Phil Galewitz, Kaiser Health News (presentation)
Stay in contact with your state insurance regulator and watch for filings from insurers at state Insurance Department. These filings are good because insurers have to cite specific reasons for why rates are rising: is it higher hospital or drug prices or patients needing more care? Who are they pointing the finger at and what are they doing in response? Then regulators and consumer groups often file their own responses questioning the insurers’ math and rationale. Here’s one example from California Department of Managed Health Care.
Some web sites show how much insurers pay providers, though all are limited. Sometimes the most helpful thing is to look at your own health plan’s site, and ask friends with different plans to show you what their insurers have.
Guroo has data from some of the biggest health insurers and can provide at least a range or baseline for what’s being paid by insurers for certain medical services, both locally and nationally.
This group represents operators of all-payer claims databases. It includes a map with links to sites in states that operate such databases.
Fair Health Consumer and Health Care Bluebook have at least limited data on pricing, though it is not provider-specific.
An issue that is increasingly central to health-business stories is consolidation – among and between both providers and insurers. This hearing jointly held by the FTC and Justice Department has a lot of interesting background on the antitrust implications.
For more national context, Irving Levin Associates tracks health-care mergers.
Anna Matthews, The Wall Street Journal (presentation)
Monitor and read financial disclosure statements, both quarterly and annual from companies. They exist for both for-profits (the Securities and Exchange Commission) and not-for-profits (bond filings).
For publicly traded companies (which includes not just hospital chains like HCA and Tenet; large ‘other’ providers like Davita, Fresenius and HealthSouth; insurers like UnitedHealth, Anthem, Cigna, Aetna and Humana; drug, biotechnology, medical device companies; pharmacy and PBMs; distributors like McKesson and Becton Dickinson; GPOs like Premier and MedAssets; HIT companies like Cerner and Allscripts, etc.), learning how to navigate and set up alerts for the SEC’s Edgar system is the place to start. For companies you care about, set up alerts for the 8-ks (material disclosure statements). And don’t forget to read the “litigation” section in every report in addition to the core discussion of the financial results. This is where companies reveal whether they are under investigation or have been sued. Reporters should scan company earnings reports and listen to an quarterly earnings conference call or read over the transcript for clues on how a hospital chain, drugmaker or health insurer makes its money. They will tout profit-making moves to Wall Street that they wouldn’t necessarily discuss in front of consumers. They will talk about government rules they’re trying to change or big contracts they’re trying to win. Most of this information is available at a company website under investor information.
Get on a couple email lists for Wall Street analysts who cover healthcare. It’s a good way to stay current on industry trends like hospital use, Medicare Advantage rates or market consolidation. Some suggestions would be Ana Gupte, Leerink Partners, or Joshua Raskin, Barclays.
For non-profits, whether hospitals, patient advocacy groups, home health agencies and myriad other organizations in the healthcare space, one starting place is the IRS 990 filings available through Guidestar.
But the more insightful filings come from the bond disclosure documents for large hospital systems, filed both quarterly and annually. There you can go to DACBond and MuniOS for real-time filings.
For crime and waste, fraud and abuse beats (adjuncts to the antitrust beats mentioned by Anna), the go-to starting places are the OIG’s office at HHS (OIG news releases and Medicare Fraud Strike Force), as well as the routine announcements of the DOJ and FTC on these subjects. The joint HHS-DOJ task force website is an education unto itself. Many state attorneys general are active in the fraud arena, especially in the big, traditionally more activist states like California, New York and Connecticut.
Consumer protection issues are huge. Mostly a state-based affair when it comes to healthcare. Insurance commissioners, who belong to National Association of Insurance Commissioner, are vital but don’t forget the quality and safety side: state health departments, medical and other healthcare professional licensing boards, etc.
Covering the physicians’ business, where they are mostly organized into large specialty practices, is tougher. They are privately-held and have few publicly available filings that reveal their financing. However, many are also employed by hospitals and their salaries are revealed in 990s.
Retail clinics and urgent care are drawing more attention and competition in every community. Tom Charland at Merchant Medicine issues a free industry report every month full of names and numbers on drugstores, big box retailers and hospitals battling over all this, perfect for local or national stories.
Medicare and Medicaid are both a treasure trove of stories — particularly as both programs are increasingly run by private sector companies. Which Medicare Advantage plans have the highest enrollees? Which Medicaid health plans are enrolling the most members? Data on both can be had from state insurance departments. Other sources for data are MEDPAC (Medicare) and MACPAC (Medicaid).
Merrill Goozner, Modern Healthcare (presentation)
Modern Healthcare is getting into the data game in a big way. It has publicly available data that tracks hospital system finances, some quality and safety data, compensation by hospital and other titles, mergers and acquisitions, and lobbying. Find descriptions of those databases here. The magazine will give free access to any journalist as long as they cite Modern Healthcare as the source of the information if they use it. There’s a lot journalists can do by doing comparisons of institutions within their cities or states. For more info, email Editor Merrill Goozner.
