“There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people.[..] Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control … Read More
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“Our study of the quality of end-of-life care in MA [Medicare Advantage] plans comes as the Centers for Medicare & Medicaid Services is set to start testing a “carve-in” of hospice services in 2021, meaning that hospice will be a covered benefit within MA and therefore MA plans will take a more active role in hospice services. Currently, the hospice benefit is “carved out” from MA, although MA plans are still involved in the care of hospice enrollees through several mechanisms. Older adults in MA are more likely to receive hospice services, potentially through direct care coordination or by contracting … Read More
“This report provides data on individual health insurance market enrollment trends for people who purchase health insurance with (subsidized) and without (unsubsidized) advanced premium tax credits (APTC). From plan years 2016 to 2019, unsubsidized enrollment declined by 2.8 million people, representing a 45 percent drop nationally. At the state level, the percentage change in unsubsidized enrollment over this period ranged from a 4 percent drop in Rhode Island to a 90 percent drop in Iowa. [..] average monthly enrollment across the individual market nationally decreased by 3 percent between 2018 and 2019. Eighty percent of the decrease in enrollment between … Read More
“The Medicare Advantage (MA) quality bonus program (QBP), which rewards MA plans on a quality star rating scale, is flawed and inconsistent with the Commission’s principles for quality measurement. First, the QBP includes almost 50 quality measures, including process and administrative measures, instead of focusing on a small set of population-based outcome and patient experience measures. Second, organizations are rated at the MA contract level. Contracts cover very wide areas—including noncontiguous states—and therefore a contract-level rating may not be a useful indicator of the quality of care provided in a beneficiary’s local area. Third, the QBP uses a “tournament model,” … Read More
“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed. Billing quality is a type of medical quality. In the same way that medical complication rates are collected for improvement purposes and some are available to the public, metrics of billing quality could be used to create public accountability for US hospitals. [..] The first proposed metric is whether patients are routinely provided with an itemized bill of services in plain English. Most bills have historically listed medical codes and terms. However, describing services in a way that is understandable to patients … Read More
“The program [Medicare Part D] itself does not negotiate drug prices with pharmaceutical companies. Instead, the government partners with pharmacy benefit managers (PBMs) to leverage its market power and reduce drug prices for seniors in Part D. Insurance companies, unions, large employers, and state governments also engage PBMs in similar arrangements. By representing such a wide swath of the purchasers of prescription drugs, PBMs can use their purchasing power to negotiate lower prices from pharmaceutical companies. [..] the Department of Health and Human Services has issued a rule that would limit their ability to pass back the rebates they negotiate … Read More
“Competition in health care fails for several fundamental reasons. First, patients often lack the information needed to assess both their care needs and the quality of their care. Second, illness and health care needs are inherently difficult to predict, exposing people to financial risks that they must insure against. This risk gives rise to an insurance system that shields patients from the price of care, dampening their incentive to use care judiciously and to seek care from providers offering high-quality care at affordable prices. The information problem, amplified by insurance, reduces the ability and incentives for patients to seek low-price, … Read More
“This study was produced independently by the IQVIA Institute for Human Data Science as a public service, without industry or government funding. [..] In 2019, the United States spent $493 billion on medicines at ex-manufacturer invoice prices, including $211 billion on biologics, which now comprise 43% of total medicine spending. [..] The correlation between the magnitude of molecule sales and the number of biosimilar competitors attracted to the space is not as robust as expected. Rather it appears that the selection of molecules for biosimilar development may be influenced by multiple factors such as technical complexity, intellectual property issues, or … Read More
“because a vast majority of programs that tie payment to cost and quality goals aren’t focused on disadvantaged populations, they create incentives for hospitals to avoid patients from these groups. For example, in the 1990s, the New York State Department of Health began grading surgeons who performed coronary bypass surgery and making their report cards available to the general public. The aim was to make outcomes more transparent and to help surgeons improve. But to this day, the initiative makes it harder for Black patients to get surgery. Why? Because statistically, outcomes are generally worse for Black patients because of … Read More
“The Covid-19 pandemic has added another twist in the U.S. health-care saga. While some providers initially struggled financially as elective and outpatient care were cancelled or deferred, private health insurers saw record profits in the second quarter. In fact, major insurance companies such as UnitedHealthcare, Anthem, and Humana doubled their profit margins, pushing Democrats to launch an investigation into insurers’ practices. During a time when public confidence in political and corporate institutions is low, the paradox of soaring insurers’ profits and unprecedented providers’ losses is painful, potentially detrimental, and likely unnecessary. [..] Under Affordable Care Act (ACA) regulations, insurers’ excess … Read More