Talking Points: 8 May 2023

A quick roundup of the issues driving the healthcare reform conversation.

Item of the Week


HOSPITAL COSTS Cardiac care is more expensive in hospitals.

Quick takeaway: According to a new study, heart patients were more likely to receive high-intensity interventions by doctors employed by a hospital compared to patients who received their care from an independent cardiologist.

Further context: The data adds to the growing body of research detailing the impact that hospitals acquiring independent and specialty practices can have on patients, such as:

  • Hospital-integrated oncologists prescribing costlier drugs
  • Integrated primary care physicians ordering inappropriate imaging services

What it means: Researchers point to the data as further evidence that hospital consolidation leads to riskier – and, costlier – care, since the lucrative services ordered by in-house cardiologists contribute to hospitals’ bottom lines.

Rx PRICES Price transparency will hold Big Pharma accountable and help lower prescription drug prices.

Quick takeaway: Despite the inflamed rhetoric seeking to distract attention away from who bears responsibility for out-of-control drug prices, it’s important to remember that drug companies alone determine the prices of the products in their portfolios.

Digging deeper: To counteract this, stakeholders are calling for solutions that boost price transparency in order to shine a light on the drug industry’s worst price-gougers, better arm patients, health plans, and policymakers with insights into Big Pharma’s pricing decisions, and alert the public to looming price hikes.

What it means: Enhanced price transparency puts pressure on pharmaceutical companies to lower the prices of their drugs.  Put another way, by failing to disclose how and why they raise their prices, drugmakers are free to repeatedly hike prices without justification or public scrutiny.

INTEGRATION OF BENEFITS Medical and pharmacy benefit integration drives savings.

Quick takeaway: A new white paper shows improved cost savings and health outcomes resulting from an integrated approach to specialty drug management.

Further context: According to the data, integrating medical and pharmacy benefits not only led to significant per member per month all-cause medical spending savings, but reduced inpatient utilization and shorter hospital stays, too. 

What it means: The results are especially meaningful given the study’s focus on specialty drugs, which, despite accounting for a small percentage of total drugs prescribed, make up the lion’s share of total drug spending.

Additionally, as the study’s authors learned, not integrating specialty pharmacy benefits can actually be more costly in the long run, due to fragmented patient care, increased hospitalizations, and ER visits.

SOCIAL DRIVERS OF HEALTH A look at how social drivers of health impact health outcomes.

Quick takeaway: New data tells the story of how the different social drivers of health (SDoH) impact outcomes, with some of these factors being more closely related to poor care quality, with others more closely tied to high utilization.

Further context: Some SDoH, such as social isolation and limited access to transportation, were actually linked to both poor care quality and high acute care utilization.

What it means: The study serves to reinforce the importance of understanding how the environments in which people live, work, and play impact their health and well-being – something that’s become a priority for stakeholders, who are working to better address SDoH.

NONPROFIT HOSPITALS Less charity care is provided by nonprofit hospitals that compensate their board members.

Quick takeaway: As has been featured in this newsletter, greater attention is being paid to whether nonprofit hospitals are providing sufficient levels of charity care to justify their tax breaks.  A new study provides an added wrinkle to that developing conversation.

Digging deeper: According to the data, nonprofit hospitals that pay their board members provide less charity care than nonprofit hospitals that do not compensate their trustees.  Among the key takeaways:

  • More than 37 percent of all nonprofit hospitals compensated their board members in 2019.
  • Between 2011 and 2019, that compensation increased by 57 percent.
  • On average, a $10,000 increase in board compensation was linked to a nearly $70,000 decrease in annual provided charity care.


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