House Energy and Commerce hearing includes V-BID
A House Energy and Commerce Health Subcommittee hearing on December 4th included a discussion of the potential role for V-BID in Medicare Advantage. As part of his remarks, Subcommittee Chairman Joe Pitts (R-PA) observed:  Medicare Advantage has a proven record of success and is popular with seniors because it provides better services, higher quality of care and increased care coordination. To ensure the program's viability, I believe there are several existing reform proposals for Medicare Advantage that merit further discussion and feedback-concepts like overlaying a value-based insurance design over the existing Medicare Advantage Program to address the substantial variation in value across health care services and providers. (Minutes 44:45-45:15)
As part of his written testimony, Medicare Rights Center President Joseph Baker voiced support for eliminating or lowering cost sharing to facilitate access to high-value health care services--such as the ACA policies that eliminated cost-sharing for select preventive care--but expressed concern regarding the use
of increased cost-sharing as a deterrent to certain types of care,
or as a vehicle for securing savings.
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Paying more for "bad medicine" highlights V-BID sticks
A Reuters feature story explores how a V-BID plan that incorporates a precise mix of financial carrots and sticks can steer patients toward medical services that will help them and away from ineffective or unnecessary ones. The story highlights several additional public and private payer V-BID examples, including a current initiative at San Luis Valley Regional Medical Center.
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Gallup Poll: Costs keep Americans from seeking care
A new Gallup Poll indicates that 3 in 10 Americans put off medical care (nearly 20% of delayed care was for serious conditions) for themselves or their family in the past year because of the cost. These results are higher than what Gallup found a decade earlier.
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Bloomberg: The controversy of high deductibles
Many plans on the new health exchange offer lower premiums coupled with high deductibles--a design similar to high deductible health plans (HDHPs). However, critics who favor HDHPs argue that people who choose this nwe plan may forgo care or make poor health choices due to cost. Dr. Aaron Carroll explores this dualism and notes that a balance must be struck to spend less on health care while ensuring that people avoid skipping necessary care due to cost.
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KHN: Costs likely to rise on employer-sponsored plans
Costs are expected to increase for those who have employer-sponsored insurance coverage. A recent Kaiser Health News story notes that the new year will likely bring higher deductibles and co-payments, penalties for not joining wellness programs and smaller employer contributions toward family coverage.
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NYT: U.S. health care spending slows, but out-of-pocket rises
Nationally, spending on health care is growing at the slowest pace ever recorded, however, deductibles--the amount a covered individual has to pay for health care before the plan kicks in--have become more common and more expensive while wages have stagnated.
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CWF: Premium increases mostly due to routine factors
Upon review of a sample of individual and small-group markets claims data between July 2012 and June 2013, a new Commonwealth Fund study found that roughly three-quarters of premium rate increases were due to routine factors such as trends in medical costs,while only a small percentage of increases were related to the Affordable Care Act.
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CalPERS reference pricing prompts hospitals to lower prices
In 2011, the California Public Employees' Retirement System (CalPERS) adopted a strategy known as reference pricing to guide enrollees to hospitals that provide hip and knee replacements below a certain price threshold. The initiative saved money without shifting costs to enrollees or sacrificing quality and prompted other hospitals to lower costs on similar procedures to remain competitive.
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AHIP issue brief: High performance provider networks
To address efficiency, clinical effectiveness and value, AHIP's latest issue brief focuses on providers and facilities that deliver high-quality, efficient health care and offer consumers incentives (such as reduced cost-sharing) to obtain care from high-performing providers. Establishing high-value provider networks--particularly in Medicare Advantage plans--can help preserve benefits and mitigate the cost impact on beneficiaries as payment cuts increase.
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Health Exchange report card: Premiums low, other costs high
Insurance plans sold on the exchange generally have low premiums and high deductibles. While cost-sharing subsidies are available for those below 250% of the federal poverty level who buy a mid-level plan, most people are expected to choose bronze or silver plans, which have lower premiums but provide less generous coverage than most employer-sponsored plans.
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The University of Michigan Center for Value-Based Insurance Design
