Tag Archives: business

ACA limits Medicare’s use of key value metric for drug prices

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.

Health insurers are trying a wide variety of methods to link drug costs to the value medications deliver to patients. Value-based payment strategies bear watching for two reasons. First, they are aimed at controlling the high costs of prescription medications, and, second, they could usher in new ways of pricing all medications.

The idea that insurers should link a drug’s value to price is not new, but it is gaining traction, at least among private health plans. One proposal calls for paying for drugs based on the quality-adjusted life year, or QALY, a measure used to quantify the value of treatment. Continue reading

Reports graphically illustrate spending on dental, other health care

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

Photo: Rob Campbell via Flickr 

Photo: Rob Campbell via Flickr 

America spends a lot of money on dental care – roughly $111 billion a year – according to a new study by the California Health Care Foundation.

Yet that figure was just a tiny slice of the nation’s enormous health care pie, which cost $2.9 trillion in 2013 (the most recent year available) according to foundation’s report, Health Care Costs 101: Reaching a Spending Plateau? Continue reading

Hospital companies see fewer unpaid bills under ACA

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

GraphicStock

GraphicStock

A recent post by Bruce Japsen at Forbes makes a quick supplement to a post we did recently highlighting how hospitals are faring in Medicaid expansion states vs. nonexpansion states.

Japsen knows a lot about the business side of the hospital industry and has written about the ACA’s impact on hospital finance. Recently he’s been paying attention to second-quarter earnings reports of publicly traded hospital companies. (As he notes, it’s the sixth quarter since ACA coverage expansion began.) Continue reading

Report shows lack of competition among Medicare Advantage plans

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.

Source: B. Biles, G. Casillas, and S. Guterman, “Competition Among Medicare’s Private Health Plans: Does It Really Exist?” The Commonwealth Fund, August 2015.

Source: B. Biles, G. Casillas, and S. Guterman, “Competition Among Medicare’s Private Health Plans: Does It Really Exist?” The Commonwealth Fund, August 2015.Click to enlarge.

Anyone examining health insurance competition should look closely at a new report from the Commonwealth Fund, which indicates competition among Medicare Advantage (MA) plans is so rare that only one county studied is considered to not have a highly concentrated MA market.

After reviewing enrollment data in all U.S. counties with at least 10 residents enrolled in Medicare Advantage plans, the report, “Competition Among Medicare’s Private Health Plans: Does It Really Exist?,” said that in the 100 counties with the most MA members, market power is concentrated among three big insurers in almost two-thirds of those counties. Continue reading

Hospital association says consolidation could reduce competition in 817 markets

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.

GraphicStock

GraphicStock

One local story to follow when any health insurer considers acquiring another is how the new entity could affect competition. By that standard, there could be 817 local stories to cover simply as a result of Anthem’s plan to acquire Cigna, according to the American Hospital Association (AHA).

In a letter Thursday to the U.S. Department of Justice, Melinda Reid Hatton, AHA’s senior vice president and general counsel, said Anthem’s acquisition of Cigna could reduce competition among health insurers in at least 817 geographic markets and affect 45 million Americans. Continue reading