Newsletter

Talking Points: 28 October 2024

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

Week in Review

HOSPITAL CONCENTRATION I Hospital consolidation linked to consumer medical debt.

Quick takeaway: A new analysis finds persistent medical debt in markets with high hospital market concentration.

Digging deeper: Forty percent of Americans carry some form of medical debt. As health systems merge and large hospitals gobble up smaller, independent ones, there’s growing concern that this problem is only going to get worse.

Research has established that hospitals raise prices when they gain market power. As these large systems get even larger, patients have fewer options and face higher prices, leading to delayed care, worse outcomes, and even higher levels of medical debt.

What it means: While researchers acknowledge that other issues, such as chronic illness, can also contribute to rising medical debt, the data points to the need for greater scrutiny of hospitals’ growing market power. As one of the study’s authors put it, “Limiting hospital consolidation could be beneficial for consumers in limiting medical debt.”

HOSPITAL CONCENTRATION II How one hospital took over an entire region – and, what happened to prices.

Quick takeaway: Parkview Health ranks among the most expensive facilities in the country.

Digging deeper: A recent article highlights the impact that hospital market concentration can have on the communities they serve, in this case Fort Wayne, Indiana, which currently holds the top spot as the most affordable place to live in the U.S.

That community, however, is dominated by Parkview, a sprawling, not-for-profit hospital system, also headquartered in Fort Wayne, which has ranked among the top 10 percent of most expensive hospitals in the country in 10 of the past 13 years.

According to the article, by buying out its rivals, Parkview has exploited its market dominance to keep patients within their system and direct them to potentially higher-cost procedures and types of care.

What it means: This example adds to the growing narrative that hospital market consolidation leads to price increases. In fact, research has shown that prices can rise as much as 65 percent, and that hospitals may charge up to 50 percent more due to mergers.

MEDICARE ADVANTAGE New analysis details the impact of policy changes to the Medicare Advantage program.

Quick takeaway: Millions of seniors face disruption to their care as Medicare Open Enrollment gets underway.

Digging deeper: As featured last week, successive years of cuts to Medicare Advantage (MA) have resulted in changes to the program that leave beneficiaries exposed to higher costs and reduced benefits. According to a recent analysis:

  • MA plan offerings will decrease by 6.5 percent next year
  • Median out-of-pocket maximum will increase by 8 percent in 2025
  • Fewer plans will offer certain supplemental benefits, such as meals (6 percent decrease), nutrition services (11 percent decrease), and transportation (7 percent decrease)

What it means: More than half of the Medicare eligible population is now enrolled in MA, meaning millions face uncertainty in what their plans will cost, what benefits they offer, and, in some cases, whether that plan will even be available anymore.

VIRTUAL CARE Consumer demand for virtual care increases.

Quick takeaway: The increased demand comes as systems struggle to keep up.

Digging deeper: In the immediate wake of the coronavirus public health crisis, virtual care provided a critical access point for patients seeking medical services. 

As consumer comfort with the technology grew, so did demand. In fact, according to a new survey, nearly a quarter (24 percent) of consumers go so far as to say they’d be willing to switch doctors if it meant being able to access virtual health options.

Despite this demand, many health systems find their organizational priorities misaligned with this growing consumer need, with some reducing or discontinuing their virtual health offerings altogether.

What it means: With consumers pointing to convenience and cost as driving their embrace of virtual care, experts caution that health systems failing to match evolving patient expectations and demand for digital health, run the risk of being left behind.

Spotlight

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The Health Action Network includes everyday Americans—families, workers, businesses, patients, providers, neighbors, and friends. We are working together because we support market-based solutions that offer better healthcare choices and help build a stronger economy. The Health Action Network is an Elevance Health, Inc., initiative.