marilyn Serafini of the Alliance for Health Reform moderated.
Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation, led a discussion of the growing interest in transparency in the quality and cost of health care. Panelists include Anne Weiss, senior program officer at the Robert Wood Johnson Foundation; Elizabeth Mitchell, president and CEO of the Network for Regional Healthcare Improvement; Peter Isaacson, chief marketing officer at Castlight Health, a leading health care transparency company; and Chris Baily, interactive designer at Consumer Reports and winner of the RWJF Transparency and Data Challenge.
In this video, John E. McDonough, DPH, MPA, a professor of public health practice at the Harvard School of Public Health, explains risk corridors under the Affordable Care Act. Risk corridors are common in all kinds of insurance, particularly when insurers introduce policies in new markets where risk is unpredictable, he explains. The corridors help to prevent insurers from suffering steep losses or from having to set premiums too high, he adds. McDonough helped to write the ACA when he served as senior advisor on national health reform to the U.S. Senate Committee on Health, Education, Labor and Pensions from 2008 to 2010.
Daryl Wansink, director of health economics for Blue Cross Blue Shield of North Carolina, talks about how BCBSNC is using data to identify those members who are high utilizers of the emergency room and inpatient services. Health insurers are interested in this small proportion of members (usually about 5 percent) who are responsible for a big chunk of costs (some estimate as much as 50 percent of all spending). These are the patients who use the ER for primary care or who have multiple in-patient stays in a year. By using data to identify these patients, the insurer can get them the care and the resources they need to help them use the health system more effectively. Such strategies are important for health plans seeking to contain costs in accountable care organizations and in patient-centered medical homes. They also are important for these patients who are often neglected by the health system and end up getting care in the ER repeatedly rather than with a primary care physician.
During a forum sponsored by the Harvard School of Public Health, experts from Harvard discussed the introduction of the Affordable Care Act and the issues that insurers and the federal and state governments will face in the coming months and years. David Morgan, a correspondent for Reuters, moderated the session. The speakers included David Cutler, a Harvard professor of applied economics; Katherine Baicker, a professor of health economics at the Harvard School of Public Health; Robert Blendon, a professor of public health and senior associate dean for policy translation and leadership development at the Harvard School of Public Health; and John McDonough, a professor of the practice of public health and director of the center for public health leadership at the Harvard School of Public Health.