Publications
The latest content from HCCI

HCCI’s original reports and external researcher publications powered by #HCCIdata

Mar
01

Obstetrics & Gynecology: Rate of Pelvic Organ Prolapse Surgery Among Privately Insured Women in the United States, 2010-2013

AbstractOBJECTIVE: To analyze utilization of, and payments for, pelvic organ prolapse procedures after the 2011 U.S. Food and Drug Administration (FDA) communication regarding transvaginal mesh.METHODS: This is a retrospective cohort study examining private claims from three insurance providers for inpatient and outpatient prolapse procedures from 2010 to 2013 in the Health Care Cost Institute. Pr...
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Feb
21

How common is your health care spending?

It is well documented that Americans spend a lot on health care, but this issue is often discussed in terms of share of GDP, billions of dollars, or an astoundingly high hospital bill. These numbers can be hard to relate to; it's hard to imagine billions of dollars, let alone a share of the national economy. A pricey bill may get our attention, but can seem like a special case that doesn't relate ...
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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 f...
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Feb
01

NBER: Hospital Pricing and Public Payments

ABSTRACT: A longstanding debate in health economics and health policy concerns how hospitals adjust prices with private insurers following reductions in public funding. A common argument is that hospitals engage in some degree of "cost-shifting," wherein hospitals increase prices with private insurers in response to a reduction in public payments; however, evidence of significant costshifting...
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Feb
01

New England Journal of Medicine: Consistently High Turnover in the Group of Top Health Care Spenders

 NEJM CATALYST:"The concentration of most U.S. health care spending in a small proportion of individuals is well documented. The notion that high health care spending only affects a small portion of people in a given year is particularly relevant to the ongoing policy debate about how to make health insurance affordable for all, while accommodating people with complex health care needs and ac...
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Feb
01

Top Spenders Among the Commercially Insured Increased Spending Concentration and Consistent Turnover from 2013 to 2015

 This issue brief explores the distribution of health care spending among commercially insured individuals, with a focus on the top 5 percent of spenders and turnover within that group from year to year. It considers the share of spending incurred by this group of top spenders, how those dollars are distributed among the health care service categories, turnover within the group of top spender...
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Dec
20

Workers in low income counties more likely to be long-term opioid users

Past literature has found links between higher opioid use and local economic conditions for people enrolled in public health programs, but there has been little discussion of whether this relationship occurs among the privately insured. Using HCCI claims data and county level income data from the US Census Bureau, we examined how a county's median household income relates to long-term opioid use a...
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Dec
07

Health Affairs: Understanding Health Spending - Lessons From The Healthy Marketplace Index

HEALTH AFFAIRS BLOG:"As policymakers consider actions to address challenges with the Affordable Care Act and ongoing growth in health spending, the importance of understanding local health care market dynamics is more important than ever. Traditionally, policy makers and other stakeholders have evaluated commercial health care markets' total spending and often attributed high spending to high pric...
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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 t...
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Dec
01

Health Affairs: Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

ABSTRACT:  Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received cons...
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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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Nov
20

New England Journal of Medicine: The Value of Health Insurance through Price Discounts

 NEJM CATALYST:"As context for the ongoing health care reform debate, we analyzed Health Care Cost Institute (HCCI) data. HCCI is a nonpartisan, nonprofit organization aimed at providing complete and accurate information about health care utilization and costs in the United States.Our goal was to demonstrate the value of insurance through these discounted rates. We did so by calculating media...
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Oct
01

Health Affairs: Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

ABSTRACT: Forty-six states and the District of Columbia have enacted insurance mandates that require commercial insurers to cover treatment for children with autism spectrum disorder (ASD). This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for m...
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Oct
01

JAMA Oncology: Association Between Quality of Care for Breast Cancer and Health Insurance Exchange Coverage An Analysis of Use of Radiation Therapy After Breast-Conserving Surgery

ABSTRACTResearch comparing quality of cancer care by insurance categories concluded that cancer patients without insurance or with Medicaid experienced inferior quality of care compared with those with private insurance. A new insurance category created from the Affordable Care Act (ACA) is insurance purchased from the Health Insurance Marketplace (also known as the exchange). The present stu...
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Sep
01

Health Affairs: Insurer Market Power Lowers Prices In Numerous Concentrated Provider Markets

 ABSTRACT: Using prices of hospital admissions and visits to five types of physicians, we analyzed how provider and insurer market concentration—as measured by the Herfindahl-Hirschman Index (HHI)—interact and are correlated with prices. We found evidence that in the range of the Department of Justice's and Federal Trade Commission's definition of a moderately concentrated market (HHI of...
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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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Sep
01

Women's Health Issues: Maternal Medical Complexity Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section

ABSTRACTBackground: Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured.Objective: The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending dur...
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Sep
01

Psychiatric Services: Telehealth Delivery of Mental Health Services: An Analysis of Private Insurance Claims Data in the United States

ABSTRACT: Objective: This study characterizes telehealth claims for mental health and substance abuse (MH/SA) services by using national private claims data.Methods: Telehealth-related mental health service claims were identified with private claims data from 2009 to 2013. These data—provided by the Health Care Cost Institute—included claims from Aetna, Humana, and UnitedHealth for ...
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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 administrati...
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Aug
01

Trends in Total and Out-of-Pocket Spending in Metro Areas: 2012-2015

This data brief examines geographic variation in health care per capita spending, with a focus on consumer per capita out-of-pocket spending across geographies (2012-2015). It also explores whether the proportion of people enrolled in consumer-directed health plans (CDHPs) and the proportion not utilizing health care services had any influence on out-of-pocket spending.​   Download PDF File H...
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May
04

Academic Emergency Medicine: Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women

ABSTRACTObjectives: Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department (ED) use among a national sample of commercially insured pregnant women.Methods: We conducted a retrospective cohort study using multipayer med...
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Apr
04

Congressional Budget Office Working Paper Series: An Analysis of Private-Sector Prices for Hospital Admissions

ABSTRACT: Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this paper, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them wit...
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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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Feb
28

Non-Shoppable Health Care Services: Inpatient Hospitalizations

This data brief reports on spending and utilization in populations likely unable to shop for a hospital prior to seeking care, comparing spending and length-of-stay for individuals who were admitted through the emergency department (ED) to that of individuals who needed ambulance services the day of their admission through the ED.    Download PDF File Here
Feb
19

Health Services Research: Payer Type and Low‐Value Care: Comparing Choosing Wisely Services across Commercial and Medicare Populations

ABSTRACTObjective: To compare low‐value health service use among commercially insured and Medicare populations and explore the influence of payer type on the provision of low‐value care.​Data Sources: 2009–2011 national Medicare and commercial insurance administrative data.Design: We created claims‐based algorithms to measure seven Choosing Wisely‐identified low‐value services and examined the cor...
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Jan
01

JAMA Internal Medicine: A Perspective on Out-of-Pocket Spending

To the Editor Understanding out-of-pocket spending is critical to understanding health care costs in the United States. We applaud the efforts of Adrion et al as an important contribution to understanding the out-of-pocket spending of the commercially insured population younger than 65 years. The commercially insured comprise over 50% of the nonelderly US population and, as demonstrated by Ad...
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Jan
01

NBER Working Paper: Healthcare Spending and Utilization in Public and Private Medicare

ABSTRACT: We compare healthcare spending in public and private Medicare using newly available claims data from Medicare Advantage (MA) insurers. MA insurer revenues are 30 percent higher than their healthcare spending. Healthcare spending is 25 percent lower for MA enrollees than for enrollees in traditional Medicare (TM) in the same county with the same risk score. Spending differences between MA...
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Dec
01

Medicare Advantage Health Care Utilization - Observation Stays

This data brief reports on outpatient observations stays in the Medicare Advantage population from 2010 through 2014. The results show that the rate of observations stays increased in total as well as following hospitalizations.    Download PDF File Here
Nov
01

Medicare Advantage Health Care Utilization - Hospital Readmissions

 This data brief, reports on five readmission rate measures for the Medicare Advantage (MA) population: 30-day all-cause hospital-wide readmissions and 30-day all-cause readmissions following acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia. The results show that MA readmission rates have been declining over the past five years. &nb...
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Oct
01

NBER: Why Don't Commercial Health Plans Use Prospective Payment?

ABSTRACTOne of the key terms in contracts between hospitals and insurers is how the parties apportion the financial risk of treating unexpectedly costly patients. "Prospective" payment contracts give hospitals a lump-sum amount, depending on the medical condition of the patient, with limited adjustment for the level of services provided. We use data from the Medicare Prospective Payment System and...
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Sep
01

JAMA Pediatrics: Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

ABSTRACTImportance: Most states have passed insurance mandates requiring commercial health plans to cover services for children with autism spectrum disorder (ASD). Insurers have expressed concerns that these mandates will increase the number of children diagnosed with ASD (treated prevalence) and therefore increase costs associated with their care. To our knowledge, no published studies have addr...
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Sep
01

Consumer-Driven Health Plans: A Cost and Utilization Analysis

This data brief examines the health care use and spending from 2010-2014 for people who are enrolled in consumer-driven health plans (CDHPs), and compares these trends to non-CDHP enrollees. Findings indicate that although fewer total dollars were spent on health care for CDHP enrollees, they had higher per capita out-of-pocket spending on deductibles, copays, and coinsurance.    Downloa...
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Sep
01

JAMA Internal Medicine: Out-of-Pocket Spending for Hospitalizations Among Nonelderly Adults

ABSTRACTImportance: Patients' out-of-pocket spending for major health care expenses, such as inpatient care, may result in substantial financial distress. Limited contemporary data exist on out-of-pocket spending among nonelderly adults.Objectives: To evaluate out-of-pocket spending associated with hospitalizations and to assess how this spending varied over time and by patient characteristics, re...
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Aug
01

Health Affairs: Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays

ABSTRACTThere is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per ad...
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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
Jun
20

2014 Diabetes Health Care Cost and Utilization Report

The 2014 Diabetes Health Care Cost and Utilization Report examines how much is spent on health care for adults and children with diabetes, where those dollars are spent, and how that compares to people without diabetes. It is based on the health care claims of more than 40 million Americans younger than 65 covered by employer-sponsored insurance from 2012 to 2014.   Key Findings​Per capita sp...
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Jun
03

Journal of Telemedicine and Telecare: Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States

ABSTRACT: Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursem...
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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.   Key Findings ...
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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 PDF File Here Among the commercially insured, wide variation in prices have some states payi...
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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
Mar
01

Spending on Shoppable Services in Health Care

This issue brief examines health care spending on shoppable services in 2011. Contrary to expectations, giving consumers prices so they can shop for health care services may only have a modest effect on reducing health spending.  Key Findings:​In 2011, about 43% of the $524.2 billion spent on health care services for commercially insured people was considered shoppable.About 15%—nearly $...
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Feb
01

An Examination of Private Payer Reimbursements to Primary Care Providers for Healthcare Services Using Telehealth, United States 2009-2013

This issue brief, in partnership with the National Academy for State Health Policy,  reports on reimbursement to primary care provides for health care services using telehealth. Key findings include: • Half of telehealth-related state policies were implemented in the last five years.• Although many states permit reimbursements for telehealth services, only seven ...
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Sep
30

Healthy Marketplace Index - 2015

The Healthy Marketplace Index is a series of metrics that measure the economic performance of health care markets across the country. The HMI was developed with support from the Robert Wood Johnson Foundation.    Download PDF File Here The Healthy Marketplace Index Report (HMI) shows the economic performance of more than 40 health care markets across the country. Developed by the He...
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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
Jul
08

Children's Health Spending: 2010-2013

Children's Health Spending: 2010–2013 shows that spending on healthcare for children (ages 0-18) covered by employer-sponsored insurance grew an average of 5.7% per year. The increase in spending in 2013 occurred despite a drop in the use of prescription drugs and visits to the emergency room, demonstrating that rising health care prices were an evident driver behind the spending increase in that ...
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May
07

Per Capita Health Care Spending on Diabetes: 2009-2013

This issue brief examines health care spending for adults and children with diabetes relative to those without diabetes, both in terms of total per capita health care spending and out-of-pocket costs from 2009-2013. Key Findings: ​ In 2013, $14,999 was spent per capita on health care for people with diabetes.Per capita health care spending for children with diabetes rose 7% from 201...
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Feb
01

Shopping for Health Care Makes “Cents” for Consumers

This data brief looks at per capita out-of-pocket spending rates nationally and statewide and examines average differences in consumer prices for a set of five common medical procedures: office visit for the evaluation of a new patient, colonoscopy, cataract removal, lower leg MRI; and ultrasound for pregnancy nationally and in nine states: Arizona, Colorado, Florida, Georgia, Maryland, New Jersey...
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Nov
20

American Journal of Managed Care: Overcoming barriers to a research-ready national commercial claims database

ABSTRACTObjectives: Billions of dollars have been spent on the goal of making healthcare data available to clinicians and researchers in the hopes of improving healthcare and lowering costs. However, the problems of data governance, distribution, and accessibility remain challenges for the healthcare system to overcome.Study Design: In this study, we discuss some of the issues around holding,...
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Oct
01

Out-of-Pocket Spending Trends 2013

This issue brief accompanies the 2013 Spending Cost & Utilization Report and examines trends in out-of-pocket expenditures per capita for the national, younger than age 65 population covered by employer-sponsored insurance for the period of 2011 through 2013.    Download PDF File Here
Sep
01

Selected Health Care Trends for Young Adults: 2007-2012

This issue brief is one of the first to examine health care trends for young adults (ages 19-25) with employer-sponsored insurance before and after implementation of Section 1001 of the Affordable Care Act that allows parents to include their adult children in family health plans.    Download PDF File Here