Explains how reference pricing programs, when implemented in consumer-friendly ways, can minimize price variation and encourage consumers to shop for care based on price and quality.
In health care, one of the most common questions asked by doctors, researchers, policymakers, and even patients is, “What works?” The answer lies in measuring and quantifying the quality of the different types of health care services that patients receive. To do this, quality measures are developed, typically through evidence-based research that points to a specific treatment, procedure, or drug as the clinical standard of care for a disease or condition. This research (often in the form of clinical trials) underpins much of what is practiced in medicine, providing critical information that helps the field determine the most effective treatments and approaches to helping patients.
Top 9 Occupations of the Employed but Uninsured in Virginia Who Would Benefit from Medicaid Expansion
Those who would most benefit from expanding Medicaid in Virginia are working individuals and families with incomes up to 138 percent of the federal poverty level ($27,310 for a family of three in 2014). 59% of this population is employed but uninsured.
This report outlines major factors, such as the use of community-based roundtables for navigators and assisters, that led to Maine’s successful enrollment efforts in the health insurance marketplace.
Each month, we will report on selected health care stories and trends that are shaping the direction and implementation of the Affordable Care Act.
“How much does it cost?” is the first question that consumers ask when comparing health insurance plans. In the coming months, they’ll have an answer as health insurance companies begin announcing premium rates for 2015. The news from this past month is encouraging—proposed rate increases for the individual market in 2015 could be more modest than what we expected to see in some states.
Challenging Health Insurance Premium Rate Increases: Part 4 - How to Challenge the Amounts Health Insurers Keep for Administrative Expenses, Reserves, and Surpluses
This blog examines how advocates can challenge the amounts insurers keep on hand for administrative expenses, reserves, and surpluses. Health insurers set their premium rates to cover two primary categories of expenses: future medical costs and administrative costs for processing claims. In this post, we’ll explore how, as part of the rate review process, you can evaluate what insurers are spending on administrative costs, as well as the amounts they keep on hand as reserves (to pay future claims) and surpluses (the money left over).
Find out how health care data can be used to measure and improve the quality of health care that patients receive.
Recent Hospital Earnings Data Show Stark Contrast in Numbers of Uninsured Patients in Medicaid Expansion States Compared to Non-Expansion States
There is now more proof that hospitals have an enormous financial stake in state decisions about expanding health coverage to low-income families.
Since the passage of the Affordable Care Act, about half the states have chosen to expand health coverage to low-income families, taking advantage of federal matching funds to pay for a Medicaid expansion. This expansion has provided health insurance and financial security to millions of people while also injecting needed federal dollars into local economies. But for the states that have rejected the option to expand health coverage, the economic consequences are wide-ranging.
Although the Affordable Care Act now offers individuals greatly expanded access to health coverage, simply having an insurance card does not guarantee access to high-quality health care.
Effective medical treatment requires that physicians apply the best available evidence, rely on their clinical expertise, and consider individual patient preferences and values to make decisions about patient care. Yet across most areas of medicine, practice consistently lags behind evidence. Even when physicians have access to evidence in usable formats, like clinical practice guidelines, it can take more than five years for them to adopt these guidelines into routine clinical practice.