A quick roundup of the issues driving the healthcare reform conversation.
Week in Review
HOSPITAL CONSOLIDATION As hospitals grow larger, so do consumers’ bills.
Quick takeaway: Giant hospital systems continue to swallow up huge chunks of our healthcare system, exploiting their size to negotiate higher reimbursement and driving up costs for everyone.
Digging deeper: Hospital representatives have long claimed that mergers in the industry lead to better efficiencies and improved patient outcomes. What’s really happened, though, is that most regions in the U.S. are now dominated by a few large hospital systems, which has only resulted in higher prices with no significant improvements to care.
Over the past two decades, there’ve been more than 1,000 mergers among the approximately 5,000 hospitals in our country, and as a result, spending on hospital care now makes up the largest part of our overall healthcare spend, with 30 cents of every dollar going to hospitals.
What it means: While the rising costs that result from these mergers lead to alarmingly high medical bills, there’s a greater cost that affects all of us in the form of higher premiums.
MA SAVINGS Medicare Advantage helps beneficiaries save thousands of dollars every year.
Quick takeaway: According to a new study, seniors enrolled in Medicare Advantage (MA) plans spend over $2,500 less per year on out-of-pocket costs than those enrolled in original Medicare Fee-for-Service (FFS).
Digging deeper: The analysis shows an uptick from the previous year, when MA beneficiaries spent over $2,400 less than FFS enrollees.
That reduced spending extends across racial and ethnic groups. And, it’s even higher for clinically complex beneficiaries, with seniors having three or more chronic conditions spending an average of $3,165 less per year compared to FFS.
MA also serves more of the low-income population than FFS, with the report showing that more than half of those enrolled in MA plans had income levels below 200 percent of the federal poverty line, compared to about one-third in FFS.
What it means: The data reinforces what stakeholders are urging lawmakers and regulators to keep in mind as they continue to chip away at the program – namely, that MA does a better job of taking care of vulnerable seniors for less money.
PBM VALUE Stakeholders urge lawmakers to protect their pharmacy benefits.
Quick takeaway: Employers highlight the critical role that pharmacy benefit managers (PBMs) play in helping them provide access to affordable, quality prescription drug benefits.
Digging deeper: Business leaders from across the country are voicing concerns over misguided policies targeting PBMs and seeking to eliminate their ability to drive value for employers and consumers.
In defending the work that PBMs do on their behalf, these employers point to the importance of being able to design benefit packages that allow them to offer quality, affordable prescription drug coverage to their employees, something their PBMs help them do.
They also point to the potential cost of some of the policies currently being considered, such as a ban on “de-linking,” which would not only raise premiums in the commercial market by nearly $27 billion, but would amount to a $22 billion bailout for the pharmaceutical industry.
Increased regulation of the private market, they maintain, only takes away the optionality that’s so important to employers.
What it means: The message reinforces polling from late last year in which 9 out of 10 employers said they value their relationship with their PBM and the full range of contract options they provide.
EMPLOYER-PROVIDED COVERAGE American workers value their employer-provided healthcare coverage.
Quick takeaway: A recent report details high satisfaction among people relying on access to high-quality, affordable healthcare through their employer.
What they’re saying: Highlights from the study include:
- 89 percent saying their employer-provided coverage had provider options that were convenient to them
- 71 percent saying they are better able to manage their chronic conditions because of their employer-provided coverage
- Of the 1 in 5 taking advantage of the cost comparison tools made available through their employer-provided coverage, 60 percent saying it changed their behavior, even causing some to choose less expensive treatment options
- 41 percent of those who changed their behavior saying that they used those cost comparison tools to predict the cost of a procedure or treatment in advance
Why it matters: Stakeholders from across the healthcare spectrum recently came together, sending a letter to Congress highlighting the importance of employer-provided coverage and urging lawmakers to protect this critical source of care for nearly 180 million workers and their families.
Spotlight
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