A quick roundup of the issues driving the healthcare reform conversation.
Week in Review
WAITING ROOM As healthcare costs go up, so too do patient wait times.
Quick takeaway: Increased demand for healthcare services, coupled with provider burnout, mean people are waiting longer to see their doctor.
Digging deeper: According to a recent analysis, 17 percent of patients had to wait up to three months for their latest appointment. The most frequently cited specialties with long wait times included:
- Neurology at 26 percent.
- Ear, nose, and throat, also at 26 percent.
- Psychiatry at 20 percent.
- OB/GYN at 17 percent.
For context, primary care stood at 19 percent of patients reporting having to wait to schedule an appointment.
What it means: Experts point to pent-up demand for medical services coming out of the COVID public health emergency. Additionally, tens of thousands of doctors have left the profession or plan to, putting further strain on the system.
While there’s hope that technology and at-home care will fill some of these gaps, there’s concern that patients who’ve had negative experiences accessing care are likely to avoid seeking it in the future.
EMPLOYER COSTS High-cost treatments are projected to drive up employer healthcare costs.
Quick takeaway: The increased demand for weight-loss drugs and gene and cell therapy treatments will see employers’ healthcare costs go up by as much as eight percent next year.
Digging deeper: New research points to high-cost GLP-1 drugs and multimillion dollar gene and cell therapy treatments as being primarily responsible for increases to employers’ healthcare cost burden in 2025.
More than half of employers (56 percent) pointed to these weight-loss drugs as being a “great” or “very great” driver of their increased costs, while 46 percent cited high-cost cell and gene therapies.
What it means: Other spending data paints a grim picture, as spending on prescription drugs was shown to have increased nearly 10 percent in 2023, driven by price hikes on existing drugs outpacing inflation, skyrocketing launch prices for new medicines, and costly GLP-1 weight-loss drugs.
NO SURPRISES New data provides insights into how consumer protections from surprise medical bills are performing.
Quick takeaway: Despite its strong start, persistent issues with the arbitration process intensify concerns about the No Surprises Act’s (NSA) ability to control healthcare costs.
Digging deeper: While implementation of the NSA prevented millions of consumers from being hit with surprise bills last year, recent analysis of the latest data from the Centers for Medicare & Medicaid Services detailing arbitration outcomes provides key takeaways for how the NSA is doing now, including:
- Arbitration decisions for payments to out-of-network providers coming in significantly higher than Medicare reimbursement and in-network rates.
- Arbitration decisions overwhelmingly favoring providers.
- The lack of transparency in how decisions are reached by arbitrators.
What it means: Perhaps the key takeaway for regulators is that, without necessary adjustments to the arbitration process, the NSA will ultimately fail to reduce costs for patients.
HOSTAGE-TAKING A recent report highlights a dangerous negotiating tactic increasingly deployed by hospitals.
Quick takeaway: By threatening to dump health plan networks, hospitals’ “hostage-taking” strategy puts patients at risk and threatens to blow up healthcare costs for everyone.
Digging deeper: Health plans and their customers – including employers and government partners – are finding themselves caught between a rock and a hard place in their rate negotiations with large hospital systems. Essentially, these health systems are threatening to terminate their contracts with health plans, which would remove these providers from the insurers’ networks, meaning patients would no longer have coverage at these facilities.
But, it’s not just commercially-insured customers who are at risk, as hospitals are also threatening to eliminate Medicare beneficiaries and Medicaid enrollees from their network agreements, jeopardizing access for the most vulnerable patient populations.
What it means: It’s not just health plans finding themselves on the receiving end of hospitals’ aggressive negotiating tactics. Across the country, healthcare workers are also fighting with these large health systems for new contracts.
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