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Prices

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...
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Prices The New York Times HMI Healthy Marketplace Index
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Apr
30

Past the Price Index: Exploring Actual Prices Paid for Specific Services by Metro Area

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...
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Apr
18

New York Post: Man Shows Shocking Health Care Cost of His Attempted Suicide

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 ...
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Prices Charges Emergency Room
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Apr
03

The New York Times: Express Scripts Offers Diabetes Patients a $25 Cap for Monthly Insulin

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...
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Chronic Conditions Diabetes Insulin Prices The New York Times Drug Spending
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Apr
02

Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices

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 ...
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Utilization Prices Outpatient Spending Physician Spending
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Feb
19

2017 Annual Health Care Cost and Utilization Report Webinar

Watch the Webinar HCCI recently held a webinar to discuss the 2017 Annual Health Care Cost and Utilization Report.    Download PDF File Here
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Utilization Prices HCCUR Outpatient Spending Inpatient Spending Drug Spending Physician Spending
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Feb
11

2017 Health Care Cost and Utilization Report

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...
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Out-of-Pocket Utilization Prices HCCUR Outpatient Spending Inpatient Spending Drug Spending Physician Spending
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Feb
05

HCCI Research Used in Support of Congressional Inquiries

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...
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Insulin Prices Surprise Billing Congress Emergency Room
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Feb
04

Health Affairs: Hospital Prices Grew Substantially Faster Than Physician Prices For Hospital-Based Care In 2007–14

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...
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Hospital Prices Prices Health Affairs Peer Reviewed Journals
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Jan
28

HCCI Insulin Report Receives Extensive Media Coverage

 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...
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Chronic Conditions Diabetes Insulin Prices The New York Times NBC CBS CNN The Hill Drug Spending
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Jan
22

Reuters: U.S. Insulin Costs Per Patient Nearly Doubled From 2012 to 2016: Study

​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...
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Chronic Conditions Diabetes Insulin Prices Reuters Drug Spending
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Jan
22

Vox: Prices at Zuckerberg Hospital’s Emergency Room are Higher Than Anywhere Else in San Francisco

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 ...
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Jan
21

Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices

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...
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Chronic Conditions Diabetes Insulin Prices Drug Spending
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Nov
15

Trends In Primary Care Visits

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...
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Utilization Prices Commercially Insured Physician Spending Primary Care
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Nov
01

American Academy of Actuaries: Estimating the Potential Health Care Savings of Reference Pricing

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 ...
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Oct
24

Understanding how price growth affected areas differently across the country

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...
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Price Growth Geographic Variation Prices HMI Healthy Marketplace Index
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Oct
03

Wall Street Journal: Employer-Provided Health Insurance Approaches $20,000 a Year

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...
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Price Growth Wall Street Journal Prices Commercially Insured
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Sep
18

Wall Street Journal: Behind Your Rising Health-Care Bills: Secret Hospital Deals that Squelch Competition

​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. Read the Article
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Wall Street Journal Prices Outpatient Spending Physician Spending
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Sep
18

The Wall Street Journal: Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition

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...
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Sep
11

ER facility prices grew in tandem with faster-growing charges from 2009-2016

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...
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Prices Outpatient Spending Commercially Insured Charges Emergency Room
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Jun
25

Medical Care Research and Review: Prices for Physicians’ Services in Medicare Advantage and Commercial Plans

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...
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Medicare Advantage Prices Commercially Insured Peer Reviewed Journals Physician Spending Out-of-Network
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Jun
19

2016 Health Care Cost and Utilization Report

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...
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Out-of-Pocket Geographic Variation Utilization Prices HCCUR Outpatient Spending Inpatient Spending Drug Spending Physician Spending
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May
30

ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)

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...
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Geographic Variation Utilization Prices Outpatient Spending Commercially Insured Emergency Room
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Apr
30

Business Wire: Vitals Reduced Medical Spending for Employers by $56M. Three people every hour shop and save on their health care

 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...
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Prices Shoppable Commercially Insured
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Mar
05

KHN: Need A Medical Procedure? Pick The Right Provider And Get Cash Back

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 ...
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Feb
09

Health Affairs: Health Spending Growth Is Accelerating; Prices Are In The Driver’s Seat

 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 ...
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Utilization Prices HCCUR Health Affairs Commercially Insured
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Jan
30

CNN Money: Jeff Bezos, Warren Buffett, and Jamie Dimon want to fix health care

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...
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Jan
23

Washington Post: Working Americans are using less health care, but spending more

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...
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Dec
08

Advisory Board: ED visits down - but ED facility fee spending is up, Vox analysis suggests

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-...
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Prices Vox Outpatient Spending Emergency Room
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Dec
04

ER spending increased 85%, driven by price increases for the most severe cases (2009-2015)

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...
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Transparency Prices Commercially Insured Emergency Room
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Nov
29

Price of insulin prescription doubled between 2012 and 2016

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 ...
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Diabetes Insulin Geographic Variation Prices Drug Spending
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Nov
28

ProPublica: A Hospital Charged $1,877 to Pierce a 5-Year-Old's Ears. This Is Why Health Care Costs So Much.

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...
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Prices Outpatient Spending
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Sep
02

Modern Healthcare: Q&A with Brennan - "You are going to have more of an interest in what services actually cost"

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...
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Sep
01

NBER: Does Multispecialty Practice Enhance Physician Market Power?

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...
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Prices NBER Market Concentration Peer Reviewed Journals
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Aug
07

New York Times: Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?

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...
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Medicare Advantage Prices Medicare
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Aug
01

Health Affairs: Medicare Competitive Bidding Program Realized Price Savings For Durable Medical Equipment Purchases

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...
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Prices Medicare Health Affairs Commercially Insured Competitive Bidding Durable Medical Equipment
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Mar
01

Health Affairs: Reference Pricing Changes the 'Choice Architecture' of Health Care for Consumers

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...
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Out-of-Pocket Prices Shoppable Health Affairs Peer Reviewed Journals
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Jan
09

Slate: A Failed Cure for Health Care Costs

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...
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Transparency Prices ACA
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Nov
23

CNBC: Health-care spending increased at a faster pace in 2015 as prices rose

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...
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Prices Commercially Insured Drug Spending
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Jul
01

Necessary versus Sufficient Claims Data

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
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Transparency Prices Commercially Insured
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May
16

Children’s Health Spending Report 2010-2014

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.   Download Report Ap...
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Geographic Variation Prices Children
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May
16

U.S. News & World Report: Cost for Kids' Medical Care Increasing

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...
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May
16

CNBC: Children are using health services less - but medical costs still rising

 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 ...
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Apr
28

Becker's Hospital Review: No 2 prices the same - 13 different findings on healthcare price variation across the U.S.

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...
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Apr
27

USA Today: Huge health care price differences even within same area, by state

 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...
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Apr
21

National Chartbook of Health Care Prices 2015

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 Report   Download PDF File Here Among the commercially insured, wide variation in prices have ...
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Apr
01

The Price-Quality Paradox in Health Care

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
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Hypertension Diabetes Geographic Variation Prices Asthma
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Mar
18

Forbes: Don't Be Fooled - Patients Can Shop For Healthcare

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 ...
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Mar
03

The Washington Post: Why Savvy Shoppers Can't Fix Health-Care Spending

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...
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Sep
01

Taking the Pulse of Health Care Markets

 This data brief discusses patterns in the price and utilization indices reported in the 2015 Healthy Marketplace Index Report.   Download PDF File Here
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Geographic Variation Utilization Prices Healthy Marketplace Index
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Feb
01

Key Findings from Children's Health Spending 2009-2012 Report

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
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Prices Children Commercially Insured Drug Spending
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Oct
01

Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five

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...
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Out-of-Pocket Prices Health Affairs Commercially Insured Peer Reviewed Journals
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May
01

Health Care Costs from Birth to Death

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...
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Chronic Conditions Out-of-Pocket Prices Children Childbirth
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Sep
25

2011 Health Care Cost and Utilization Report

 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. Download Report Appendix Ta...
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Out-of-Pocket Prices HCCUR Outpatient Spending Inpatient Spending Commercially Insured Drug Spending Physician Spending
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Sep
05

Changes in Health Care Spending in 2011

A summary of HCCI's 2011 Health Care Cost and Utilization Report.    Download PDF File Here
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Out-of-Pocket Prices HCCUR
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Jul
01

Trends in Children's Health Care Costs and Utilization

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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Utilization Prices Children Commercially Insured
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