Spending per person in employer-sponsored plans reaches all-time high of $6,335 Health care spending for the average New Yorker with employer-sponsored health insurance is increasing faster in New York State than the rest of the country, according to a new analysis released today by the New York State Health Foundation (NYSHealth) and the Health Care Cost Institute (HCCI). Per-person spending grew...
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Jul
29
Jul
23
Committees in both the House and Senate have advanced legislation that includes measures to address "surprise bills." A surprise bill results when a person unknowingly receives medical care from a provider that is not part of their insurer's network. Both pieces of legislation set a benchmark for out-of-network payments. Those benchmarks are determined based on the median in-network amount paid by...
Jun
29
HCCI's Healthy Marketplace Index research on prices for specific services was recently featured in an article in the Economist Will transparent pricing make America’s health care cheaper? - Never a bargain https://www.economist.com/united-states/2019/06/29/will-transparent-pricing-make-americas-health-care-cheaper
Apr
30
The New York Times: They Want It to Be Secret: How a Common Blood Test Can Cost $11 or Almost $1,000
HCCI's recent research on variation of prices of specific services was recently featured in an article in The Upshot by The New York Times. From the article: "It's one of the most common tests in medicine, and it is performed millions of times a year around the country. Should a metabolic blood panel test cost $11 or $952? Both of these are real, negotiated prices, paid by health insura...
Apr
30
As policymakers, employers, and patients increasingly struggle with rising health care costs, there is a lack of clarity around the actual price of health care services and why those prices are so different. Recent efforts have focused on greater price transparency as a way to impact growing prices. A range of proposals from both Congress and the White House seek to shed more light on the confusin...
Apr
18
HCCI's research on ER facility prices was cited by the New York Post in a recent article. From the article: "While Jordan's case is extreme, the typical tab for an emergency room visit is still hard to fathom. The average visit costs $1,917, according to the Health Care Cost Institute , which looked at data from 2016. A different study from Johns Hopkins Bloomberg School of Public ...
Apr
03
HCCI's research on rising insulin list prices was recently cited by The New York Times in its reporting on Express Scripts' new plan to offer a $25 cap for month insulin. From the article: "Consumers whose drug benefits are managed by Express Scripts could see their out-of-pocket costs for insulin limited to $25 a month under a plan announced on Wednesday. The move is aimed at addressing rising an...
Apr
02
Where people receive health care matters, especially in terms of costs. The same services may have a much higher price tag when performed in one setting rather than another, but this price difference is rarely publicized to patients. To understand what settings people used and how prices differed, we looked at the utilization and average price paid from 2009 to 2017 for a set of services commonly ...
Feb
19
HCCI recently held a webinar to discuss the 2017 Annual Health Care Cost and Utilization Report. Download PDF File Here
Feb
11
The 2017 Health Care Cost and Utilization Report shows that spending per privately insured person grew by 4.2 percent, the second year in a row of spending growth over four percent. Price increases were the primary driver. The report covers the period 2013 through 2017 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedH...
Feb
05
HCCI's recent report on rising insulin prices was cited in support of congressional inquiries into drug pricing. This included a letter from U.S. Senator Tim Kaine (D-VA) to executives at Eli Lilly, Novo Nordisk, and Sanofi requesting information on insulin pricing. Additionally, HCCI's research on emergency care was cited in a letter from U.S. Senators Bill Cassidy (R-LA)&nb...
Feb
04
Abstract: Evidence suggests that growth in providers' prices drives growth in health care spending on the privately insured. However, existing work has not systematically differentiated between the growth rate of hospital prices and that of physician prices. We analyzed growth in both types of prices for inpatient and hospital-based outpatient services using actual negotiated prices paid by insure...
Jan
28
HCCI's recent report on trends in rising insulin prices received additional media coverage in the last week in outlets including NBC , CBS , CNN , The New York Times , The Hill , U.S. News & World Report , and USA Today . From CNN: "Congress and the Trump administration continue to push for a drug pricing plan and were given more ammunition Tuesday in the form of a report docu...
Jan
22
HCCI's latest research on rising insulin prices was recently featured in Reuters. HCCI's report detailed both use and price trends of insulin used by those with type 1 diabetes from 2012 to 2016. Per Reuters article: "A person with type 1 diabetes incurred annual insulin costs of $5,705, on average, in 2016. The average cost was roughly half that at $2,864 per patient in 2012, according to a...
Jan
22
HCCI's claims data was recently used to support investigations by Sarah Kliff into emergency room pricing in San Francisco. From Vox: "Data from the non-profit Health Care Cost Institute shows that the average price at other San Francisco-area emergency rooms is $2,000 — less than half the city hospital's price. "A privately insured patient does not seem to be getting a very good ...
Jan
21
We used health care claims data to investigate trends in total health care spending on individuals with type 1 diabetes between 2012 and 2016. We found a rapid increase in total health care spending, driven primarily by gross spending on insulin that doubled over the period. During that time insulin use rose only modestly. While the composition of insulins used shifted, the price of all types of i...
Nov
15
Office visits to primary care physicians (PCPs) declined 18 percent from 2012 to 2016 for adults under 65 years old with employer-sponsored health insurance, while office visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. Comparing 2012 to 2016, there were 273 fewer office visits per 1,000 insured individuals to primary care physicians over that span, while v...
Nov
01
Executive Summary: High and rising health care prices play a major role in the persistent increases in health care spending. This study, undertaken by the American Academy of Actuaries Health Practice Council, explores the potential for reference pricing to counter high health care prices and contain health care spending growth. Reference pricing is a system in which an insurer selects a price it ...
Oct
24
Recently, the Health Care Cost Institute (HCCI) published its Healthy Marketplace Index (HMI) – Price Index report, examining relative health care prices in 112 different metropolitan areas. This report is the first in a new series of releases from the HMI project , funded by the Robert Wood Johnson Foundation, which compares commercial health care markets across the country. We found widespread v...
Oct
03
HCCI's 2016 Annual Report was cited in the WSJ: The HCCI findings are "pretty compelling," said Paul Ginsburg, a professor at the University of Southern California. "Higher prices from providers is the most important element in rising premiums in the past few years." Employer-Provided Health Insurance Approaches $20,000 a Year - WSJ The average cost of health coverage offered by employers r...
Sep
18
HCCI data was featured in The Wall Street Journal showing that insurers pay higher prices for some services performed on an outpatient basis that could also be performed in doctors offices.
Sep
18
Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition - WSJ Hidden provisions in contracts between health-care providers and insurers allow hospitals to hide prices from consumers, add fees and discourage use of less-expensive rivals. https://www.wsj.com/articles/behind-your-rising-health-care-bills-secret-hospital-deals-that-squelch-competition-1537281963?mod=hp_lea...
Sep
11
HCCI often reports the prices of health care services, defined as the average amount a provider is paid for a given service based on negotiations with health care insurers. These prices typically represent a portion of charges , which are the amounts health care providers bill for the procedures they perform. The charge amount is often the starting point for negotiations between insurers and provi...
Jun
25
ABSTRACT: The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program...
Jun
19
The 2016 Health Care Cost and Utilization Report shows that spending per privately insured person grew by 4.6 percent, faster than in previous years. Price increases were the primary driver. The report covers the period 2012 through 2016 and includes claims data from four national insurance companies: Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. The data in the report can a...
May
30
HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER CPT codes were higher in 2016 than in 2009, th...
Apr
30
Vitals today released its 2018 Book of Business report . The annual summary reports the metrics associated with shopping activity and savings achieved by employers and employees using Vitals SmartShopper. SmartShopper is a high-tech, high-touch health care program that allows consumers to shop for and choose better-value medical care. Over the past four years, SmartShopper has generated over...
Mar
05
Laurie Cook went shopping recently for a mammogram near her home in New Hampshire. Using an online tool provided through her insurer, she plugged in her ZIP code. Up popped facilities in her network, each with an incentive amount she would be paid if she chose it. Paid? To get a test? It's part of a strategy to rein in health care spending by steering patients to the most cost-effective providers ...
Feb
09
HEALTH AFFAIRS BLOG: "Perhaps nothing illustrates the intractability of America's struggle with health spending more than the recent announcement by Amazon, JP Morgan, and Berkshire Hathaway that they were founding a new entity to address health care costs for their employees. Despite lacking any concrete details this announcement managed to wipe billions of dollars in market capitalization ...
Jan
30
By: Chris Isidore Amazon is partnering with Buffett's Berkshire Hathaway and JPMorgan Chase, the nation's largest bank, to try to address one of the nation's thorniest and priciest problems -- soaring health care costs. The three companies unveiled an as yet unnamed company to give their U.S. workers and families a better option on health insurance. The statement said the new company will be...
Jan
23
By: Carolyn Johnson Americans who get health insurance through their jobs are not using more medical care than they were five years ago, but they are spending more due to soaring medical prices, according to a new report. Health spending for the more than 150 million people who receive insurance through their employers was $5,407 per person in 2016. That is a 4.6 percent increase over 2015, even t...
Dec
08
Spending on emergency department (ED) facility fees rose steadily between 2009 and 2015, even as the overall number of ED fees billed declined, according to an analysis of Health Care Cost Institute (HCCI) data, Sarah Kliff writes for Vox . However, the American College of Emergency Physicians (ACEP) is pushing back against the findings, noting that the analysis examined only spending by employer-...
Dec
04
Medical bills from the Emergency Room (ER) are a mystery to many patients in the US health system. From incredibly high, varying charges to surprise bills resulting from in/out of network confusion , many Americans have no idea what to expect when it comes to the cost of this necessary service. Recently, Vox reporter, Sarah Kliff , has begun collecting ER bills in an attempt to "bring transparency...
Nov
29
In honor of National Diabetes Month, our inaugural blog post focuses on a topic of particular interest to people with diabetes: the price of insulin. Insulin is the hormone responsible for the body's ability to use sugar and prevent dangerously high and potentially deadly levels of blood sugar. Diabetics are unable to make enough insulin to support their bodies' needs, and thus many are dependent ...
Nov
28
By: Marshall Allen This story was co-published with NPR's Shots blog . Two years ago, Margaret O'Neill brought her 5-year-old daughter to Children's Hospital Colorado because the band of tissue that connected her tongue to the floor of her mouth was too tight. The condition, literally called being "tongue-tied," made it hard for the girl to make "th" sounds. It's a common problem with a simple fix...
Sep
02
Three months ago, Niall Brennan was appointed president and executive director of the Health Care Cost Institute, a not-for-profit organization based in Washington, D.C., that focuses on improving price transparency through the use of insurance data. He succeeds David Newman, a health policy expert who had led the organization since its founding in 2011. Brennan was the CMS first chief data office...
Sep
01
ABSTRACT: In markets for health services, vertical integration – common ownership of producers of complementary services – may have both pro- and anti-competitive effects. Despite this, no empirical research has examined the consequences of multispecialty physician practice – a common and increasing form of vertical integration – for physician prices. We use data on 40 million commercially in...
Aug
07
By: Austin Frakt The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare. But the government p...
Aug
01
ABSTRACT: From the inception of the Medicare program there have been questions regarding whether and how to pay for durable medical equipment, prosthetics, orthotics, and supplies. In 2011 the Centers for Medicare and Medicaid Services (CMS) implemented a competitive bidding program to reduce spending on durable medical equipment and similar items. Previously, CMS had used prices in an administrat...
Mar
01
ABSTRACT: Reference pricing in health insurance creates incentives for patients to select for nonemergency services providers that charge relatively low prices and still offer high quality of care. It changes the "choice architecture" by offering standard coverage if the patient chooses cost-effective providers but requires considerable consumer cost sharing if more expensive alternatives are sele...
Jan
09
By: Helaine Olen It's a new year, and you know what that means: Your health insurance deductible just reset. Which for many of us means looking forward to paying a significant amount out of pocket for health care until we've spent enough for our insurance payments to kick in. According to the Henry J. Kaiser Family Foundation, in 2016, the average deductible for an American with employer-bas...
Nov
23
By: Dan Mangan Spending on health care for people who have private insurance accelerated last year, ending a two-year period of more modest spending growth, a new study finds. In 2015, overall spending for people with private health insurance increased by 4.6 percent, according to the Health Care Cost Institute report. Most of that increase, again, was due to higher prices for prescription drugs a...
Jul
01
This data brief compares membership characteristics and health care service prices in non-ERISA and ERISA populations. The results suggest that non-ERISA data may be sufficient for policy relevant analyses, even when ERISA data is not available. Download PDF File Here
May
16
Children's Health Spending: 2010-2014 examines spending on health care for children covered by employer-sponsored insurance from 2010 to 2014. For the first time, HCCI analyzed children's health care spending trends at the state level, reporting on Arizona, Connecticut, Florida, Illinois, Maryland, Ohio, Texas, Virginia, and Wisconsin, as well as the District of Columbia. Key Findings ...
May
16
By: Kimberly Leonard U.S. CHILDREN COVERED by their parents' employer insurance have made fewer visits to medical facilities and used less medical care in recent years, but spending on their care has gone up, according to a report released Monday. The report , from the Health Care Cost Institute, shows that from 2010 to 2014 spending per child age 18 and younger increased by an average of 5.1 perc...
May
16
By: Dan Mangan Kids are going to the doctor's office and emergency rooms less often, and even using fewer prescription drugs — but overall health spending on children is still going up. A study released Monday by the Health Care Cost Institute indicates that price increases for health services and brand-name drugs were the biggest drivers of higher overall medical spending on kids from 2010 ...
Apr
28
By: Kelly Gooch Commercially insured Americans in some states pay more than twice what their counterparts in other states pay for healthcare, according to a study from the Health Care Cost Institute. The study, published in Health Affairs , is accompanied by HCCI's National Chartbook of Health Care Prices—2015 , which highlights differences in prices for more than 240 common medical services...
Apr
27
By: Jayne O'Donnell Huge variations exist in the prices of some of the most common medical procedures across state lines, by according to a report major insurers released Wednesday, but some experts say the data is of little use to consumers who rarely know what they owe until the bills arrive. The insurer-funded Health Care Cost Institute (HCCI) won't disclose which hospitals or doctors are...
Apr
21
The National Chartbook of Health Care Prices – 2015 and accompanying Health Affairs article "Prices For Common Medical Services Vary Substantially Among the Commercially Insured" illuminates differences in price for over 240 common medical services in 41 states and the District of Columbia. Download PDF File Here Among the commercially insured, wide variation in prices have some states payi...
Apr
01
This data brief compares average state-level prices against quality measures for asthma, diabetes and hypertension care and finds that higher prices for medical services are not always indicative of higher quality of care. Download PDF File Here
Mar
18
By: Yevgeniy Feyman Price and quality transparency in health care has often been seen as the missing link for extracting more value out of our health care system. With the appropriate financial incentives, along with easily accessible cost estimators and information on physician and hospital quality, patients could flock to the lowest-cost, highest-quality providers. But a new study by the Health ...
Mar
03
In an article from Carolyn Johnson of The Washington Post, it is postulated that there are many different reasons Americans cannot fix the often high prices of health care. " One popular view of how to corral out-of-control health-care spending is to empower smart shoppers -- to arm individual patients with the information and incentives to shop around for the cheapest imagi...
Sep
01
This data brief discusses patterns in the price and utilization indices reported in the 2015 Healthy Marketplace Index Report. Download PDF File Here
Feb
01
This issue brief summarizes the main findings of the Health Care Cost Institute's (HCCI's) Children's Health Spending: 2009-2012. Download PDF File Here
Oct
01
ABSTRACT Little is known about the trends in health care spending for the 156 million Americans who are younger than age sixty-five and enrolled in employer-sponsored health insurance. Using a new source of health insurance claims data, we estimated per capita spending, utilization, and prices for this population between 2007 and 2011. During this period per capita spending on employer-sponsored i...
May
01
Health Care Costs from Birth to Death examines health care spending from birth to age 90 for people covered by commercial health insurance and for those covered by Medicare fee-for-service. The research sponsored by the Society of Actuaries (SOA) using data from the Health Care Cost Institute (HCCI) estimates that the average 55-year-old retiree will spend about $226,000 more out of pocket on heal...
Sep
25
The Health Care Cost and Utilization Report: 2011 provides the first broad look at 2011 health care spending among those with employer-sponsored insurance (ESI). HCCI found that average dollars spent on health care services for that population climbed 4.6 percent in 2011, reaching $4,547 per person. This was well above the 3.8 percent growth rate observed in 2010. Key Findings Regio...
Sep
05
A summary of HCCI's 2011 Health Care Cost and Utilization Report. Download PDF File Here
Jul
01
This research brief highlights findings from the Health Care Cost Institute's (HCCI) Children's Health Care Spending Report: 2007—2010. 1 The report tracks changes in expenditure and utilization of health care services for children age 18 and younger, who were covered by employer-sponsored private health insurance (ESI). Download PDF File Here
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