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  • Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices

    Tags: Outpatient Spending, Physician Spending, Prices, Utilization
    Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices
    John Hargraves, Julie Reiff
    April 2, 2019

    Where people receive health care matters, especially in terms of costs. The same services may have a much higher price tag when performed in one setting rather than another, but this price difference is rarely publicized to patients. To understand what settings people used and how prices differed, we looked at the utilization and average…

    Read more: Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices
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  • Surprise out-of-network medical bills during in-network hospital admissions varied by state and medical specialty, 2016

    Tags: Geographic Variation, Out-of-Network, Senate HELP Committee, Surprise Billing
    Surprise out-of-network medical bills during in-network hospital admissions varied by state and medical specialty, 2016
    Kevin Kennedy, William Johnson, and Jean Fuglesten Biniek
    March 28, 2019

     Out-of-network billing practices have increasingly garnered attention as individuals with commercial health insurance continue to experience “surprise billing.” A surprise medical bill commonly describes a charge to a patient for care delivered by an out-of-network (OON) professional who works within an in-network facility. We used the Health Care Cost Institute’s (HCCI) vast commercial claims database to…

    Read more: Surprise out-of-network medical bills during in-network hospital admissions varied by state and medical specialty, 2016
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  • Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices

    Tags: Chronic Conditions, Diabetes, Drug Spending, Insulin, Prices
    Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices
    Jean Fuglesten Biniek, William Johnson
    January 22, 2019

    We used health care claims data to investigate trends in total health care spending on individuals with type 1 diabetes between 2012 and 2016. We found a rapid increase in total health care spending, driven primarily by gross spending on insulin that doubled over the period. During that time insulin use rose only modestly. While…

    Read more: Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices
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  • Trends In Primary Care Visits

    Tags: Commercially Insured, Physician Spending, Prices, Primary Care, Utilization
    Trends In Primary Care Visits
    John Hargraves, Amanda Frost
    November 15, 2018

    Office visits to primary care physicians (PCPs) declined 18 percent from 2012 to 2016 for adults under 65 years old with employer-sponsored health insurance, while office visits to nurse practitioners (NPs) and physician assistants (PAs) increased 129 percent. Comparing 2012 to 2016, there were 273 fewer office visits per 1,000 insured individuals to primary care…

    Read more: Trends In Primary Care Visits
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  • Understanding how price growth affected areas differently across the country

    Tags: Geographic Variation, Healthy Marketplace Index, Prices
    Understanding how price growth affected areas differently across the country
    Kevin Kennedy, William Johnson
    October 24, 2018

    Recently, the Health Care Cost Institute (HCCI) published its Healthy Marketplace Index (HMI) – Price Index report, examining relative health care prices in 112 different metropolitan areas. This report is the first in a new series of releases from the HMI project, funded by the Robert Wood Johnson Foundation, which compares commercial health care markets…

    Read more: Understanding how price growth affected areas differently across the country
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  • Health Affairs: Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective

    Tags: Commercially Insured, Drug Spending, Health Affairs, Inpatient Spending, Outpatient Spending, Peer Reviewed Journals, Physician Spending
    Health Affairs: Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective
    Amanda Frost, Eric Barrette, Kevin Kennedy, Niall Brennan
    September 19, 2018

    ABSTRACT Using a national sample of health care claims data from the Health Care Cost Institute, we found that total spending per capita (not including premiums) on health services for enrollees in employer-sponsored insurance plans increased by 44 percent from 2007 through 2016 (average annual growth of 4.1 percent). Spending increased across all major categories…

    Read more: Health Affairs: Health Care Spending Under Employer-Sponsored Insurance: A 10-Year Retrospective
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  • ER facility prices grew in tandem with faster-growing charges from 2009-2016

    Tags: Charges, Commercially Insured, Emergency Room, Outpatient Spending, Prices
    ER facility prices grew in tandem with faster-growing charges from 2009-2016
    John Hargraves, Kevin Kennedy
    September 11, 2018

    HCCI often reports the prices of health care services, defined as the average amount a provider is paid for a given service based on negotiations with health care insurers. These prices typically represent a portion of charges, which are the amounts health care providers bill for the procedures they perform. The charge amount is often…

    Read more: ER facility prices grew in tandem with faster-growing charges from 2009-2016
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  • ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)

    Tags: Commercially Insured, Emergency Room, Geographic Variation, Outpatient Spending, Prices, Utilization
    ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)
    John Hargraves; Kevin Kennedy
    May 30, 2018

    HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER…

    Read more: ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)
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  • Interactive Tool: Disease Modifying Therapies Drove 82% of Total Increase in Health Care Spending for People with Multiple Sclerosis

    Tags: Drug Spending, Multiple Sclerosis
    Interactive Tool: Disease Modifying Therapies Drove 82% of Total Increase in Health Care Spending for People with Multiple Sclerosis
    William Johnson; John Hargraves; Sally Rodriguez
    April 24, 2018

    In a recent issue brief, HCCI found that the already high cost of care for people with multiple sclerosis (MS) rose dramatically over the past several years. The primary driver was the increasing cost of a small group of prescription drugs called Disease Modifying Therapies (DMTs). To illustrate the role prescription drug prices play in…

    Read more: Interactive Tool: Disease Modifying Therapies Drove 82% of Total Increase in Health Care Spending for People with Multiple Sclerosis
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  • The Rising Cost of Specialty Drugs Drove Spending Increases for People with Multiple Sclerosis

    Tags: Chronic Conditions, Drug Spending, Multiple Sclerosis
    The Rising Cost of Specialty Drugs Drove Spending Increases for People with Multiple Sclerosis
    William Johnson
    April 12, 2018

    This issue brief investigates how the cost of prescription drugs affects the total cost of care for people with multiple sclerosis (MS). It decomposes total health care spending by category, specifically separating out spending on specialty drugs used to treat MS, called Disease Modifying Therapies (DMTs). The issue brief subsequently examines whether changes in spending…

    Read more: The Rising Cost of Specialty Drugs Drove Spending Increases for People with Multiple Sclerosis
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