On February 10, 2022 price inflation jumped by 7.5% over the past 12 months, its highest annual increase in 40 years. For employers and other health care purchasers that monitor their claims cost and utilization data religiously (who doesn’t?), this news prompts questions from purchasers about how inflation will impact their future health care spend.
Suzanne Delbanco catches up with Niall Brennan, President and CEO of the Health Care Cost Institute (HCCI), to ask the tough questions on price and utilization data for employer-sponsored health care.
Dr. Irene Dankwa-Mullan highlights the need for employers and their business associates – including TPAs, consultants, and other partners – to acknowledge that health inequities exist and use their role as plan sponsors and benefits administrators to address them through comprehensive, data-driven, health equity strategies.
Should employers impose COVID-19 vaccine mandates? The keyword here is “should” (“can” is a legal question that has already been largely answered and is not the subject of this blog). But “should vaccination be required” leaves room for debate. While bioethical analyses typically rely on multiple frameworks, this blog should be considered a primer on two of the ‘hallmark’ bioethical principles: autonomy and justice.
Suzanne Delbanco speaks with Jason Richmond, Head of Consultant Relations at Ginger, a digital mental health care provider. Jason Richmond explores the supply and demand imbalance between mental health patients
Will telehealth help save health care from unsustainable cost growth and inequities in outcomes? Or will it do the opposite?
Stakeholders across the health care industry are currently drafting their telehealth roadmaps for the future. Virtual-first health plan products are popping up. Providers are figuring out how much of their patient care will continue to stay virtual post-pandemic and studying best practices to effectively engage diverse patients. At the federal level, Congress introduced the CONNECT for Health Act of 2021, which seeks to codify telehealth provisions made during the public health emergency permanently into Medicare. The time is now for health care purchasers – including states – to demand telehealth programs and policies with two clear goals in mind:
Be financially sustainable for those who use and pay for it
Be implemented so that everyone has a fair and just opportunity to benefit
In this blog post, we offer best practices for vendors preparing for “case study” presentations in the direct-to-employer context.
First of all, why case studies? Case studies are empirical inquiries that investigate a phenomenon in a real-world context.
Suzanne Delbanco talks with David Vivero, CEO and Co-Founder of Amino Health. A self-described “product guy,” David Vivero shares his view on where price transparency can make the biggest impact for patients and plan sponsors in the commercial health care market.
Rhode Island established a cost growth benchmarking process to bring greater transparency to the market in 2018. The state also has a first-in-the-nation regulation that caps annual growth in prices paid by commercial health plans, established in 2010.
When the RBP vendor and provider “agree” on a rate, who pays the difference? The RBP vendor or the employer? It depends – and the outcome will likely be reflected in the vendor’s administrative fee.
Employers and consumers are eager for solutions that attack health care cost inflation at its root cause. One prominent strategy is using reference-based pricing (RBP) models that anchor commercial rates to Medicare, or some other rationalized external benchmark. Like so many health care innovations, reference-based frameworks encompass multiple branching models, and as such the term “RBP” has come to mean different things to different stakeholders.
During the economic recovery, we need competitive health care markets as a counterweight against health care price inflation. With the economy struggling, employers and other health care purchasers have less money than ever to spend on health care and need every tool at their disposal to keep expenses under control. Employers across the country will be watching to see if the Sutter case will serve as a warning to other dominant providers, or if anticompetitive behavior will be given a COVID hall pass. As Secretary of Health and Human Services, Becerra’s understanding of these dynamics will inevitably shape his work on health care delivery and payment reforms, policies regarding transparency of price and quality information, and much more.
According to the CDC, 51.8% of Americans age 6 months or older received the flu vaccine during the 2019-2020 flu season; yet, the CDC recommends all individuals in this age range get the vaccine, with limited exceptions. Consumers regularly get the vaccine as part of a primary care visit or at their local pharmacy. In prior years, employers would offer their employees, and sometimes dependents, the added convenience of getting their flu vaccine on-site. This year, however, many employers have limited or eliminated any widescale effort to offer on-site flu vaccines. This means that some consumers will have to seek out their vaccine elsewhere. So, what’s the appropriate site of care for the flu vaccine?
Would 2020 be the year that health care purchasers finally abandon broad PPO networks in favor of curated solutions like narrow, tiered or high-performance networks? Julianne McGarry review’s KFF’s 2020 Employer Health Benefits Survey to find out.
Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers.
What we’ve learned from health care economists, policy experts, and business leaders has begun to illuminate the contours of a new health care economy, re-shaped in the wake of the global pandemic.
Price transparency is not one-size-fits-all. The optimal price information for a patient is different from the price transparency a physician would find useful and different, too, from what an employer-purchaser
Our neighborhoods, houses, schools, jobs, income, social lives, modes of transportation, and even our broader built and natural environments. Once these were not considered factors affecting health, but they are
Let’s face it. Something has got to give. While employers and health care purchasers have long tried to implement market-based solutions, catalyzing consistent and long lasting system-wide change in health
When it comes to pharmaceutical prices, some things are certain. First, drug prices, especially for specialty pharmacy, are too high. It is also unlikely that prices will go down anytime
