An analysis of inpatient costs in 25 metropolitan areas with the most hospital consolidations from 2010 to 2013 found that the price of a typical inpatient stay in a third of those areas climbed by at least 25% from 2012 to 2014. Hospital mergers essentially eliminated competition, and prices increased even more steeply when large hospital systems acquired physician practices, according to researchers from the Petris Center at the University of California at Berkeley.
Diabetes coaching and monitoring startup Virta Health has announced a business model under which insurers and employers will pay for its program only when it works. The first payment is made only if a patient has demonstrated adequate engagement after using it for a month, and the second payment is made after one year, but only if patients hit their predetermined blood glucose targets.
AHIP has released a report outlining ways the government can lower premiums for Americans who buy their own coverage in the individual market, particularly those who don't qualify for assistance. Among the ideas are measures to enable state-level marketing and outreach, improve the risk pool, such as by providing premium discounts for members who take part in wellness programs, and bring down costs by eliminating the health insurance tax and inappropriate third-party premium payments.
The latest figures from the CMS show that almost 1.2 million shoppers selected Affordable Care Act coverage in the first 10 days of open enrollment, down about 300,000 from the first 11 days of last year's enrollment period, and daily enrollments are down about 12.5%. Among this year's HealthCare.gov enrollees, 274,913 are new to the exchange, compared with 345,719 a year ago.
Dental and vision insurance plans promote routine preventive care, which contributes to overall health and potentially reduces health care and disability spending, writes Melissa Killian of Unum. Poor oral or visual health is associated with heavy use of supplemental health benefits, such as hospital indemnity and critical illness coverage, Killian writes.
A free smartphone app called Chewsi connects patients in southern New England to dentists who offer discounts, and users pay the dentist directly through the app. The app is owned by Delta Dental and is available to people with or without dental insurance.
Fewer patients at risk for endocarditis, including people at high risk, have received antibiotic prophylaxis before dental procedures after guidelines discouraging AP in low-risk patients were released in 2007, and the number of endocarditis cases has risen 177% since then. Dentists should communicate with heart patients' cardiologists to determine risk and prescribe AP accordingly, says researcher Martin Thornhill.
The CMS approved Michigan's request for permission to forge outcome-based contracts with drugmakers for Medicaid coverage.
CMS Administrator Seema Verma said Medicare prescription drug plans will get more flexibility to negotiate lower prices on drugs in Medicare Part D protected drug classes.
The UK Supreme Court upheld a ruling that Pfizer's secondary patent claims on Lyrica for neuropathic pain are invalid. The ruling could allow the National Health Service to recover overpayments incurred from covering the cost of the brand-name drug instead of less-expensive generics.