(flickr: Images Money)
The largest public employees retirement system in the country – CalPERS – has plenty to gain from a drop in health care costs. After all, they cover 1.6 million employees, retirees and their families in California.
Now they’re saying, they found a way to decrease the amount they’ve spent on knee and hip replacements by 19 percent in a year, which could have implications for other employer health plans.
Lisa Alferis blogged about the CalPERS experiment in controlling costs right here on State of Health about a year ago. Aliferis wrote that they decided to tackle costs around these two surgeries, which cost them $55 million dollars a year in 2008.
Now, you might not think there would be much difference in the price for getting a knee or hip replacement across the state. But think again. CalPERS asked Anthem Blue Cross — which manages its PPO plans — to examine the range of prices for these operations in California.
Anthem came back with the startling information that CalPERS was paying $15,000 on the low end to $110,000 on the high end, a more than seven-fold difference from lowest to highest.
“So we started asking ourselves,” Kathy Donneson, Chief of the CalPERS Heatlhy Plan Administration Division told me, “what are we getting from the $110,000 surgery that we couldn’t get from the $15,000 surgery?”
That’s when CalPERS turned to what’s called a “value based purchasing” approach for elective hip and knee replacements, starting with its non-Medicare population. CalPERS set a threshold price of $30,000 for the hospitalization and device charges for these operations. That $30,000 is slightly higher than the average price CalPERS had been paying for a hip or knee replacement. Anthem identified 46 hospitals across the state which would do these operations at the threshold price.
By Patti Neighmond, NPR
Mike Jackson has diabetes and high blood pressure. His eye was damaged after he cut back on insulin because he couldn’t afford it. (Bryan Terry/NPR)
For many years, high medical bills have been a leading cause of financial distress and bankruptcy in America. That pressure may be easing ever so slightly, according to a survey released earlier this month by the Centers for Disease Control and Prevention.
But 1 in 5 Americans still face hardships due to medical costs — and African-Americans continue to be the hardest hit.
A poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health found that 24 percent of African-American families say they’ve had problems paying for needed prescription drugs. The poll is part of NPR’s ongoing series, The View From Black America.
Mike Jackson is one of those people. Jackson, 52, lives in Oklahoma City and works for a major insurance company. He has high blood pressure and hypertension, and has been diabetic for 15 years.
Treating these chronic health problems isn’t cheap. Jackson’s medical bills add up to nearly $500 a month. “Diabetes alone — just the two medications alone for diabetes would have run $325 a month,” he says. Continue reading
By Sarah Varney, Kaiser Health News
Researchers report that the Affordable Care Act shifted $147 million from individuals — or hospitals, in the form of uncompensated care — to private insurance plans. (Indoloony/Flickr)
Researchers at the RAND Corporation set out to find some hard data on one aspect of the health law: Does having medical insurance protect young adults from the financial ruin that often comes with a major injury or illness?
The quick answer: Yes, it does.
Since September 2010, the Affordable Care Act has allowed young adults to remain on their parents’ medical insurance until they turn 26, and an estimated 3.1 million young people have taken advantage of the new rule.
The RAND researchers looked at nearly a half a million visits young adults made to emergency departments around the country before and after the under-26 provision took effect.
“We looked at just the most serious conditions,” said Andrew Mulcahy, an associate policy researcher at the RAND Corporation. Mulcahy and his colleagues pored over actual hospital records for bone fractures, poison, traumatic brain injuries, and other incidents that would require an urgent trip to the hospital. Continue reading
It’s nearly unbelievable to average consumers, but well known to wonks: health care prices are impossible to come by. Even calling and asking about a specific procedure, as researchers recently reported, led to an “I dunno” from the hospital itself more than half the time.
But now, a little bit of light is being shed on this dark area of health care. Wednesday morning, the federal government released a massive amount of data: the prices that hospitals across the country charge for 100 of the most common inpatient treatments.
Skipping over the wonk for now, let’s dive in to some numbers right here in the Bay Area. They cast a spotlight on how random and wildly variable health care prices are.
I picked one procedure, a hip or knee replacement (“lower extremity major joint replacement”) without major complications.
A joint replacement is generally a procedure you would schedule in advance, not a race-to-the-hospital-life-or-death-spare-no-cost situation. You might think the range of prices would be somewhat narrow.
You would be wrong. Continue reading
A major new analysis shows that hundreds of thousands of Californians will see their monthly insurance premiums fall an average 47 percent under President Obama’s health care overhaul, in large part due to tax credits and subsidies. It is the first detailed look at how health insurance premiums could change under President Obama’s Affordable Care Act, which goes into effect on Jan. 1, 2014.
Covered California, the agency charged with creating the state’s new health insurance marketplace, commissioned the analysis. The report looked at the individual market only and did not examine the small or large group market.
Under the ACA people with incomes up to four times the federal poverty level (about $94,000 for a family of four; $46,000 for an individual) will be eligible for subsidies from the federal government. That’s about 570,000 people, Covered California said.
Major findings from the study include:
- Individuals with incomes less than four times the poverty level are “likely to pay” 47 to 84 percent less for their monthly premium compared to this year
- Premiums would have increased 9 percent in 2014 because of health care inflation, even without the ACA Continue reading
It seems that “32 percent” is the number of the day today. First, actuaries believe that medical claims costs will go up 32 percent, and now the Centers for Disease Control tells us that 32 percent of U.S. families are having trouble paying their medical bills:
(Centers for Disease Control)
Nearly one in four children ages birth to 17 live in families that are struggling to pay medical bills, according to CDC data from the National Health Interview Survey, from January – June, 2011.
Here are more findings. In the first six months of 2011: Continue reading
X-ray showing a new artificial hip. No, I don’t know how much the patient paid for it. (okadots/Flickr)
If you want to buy a new car, you can probably figure out a price range within a matter of minutes with a google search. The same is true for many other products. But in health care, forget it.
In a new study published today in JAMA Internal Medicine, researchers called more than 100 hospitals across the country. They included a range of both top-ranked centers and community hospitals and inquired about a common elective surgical procedure — a hip replacement — for a fictitious 62-year-old grandmother.
First off, only 10 percent of the non-top-ranked hospitals and 45 percent of the top-ranked hospitals were even able to provide a price. Researchers were a bit more successful when they called the hospital and physician separately.
“It is time we stop forcing people to buy health care services blindfolded.”
And just what was the price range? $11,100 on the low end to $125,000 on the high end.
“Patients seeking elective (hip replacement) may find considerable price savings through comparison shopping,” the authors write. No kidding — except that half of the institutions couldn’t even provide a price. Continue reading