Category Archives: Health Care

2019 Segal Health Plan Cost Trend Survey

Source: Segal Consulting, Public Sector Data Fall 2018

From the summary:
Increases in Medical and Prescription Drug Costs Projected to Be Lower for 2019

Medical and prescription drug cost trends, for both actives and non-Medicare retirees, are projected to be lower in 2019 than in previous years.

That’s the headline finding from Segal’s 2019 Health Plan Cost Trend Survey, which surveyed more than 100 managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs).

Other Key Findings
– Medical plan cost trends are projected to be lower than 2018 projections.
– Actual medical and prescription drug trend results for 2017 were significantly lower than carrier projections for 2017.
– Actual prescription drug plan cost trends for 2017 were the second lowest in the last 13 years.
– Price inflation continues to be the primary driver of overall medical and prescription drug cost trends.
– Network physician reimbursement rate increases are projected to increase by less than 2 percent for both primary care and specialists, below overall CPI rates.
– Prescription drug cost-management strategies and improved vendor contracting are still plan sponsors’ top priorities.

Related:
Multiemployer

How Democratic Candidates For The Presidency In 2020 Could Choose Among Public Health Insurance Plans

Source: Sherry A. Glied and Jeanne M. Lambrew, Health Affairs, Ahead of Print, November 16, 2018
(subscription required)

From the abstract:
Democratic candidates for president in 2020 will likely include some type of public plan in their health care reform platforms. Existing public plans take many forms and often incorporate private elements, as do most proposals to extend such plans. We review the types of public plans in the current system. We describe and assess the range of proposals to extend these plans or elements of them to additional populations. We suggest questions that candidates could use to guide their decisions about the scope and content of their health policy proposals. Developmental work during campaigns will contribute to success in turning candidates’ promises into accomplishments.

Getting Ready For Health Reform 2020: Republicans’ Options For Improving Upon The State Innovation Approach

Source: Lanhee J. Chen, Health Affairs, Ahead of Print, November 16, 2018
(subscription required)

From the abstract:
The 2020 presidential election will be consequential for the future of health reform, with the two major-party nominees taking very different views on the future of the Affordable Care Act (ACA), as well as the policies needed to lower health costs and continue to expand access to coverage. The Republican nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation–based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017. This article takes that legislation as a starting point, contextualizes it within the broader health reform discussion, and suggests ways to improve upon it to enhance the affordability of and access to coverage and to ensure that states have adequate flexibility to implement their policy goals.

Health Benefits In 2018: Modest Growth In Premiums, Higher Worker Contributions At Firms With More Low-Wage Workers

Source: Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, and Heidi Whitmore, Health Affairs, Vol. 37 no. 11, November 2018
(subscription required)

From the abstract:
The annual Henry J. Kaiser Family Foundation Employer Health Benefits Survey found that in 2018 the average annual premium for single coverage rose 3 percent to $6,896 and the average annual premium for family coverage rose 5 percent to $19,616. Covered workers contributed 18 percent of the cost for single coverage and 29 percent of the cost for family coverage, on average, with considerable variation across firms. Eighty-five percent of covered workers face a general annual deductible before they use most services, including the 29 percent of covered workers who are enrolled in a high-deductible health plan with a savings option. The share of firms covering services provided via telemedicine has increased steadily over the past several years. Nearly a quarter of large employers expect the elimination of the individual mandate to result in lower take-up in plan offerings.

Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective

Source: Amanda Frost, Eric Barrette, Kevin Kennedy, and Niall Brennan, Health Affairs, Vol. 37 No. 10, 2018
(subscription required)

From the abstract:
Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories of health services, although the increases were not uniform across years or categories. Growth rates for total per capita spending generally slowed after 2009 but increased between 2014 and 2016. Spending on outpatient services grew more quickly (average annual growth of 5.7 percent) compared to spending on the other types of services. However, the overall distribution of spending across categories remained largely unchanged. In the context of the dramatic economic and policy events that have taken place since 2007—including the Great Recession, the Affordable Care Act, and numerous medical innovations—this assessment of ten-year spending trends provides insights into how the largest insured population in the US contributes to health care spending growth.

2018 Employer Health Benefits Survey

Source: Kaiser Family Foundation, 2018

From the abstract:
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices. The 2018 survey included 2,160 interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $19,616 this year, up 5% from last year, with workers on average paying $5,547 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,573 for single coverage. Fifty-six percent of small firms and 98% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 57%.

Survey results are released in several formats, including a full report with downloadable tables on a variety of topics, a summary of findings, and an article published in the journal Health Affairs.

Related:
Health Benefits In 2018: Modest Growth in Premiums, Higher Worker Contributions at Firms with More Low-Wage Workers, More Workers Face a Deductible.
Source: Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, and Heidi Whitmore, Health Affairs, Ahead of Print, October 3, 2018
(subscription required)

From the abstract:
The annual Henry J. Kaiser Family Foundation Employer Health Benefits Survey found that in 2018 the average annual premium for single coverage rose 3 percent to $6,896 and the average annual premium for family coverage rose 5 percent to $19,616. Covered workers contributed 18 percent of the cost for single coverage and 29 percent of the cost for family coverage, on average, with considerable variation across firms. Eighty-five percent of covered workers face a general annual deductible before they use most services, including the 29 percent of covered workers who are enrolled in a high-deductible health plan with a savings option. The share of firms covering services provided via telemedicine has increased steadily over the past several years. Nearly a quarter of large employers expect the elimination of the individual mandate to result in lower take-up in plan offerings.

Mercer National Survey of Employer-Sponsored Health Plans – 2018

Source: Mercer, 2018

From the press release:
Highlighting the many ways that health technology is transforming employer-sponsored health benefit programs, Mercer unveiled early results from its industry-leading survey at this year’s HR Technology Conference & Expo in Las Vegas. Based on the first 1,566 responses to the Mercer National Survey of Employer-Sponsored Health Plans, Mercer projects that health benefit cost per employee will rise by 4.1% on average in 2019 (see Figure 1).

This increase is in line with recent low single-digit annual increases. Mercer notes that the underlying medical plan cost trend has cooled from 6.5% to 5.3% heading into 2019 (the underlying trend is the estimated increase in medical plan cost if employers made no changes). In past years, common employer cost-control tactics included raising deductibles and offering less generous plans. For 2019, however, fewer than half of the responding employers (44%) will be making these types of changes. But many employers are adopting new technology-enabled tools and solutions to address the root causes of the high cost of health care without cutting benefits or increasing the financial burden on employees. ….

Hospitals keep ER fees secret. We’re uncovering them.

Source: Sarah Kliff, Vox, 2017-2018

Each year, Americans make 141 million trips to the emergency room. In nearly all those visits, hospitals charge patients something called a facility fee: the price for walking in the door and seeking medical service. Facility fees can be big: Reporter Sarah Kliff has seen charges that range from $533 to more than $3,000. But because these fees are kept secret until you receive your bill, we can’t know how high they get — or how much they vary. We want to bring transparency to these extremely common but little-understood fees. So we have been collecting facility fee bills from our readers as part of a year-long project focused on American health care prices.

Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?

Source: Rebecca D. Kehm, Logan G. Spector, Jenny N. Poynter, David M. Vock, Sean F. Altekruse, Theresa L. Osypuk, Cancer, Early View, First published: 20 August 2018

From the abstract:
Background:
For many childhood cancers, survival is lower among non‐Hispanic blacks and Hispanics in comparison with non‐Hispanic whites, and this may be attributed to underlying socioeconomic factors. However, prior childhood cancer survival studies have not formally tested for mediation by socioeconomic status (SES). This study applied mediation methods to quantify the role of SES in racial/ethnic differences in childhood cancer survival.

Methods:
This study used population‐based cancer survival data from the Surveillance, Epidemiology, and End Results 18 database for black, white, and Hispanic children who had been diagnosed at the ages of 0 to 19 years in 2000‐2011 (n = 31,866). Black‐white and Hispanic‐white mortality hazard ratios and 95% confidence intervals, adjusted for age, sex, and stage at diagnosis, were estimated. The inverse odds weighting method was used to test for mediation by SES, which was measured with a validated census‐tract composite index.

Results:
Whites had a significant survival advantage over blacks and Hispanics for several childhood cancers. SES significantly mediated the race/ethnicity–survival association for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non‐Hodgkin lymphoma; SES reduced the original association between race/ethnicity and survival by 44%, 28%, 49%, and 34%, respectively, for blacks versus whites and by 31%, 73%, 48%, and 28%, respectively, for Hispanics versus whites ((log hazard ratio total effect – log hazard ratio direct effect)/log hazard ratio total effect).

Conclusions:
SES significantly mediates racial/ethnic childhood cancer survival disparities for several cancers. However, the proportion of the total race/ethnicity–survival association explained by SES varies between black‐white and Hispanic‐white comparisons for some cancers, and this suggests that mediation by other factors differs across groups.