April 2020 •
Volume 4 •
Issue 13
Providing Current Information on
Health Insurance Industry Issues and Legislation
States Act to Curb Costly Provider Consolidation
Mergers and acquisitions among providers and hospital groups theoretically lead to
lower costs. Unfortunately, the opposite has been the case. Some healthcare costs for
commercial payors have risen to 400% of the Medicare charge. Commercial insurers
paid the average hospital 110% of the Medicare rates for inpatient care in the 1990s.
By 2017, they were paying an average of 204% for inpatient care and almost 300% for
outpatient care. Now states are starting to act to prevent or mitigate the impact of
provider consolidation and market power.
lower costs. Unfortunately, the opposite has been the case. Some healthcare costs for
commercial payors have risen to 400% of the Medicare charge. Commercial insurers
paid the average hospital 110% of the Medicare rates for inpatient care in the 1990s.
By 2017, they were paying an average of 204% for inpatient care and almost 300% for
outpatient care. Now states are starting to act to prevent or mitigate the impact of
provider consolidation and market power.
Battling Consolidated Providers
While the states and the federal government are working on ways to mitigate the
costs of provider and hospital group consolidation, the claims just keep coming.
One way to fight back right now is to have a high quality, cost-containment
company use its entire arsenal to reduce what your clients pay. HHC Group uses
them all and its bulldog tenacity to maximize your clients' savings.
costs of provider and hospital group consolidation, the claims just keep coming.
One way to fight back right now is to have a high quality, cost-containment
company use its entire arsenal to reduce what your clients pay. HHC Group uses
them all and its bulldog tenacity to maximize your clients' savings.
Extended-Release Drugs – The High Price of Convenience
Prescribing short-acting, twice a day medications instead of extended release, once a
day versions could save the U.S. healthcare system, including commercial payors, billions
of dollar a year. Researchers looked at 20 drugs for which the therapeutic impact was
the same for the short-acting and time release versions. In 2017 alone, Medicare and
Medicaid spent $3.15 billion on extended release formulations. The researchers estimated
switching to twice daily versions would have saved Medicare and Medicaid $2.6 billion on
these drugs alone.
day versions could save the U.S. healthcare system, including commercial payors, billions
of dollar a year. Researchers looked at 20 drugs for which the therapeutic impact was
the same for the short-acting and time release versions. In 2017 alone, Medicare and
Medicaid spent $3.15 billion on extended release formulations. The researchers estimated
switching to twice daily versions would have saved Medicare and Medicaid $2.6 billion on
these drugs alone.
The New York Times article referenced here is no longer accessible.
Colorado Healthcare Payment Model – A Blue Print for the Nation?
Colorado is emerging as the potential model for revamping healthcare related
payment in other states and, potentially, nationally. The state legislature has already
taken action; passing bills addressing surprise billing, drug importation and high
drug costs. They also passed a reinsurance bill shielding insurance plans from the
costs of their sickest patients, resulting in a 20% drop in 2020 premiums for those
buying coverage on the individual market. Colorado is now considering whether to
implement a public option plan.
payment in other states and, potentially, nationally. The state legislature has already
taken action; passing bills addressing surprise billing, drug importation and high
drug costs. They also passed a reinsurance bill shielding insurance plans from the
costs of their sickest patients, resulting in a 20% drop in 2020 premiums for those
buying coverage on the individual market. Colorado is now considering whether to
implement a public option plan.
Three Star Preferred Provider Program Additions
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