The Impact of Medicare on Private Health Plans

ASHA Leader ◽  
2003 ◽  
Vol 8 (13) ◽  
pp. 8-13 ◽  
Author(s):  
Patricia Ourand
Keyword(s):  
2019 ◽  
Vol 40 (1) ◽  
pp. 411-421 ◽  
Author(s):  
Olena Mazurenko ◽  
Melinda J.B. Buntin ◽  
Nir Menachemi

High-deductible health plans (HDHPs) are becoming more popular owing to their potential to curb rising health care costs. Relative to traditional health insurance plans, HDHPs involve higher out-of-pocket costs for consumers, which have been associated with lower utilization of health services. We focus specifically on the impact that HDHPs have on the use of preventive services. We critique the current evidence by discussing the benefits and drawbacks of the research designs used to examine this relationship. We also summarize the findings from the most methodologically sophisticated studies. We conclude that the balance of the evidence shows that HDHPs are reducing the use of some preventive service, especially screenings. However, it is not clear if HDHPs affect all preventive services. Additional research is needed to determine why variability in conclusions exists among studies. We describe an agenda for future research that can further inform public health decision makers on the impact of HDHPs on prevention.


2018 ◽  
Vol 77 (5) ◽  
pp. 483-497
Author(s):  
Weiwei Chen ◽  
Timothy F. Page

High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Results from multivariable and propensity score weighted regression models showed that many of the outcomes were adversely affected by deductible levels and Marketplace enrollment. These results highlight the importance of efforts to help individuals choose the plan that fits both their medical needs and their budgets. The study also calls for more attention to improving provider acceptance of HDHPs and Marketplace plans as these plans become increasingly common over time.


10.36469/9800 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 75-88
Author(s):  
Rolin L. Wade ◽  
Chi-Chang Chen ◽  
Ajita P. De ◽  
Jaren C. Howard

Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261363
Author(s):  
Andrew D. Wilcock ◽  
Sushant Joshi ◽  
José Escarce ◽  
Peter J. Huckfeldt ◽  
Teryl Nuckols ◽  
...  

Pay-for-performance programs are one strategy used by health plans to improve the efficiency and quality of care delivered to beneficiaries. Under such programs, providers are often compared against their peers in order to win bonuses or face penalties in payment. Yet luck has the potential to affect performance assessment through randomness in the sorting of patients among providers or through random events during the evaluation period. To investigate the impact luck can have on the assessment of performance, we investigated its role in assigning penalties under Medicare’s Hospital Readmissions Reduction Policy (HRRP), a program that penalizes hospitals with excess readmissions. We performed simulations that estimated program hospitals’ 2015 readmission penalties in 1,000 different hypothetical fiscal years. These hypothetical fiscal years were created by: (a) randomly varying which patients were admitted to each hospital and (b) randomly varying the readmission status of discharged patients. We found significant differences in penalty sizes and probability of penalty across hypothetical fiscal years, signifying the importance of luck in readmission performance under the HRRP. Nearly all of the impact from luck arose from events occurring after hospital discharge. Luck played a smaller role in determining penalties for hospitals with more beds, teaching hospitals, and safety-net hospitals.


2011 ◽  
Vol 20 (9) ◽  
pp. 1025-1042 ◽  
Author(s):  
Bijan J. Borah ◽  
Marguerite E. Burns ◽  
Nilay D. Shah

Author(s):  
Jorge L. Tizón

ABSTRACTThe article takes as its starting point the recent meeting held in Menorca in September 2011 on «Healthy Urban Planning», sponsored by the International University Menéndez Pelayo and the School of Public Health of Menorca, which together planners, architects planners, sociologists, foresters, representatives of citizens’ movements, active politicians, political alternative, mathematicians, physicians, epidemiologists, psychologists and a psychiatrist. The key idea of the meeting was that cities are a fundamental building for our species and present data and studies on the «psychodynamic and psychosomatic of urban life». For this reason, and the conflicts that today is subject, should be used to make not only studies and environmental impact assessments and / or ecological urban and territorial plans. We will have to go by requiring previous studies, which have to be agreed between citizens, political representatives and promoters of change, the impact of each of these health plans and health (mental) of citizens and societies.RESUMENEl artículo toma como punto de partida el encuentro recientemente celebrado en Menorca, en septiembre del 2011, sobre «Planificación urbana saludable», patrocinado por la Universidad Internacional Menéndez Pelayo y la Escuela de Salud Pública de Menorca, en el que se juntaron urbanistas, arquitectos, planificadores, sociólogos, ingenieros de montes, representantes de los movimientos ciudadanos, políticos en activo, políticos alternativos, matemáticos, médicos, epidemiólogos, psicólogos y algún psiquiatra. La idea clave del encuentro era que las ciudades son una creación fundamental para nuestra especie. Se aportaron datos y estudios incluso sobre la “psicodinámica y psicosomática de la vida urbana”. Por eso,  y por los conflictos a los que las ciudades se hallan sometidas hoy, habrá que acostumbrarse a realizar no sólo estudios y valoraciones del impacto ambiental y/o ecológico de los planes urbanos y territoriales, en los sentidos clásicos del término: Habrá que ir introduciendo la obligación de realizar estudios previos, que han de ser consensuados entre ciudadanos, representantes políticos y promotores del cambio, sobre el impacto de cada uno de esos planes sobre la salud y la salud (mental) de los ciudadanos y sus sociedades.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6546-6546
Author(s):  
Michael Edward Stokes ◽  
Hans-Peter Goertz ◽  
Veronica Alas ◽  
Carolina Reyes ◽  
Elyse Gatt ◽  
...  

6546 Background: Oral chemotherapy is increasingly prescribed to treat cancer. Despite benefits such as convenience of use, concerns have been raised regarding adherence to therapy. The objective was to compare and measure rates of adherence and abandonment in patients filling prescriptions in traditional retail versus specialty pharmacy channels. Methods: Using a retrospective cohort design, we selected patients aged ≥18 years with a prescription for erlotinib, capecitabine, or imatinib during 2007-2011 from a Medco population of both U.S. commercial and Medicare health plans. Patients were classified according to the initial oral oncolytic received and the pharmacy channel providing the medication. Abandonment was defined as a reversal following the initial approval of the prescription claim with no additional paid claims for the agent within 90 days of reversal. Adherence was defined as the proportion of days covered between the date of the first and last oral prescription. Patients were classified as adherent if the proportion of days covered was ≥80%. Unadjusted comparisons of adherence and abandonment measures were assessed using chi-square tests. Logistic regression models adjusted for baseline characteristics were used to examine the impact of pharmacy channel on abandonment and adherence. Results: Among patients treated with an oral oncolytic, 15,071 were prescribed erlotinib, 20,062 were prescribed capecitabine and 7,233 were prescribed imatinib. For all study cohorts, Medco specialty channel had the highest proportion of adherent patients compared with traditional retail (erlotinib 84% vs. 80%, capecitabine 63% vs. 35%, and imatinib 72% vs. 67%, P<.001 all comparisons). Abandonment of the initial prescription was low with overall rates of 1.9%, 1.6%, and 1.2% for erlotinib, capecitabine, and imatinib, respectively. In multivariate models, specialty channel was significantly associated with lower abandonment and increased adherence for each cohort. Conclusions: Pharmacy channel appears to be influential on abandonment and adherence. Lower rates of abandonment and higher rates of adherence were observed among specialty pharmacy patients compared with traditional retail.


1986 ◽  
Vol 15 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Lewis L. Jones

Few faculty members and college administrators deny the fact that unions are a permanent fixture in higher education. Even in a climate that has been hostile to the formation of unions at colleges and universities, they have survived. The real question for both faculty and administrators is the impact that unions have had on institutional policies and practices—has it been positive or negative? Most research on unions in higher education has focused on compensation (salary, vacation, health plans, merit, retirement, etc.), and neglected other areas. This article, in addition to addressing financial gains, focuses on the impact that unions have in other areas of higher education. It is especially concerned with changes in governance structures that can be attributed to the influence of unions.


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