Research using new private insurer data sheds light on how system is and isn’t working in six areas

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Six research reports released today by the Health Care Cost Institute show how the health insurance system is working and failing to work in such six major areas. Researchers report, for example, that mental health parity laws have not increased access to mental health services for some patients, and that consolidation among providers drives up treatment costs for cancer patients.

The research also shows that:

  • Giving patients with low back pain unrestricted access to physical therapy reduces the use of opioids for pain management and emergency room visits.
  • Providing financial incentives to encourage patients needing colonoscopies to choose low-cost providers keeps costs down.
  • Nurse practitioners help to cut the cost of primary care.
  • Payment for telehealth services is 40 percent lower than non-telehealth care.

For health care journalists covering any of these topics, these research reports may guide your reporting.

To produce the six reports, independent university researchers used data that HCCI collected from three health insurers (Aetna, Humana, and UnitedHealthcare). HCCI says its dataset is one of the largest private databases of health insurance claims of its kind and includes claims data from more than 50 million Americans.

The six reports follow the release in December of research, based on some of the same HCCI health insurance data, that showed how prices rose when hospitals merge. In a tip sheet and blog post earlier this week, we covered the importance of the research on hospital mergers.

“Currently, we have limited information on the effects of reforms happening at the state and national levels,” said Amanda Frost, HCCI’s senior researcher. “We believe that this data-driven research will build a knowledge base about the changing health care landscape, and serve as a resource for policymakers and consumers alike.” To pay for the research, HCCI used grants from the Laura and John Arnold Foundation and the National Academy for State Health Policy to analyze how states are implementing the Affordable Care Act (ACA) and making other health system reforms.

Of the six research reports, one on mental health parity and another patients’ cancer costs stood out as the most striking.

The federal Mental Health Parity and Addiction Equity Act has had little to no effect on access and use of mental health services for patients with depression, bipolar disorder, and schizophrenia, according to researcher Benjamin F. Miller, PsyD, an assistant professor in the Department of Family Medicine at the University of Colorado School of Medicine, and his co-researchers. The number of visits to mental health professionals did not rise as expected if parity had increased access to care.

The research on the effect of provider consolidation on cancer costs is similar to that of the earlier research on hospital consolidation, in that researchers in both projects found consolidation increased patients’ costs. “Increased medical provider consolidation with hospitals and/or health systems results in increased spending on outpatient prescription drug-based cancer treatment,” according to the research by Rena M. Conti, PhD, assistant professor of health policy and economics at the University of Chicago, and colleagues.

For additional background, note that Lola Butcher covered this topic as an AHCJ reporting fellow on health care performance.

In the four other reports, researchers found the following:

  • Seeing a physical therapist as the first point of care for lower back pain reduces potentially costly services later, such as ER visits and — most important for anyone covering opioid use — use of prescription opioids, according to an analysis by Bianca Frogner, PhD, director of Center for Health Workforce Studies at the University of Washington, and colleagues.
  • Giving patients a financial incentive to choose low-cost, reference-based pricing for colonoscopy providers can save 8.5 percent of the per-procedure cost, according to Christopher Whaley, PhD, a research economist in the School of Public Health at the University of California Berkeley, and colleagues. If just three health insurers — Aetna, Humana and UnitedHealthcare — adopted reference-based payments for colonoscopies, they would cut the costs of this procedure by about $95 million annually, the researchers estimated.
  • Allowing nurse practitioners to treat patients without a supervising physician drives down the cost of primary care, according to Ulrike Muench, R.N., Ph.D., an assistant professor in Social and Behavioral Sciences at the University of California, San Francisco, and colleagues. After examining the effects of states’ scope-of-practice laws, the researchers found that prices for primary care services fell 1 percent to 4 percent while overall health care spending rose, possibly as a result of increased access to care.
  • Payment for telehealth services is 40 percent lower than it is for non-telehealth care, according to Fernando A. Wilson, Ph.D., an associate professor in the Department of Health Services Research & Administration at the University of Nebraska Medical Center’s College of Public Health, and colleagues. Many states permit reimbursement for telehealth services, but only seven states mandate reimbursement parity between telehealth and non-telehealth care, the researchers reported.

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