This guide contains links to 25 reports and other resources that shed greater light on many of the concepts reviewed in the webinar series and elsewhere in the toolkit. They are useful for going in depth on cost, payment reform, transparency, and benefit design.
- National Health Expenditure Data—Centers for Medicare & Medicaid Services
Annual health spending in the U.S. by type of good or service delivered (hospital care, physician and clinical services, retail prescription drugs, etc.) and source of funding for those services (private health insurance, Medicare, Medicaid, out-of-pocket spending, etc.). Projections for future spending are based on the National Health Expenditures and are estimates of spending for healthcare in the U.S. over the next decade
- Milliman Medical Index Research Report
The Milliman Medical Index is an actuarial analysis of the projected total cost of healthcare for a hypothetical family of four covered by an employer-sponsored preferred provider organization (PPO) plan. Unlike many other healthcare cost reports, the MMI measures the total cost of healthcare benefits, not just the employer’s share of the costs, and not just premiums. The MMI only includes healthcare costs. It does not include health plan administrative expenses or profit loads.
- What Is Driving U.S. Health Care Spending?—Bipartisan Policy Center
This background paper provides a basic overview of the drivers of healthcare cost growth, and serves as an analytical starting point for the Bipartisan Policy Center’s work on healthcare cost containment.
- Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally—The Commonwealth Fund
This report and prior editions compare the performance of the U.S. healthcare system to those of other countries.
- Using Education, Collaboration, and Payment Reform to Reduce Early Elective Deliveries A Case Study of South Carolina’s Birth Outcomes Initiative—Catalyst for Payment Reform
This case study examines how South Carolina used a policy of non-payment for early elective deliveries to underscore a multi-stakeholder commitment to improving birth outcomes. Through this comprehensive approach, the state reduced early elective deliveries and Neonatal Intensive Care Unit (NICU) stays, and saved millions of dollars. South Carolina was the first state in the nation to have its Medicaid program partner with the largest local commercial insurer to adopt such a non-payment policy.
- Save $36 Billion in U.S. Healthcare Spending Through Price Transparency—Thomson Reuters (February 2012)
Studies show that healthcare costs for the same procedure in the same market can vary by more than 100 percent. Providing consumers with clear, comparative information on the cost of services is key to further engaging them in the decision making process and, ultimately, reducing healthcare costs. This white paper explores how reducing price variation for the 108 million Americans with employer-sponsored insurance could save the nation as much as $36 billion per year.
- Tips to Encourage Employee Use of Plan Cost Tools on Plan Website(s)—Pacific Business Group on Health
Health plans online cost calculator tools can be a powerful tool to help employees better understand and use their benefits in ways that maximize their healthcare experience and minimize the cost of care. But in order for employees to take advantage of these tools, health plans require consumers to register on their websites. This paper offers tactics to encourage employees to register online and use their plan’s cost calculator tools.
- Report Card on State Price Transparency Laws—Catalyst for Payment Reform & Health Care Incentives Improvement Institute, Inc. (March, 2014)
In this third installment of the Catalyst for Payment Reform (CPR)—Health Care Incentives Improvement Institute (HCI3) Report Card on State Price Transparency Laws, you will find little progress since last year and, in some cases, regression. For this reason, this year’s report is concise, sharing information only on the handful of states that received new grades. However, this bleak picture masks the recent legislative and regulatory activity that has sprung up around the country, spurred in part by our prior Report Cards. In fact, many states highlight this report when introducing bills for pricing transparency. As a reminder, when we assess each state, we base the grade on legislation passed during the prior year’s legislative session; this year’s report is based on legislation enacted in 2014.
- Price Transparency RFP—Catalyst for Payment Reform—(Fall 2013)
This document is a request for proposals template created for purchasers to use for sourcing price transparency tools.
- Action Brief on Price Transparency—Catalyst for Payment Reform (November, 2012)
What is price transparency? Why should purchasers push to make price and quality information public? What are some of the existing tools and strategies in the current marketplace and their limitations? This Action Brief examines these questions and provides purchasers with concrete ways they can foster transparency, which in turn can help catalyze much needed reform in our healthcare system.
- National Scorecard on Payment Reform—Catalyst for Payment Reform (2014)
Catalyst for Payment Reform has set a target of 20% of payments proven to improve value by 2020. How are we doing in 2014? The results of the second annual Scorecard are in and 40% of all commercial in-network payments are value-oriented—either tied to performance or designed to cut waste. Traditional fee-for-service (FFS), bundled, capitated and partially capitated payments without quality incentives, make up the remaining 60%. The use of value-oriented payment is growing rapidly; now we need to determine whether it makes healthcare better and more affordable.
- Action Brief: Implementing Accountable Care Organizations—Catalyst for Payment Reform
This paper explains accountable care organizations, a healthcare entity responsible for all of the healthcare and related spending for a defined population of patients.
- Action Brief: Establishing Medical Homes—Catalyst for Payment Reform
This paper explains “medical homes,” a primary care practice that organizes and delivers care to broaden access while improving care coordination.
- Action Brief: From Reference Pricing to Value Pricing—Catalyst for Payment Reform
This paper explains reference pricing, which establishes a standard price for a drug, procedure, service or bundle of services and generally requires that health plan members pay any allowed charges beyond this amount. Reference pricing has been shown to lower the cost and increase value in prescription plans, and is now expanding in the United States to selected medical and surgical services.
- Action Brief: Improving Fee-for-Service Payment—Catalyst for Payment Reform
This paper explains how reforms seek to modify or counter the perverse incentives rooted in the fee-for-service model.
- Action Brief: Implementing Bundled Payment—Catalyst for Payment Reform
This paper explains the concept of a bundled payment, sometimes called an “episode-based payment,” which entails reimbursement for all of the services needed by a patent, across multiple providers, and possibly multiple care settings, for a treatment or condition.
- Action Brief: Implementing Global Payment—Catalyst for Payment Reform
This paper explains the concept of a global payment, which is a comprehensive payment to a group of providers that is intended to account for most or all of the expected cost f care to a group of patients for a defined time period.
- Center for Value Based Insurance Design
This paper explains Value-Based Insurance Design (V-BID), which is built on the principle of lowering or removing financial barriers to essential, high-value clinical services. V-BID plans align patients’ out-of-pocket costs, such as copayments, with the value of services.
- The Evidence for V-BID: Validating an Intuitive Concept—University of Michigan Center for Value-Based Insurance Design (February 2014)
The paper summarizes the peer-reviewed research that validates the logic of V-BID. The available literature indicates that incentive-based V-BID programs (“carrots”) can improve quality of care and reduce undesirable acute care utilization such as emergency room visits and hospitalizations.
- Value-Based Insurance Design: Contributions to Consumer Health in Consumer-Directed Health Plans—University of Michigan Center for Value-Based Insurance Design (April 2012)
To mitigate the negative health effects that may result from increased cost sharing for high-value healthcare, this paper from the Center for Value-Based Insurance Design (V-BID Center) recommends that insurers add an evidence-based “V-BID waiver” to high deductible plans by instituting lower or no cost sharing for clinically proven healthcare.
- V-BID in Action: A Profile of Connecticut’s Health Enhancement Program—University of Michigan Center for Value-Based Insurance Design (January 2013)
- Reference Pricing and Bundled Payments: A Match to Change Markets—Health Care Incentives & Catalyst For Payment Reform (2013)
This paper discusses why coupling a reference pricing strategy with a bundled payment to providers for the entire episode of care could make pricing easier and create alignment among consumers, employers, and providers in a number of ways. This approach is easier for consumers to understand, limits their financial liability, and allows for greater price and quality transparency. It also improves cost predictability for employers because they will pay a consistent bundled price that does not vary based on the services rendered.
- Action Brief: Maternity Care Payment—Catalyst for Payment Reform
Early Elective Non-Payment Guide—Catalyst for Payment Reform
Labor and delivery account for nearly a quarter of all hospitalizations for many employers, and costs associated with pregnancy and its complications are a driving factor in the rising costs of healthcare. Cesarean deliveries, elective labor inductions and scheduled deliveries before 39 weeks are also the rise. These two papers explains how the growing use of medically unnecessary interventions is increasing costs and the incidence of complications among mothers and babies, with no evidence of improved outcomes, and how payment reform can help change this.
- Eliminating Waste in US Health Care (2012)—Journal of the American Medical Association
The opportunity for waste reduction in healthcare is enormous. This article identifies many potential sources of waste and provides a broad range of estimates of the magnitude of excess spending.
- Overkill (2015)—The New Yorker
This article examines the vast amount of money spent on unnecessary health-care services.
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