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Kaiser Health News reported on CMS's (Medicare) announcement that for the first time since the health insurance exchanges created by the Affordable Care Act became active in 2014, the average health insurance premium on the exchanges has dropped. While the average premium for individual health coverage dropped only 1.5 percent, it is significant that premiums have dropped at all, especially given two years of "double-digit price hikes."

Kaiser Health News reported on CMS's (Medicare) announcement that for the first time since the health insurance exchanges created by the Affordable Care Act became active in 2014, the average health insurance premium on the exchanges has dropped. While the average premium for individual health coverage dropped only 1.5 percent, it is significant that premiums have dropped at all, especially given two years of "double-digit price hikes."

Not surprisingly, different people attribute the drop to different reasons. One sentiment is that premiums have risen so much over the last couple of years that these plans are now quite profitable. Apparently, the plans are so profitable that new companies will offer plans, expanding people's options.

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Kaiser Health News released the results of their annual Employer Health Benefits Survey. Nothing stood out to be as particularly surprisingly, but there were a few notes of interest. First, the average annual premiums for employer-sponsored health insurance rose 3% for single coverage and 5% for family coverage, both outpacing inflation and wage increases. Secondly, about a third of the covered employees at the surveyed firms were on a high-deductible plan (almost twice the number of employees covered by HMOs). The average annual deductible among covered workers was $1,350, meaning that employees still need to pay a fair amount if medical services are needed (outside of preventative care).

Kaiser Health News released the results of their annual Employer Health Benefits Survey. Nothing stood out to be as particularly surprisingly, but there were a few notes of interest. First, the average annual premiums for employer-sponsored health insurance rose 3% for single coverage and 5% for family coverage, both outpacing inflation and wage increases. Secondly, about a third of the covered employees at the surveyed firms were on a high-deductible plan (almost twice the number of employees covered by HMOs). The average annual deductible among covered workers was $1,350, meaning that employees still need to pay a fair amount if medical services are needed (outside of preventative care).

With insurance premiums growing faster than inflation, healthcare continues to become more and more expensive. At some point, the industry will need to change to better contain costs, but it is unclear what exact mechanism(s) will be instrumental to that change.

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In another example of how a good system of incentives can be hard to craft, Kaiser Health News reported on Congress mandating that CMS ease its penalties for hospitals serving low-income patients whose readmission rates are too high. Originally, the policy was to penalize all hospitals whose readmission rates are too high (with the rationale that if a hospital does a sloppy job on a procedure, causing patients to return to the hospital within 30 days, then those hospitals should be paid less). Parts of the medical community argue that low-income patients can easily land back in the hospital for reasons outside of the hospitals' control (such as patient inability to afford medication), thus unfairly penalizing hospitals. Understandably, putting additional financial strain on hospitals that serve low-income patients raises the question of whether those communities will face reduced access (e.g. if some of those hospitals close).

In another example of how a good system of incentives can be hard to craft, Kaiser Health News reported on Congress mandating that CMS ease its penalties for hospitals serving low-income patients whose readmission rates are too high. Originally, the policy was to penalize all hospitals whose readmission rates are too high (with the rationale that if a hospital does a sloppy job on a procedure, causing patients to return to the hospital within 30 days, then those hospitals should be paid less). Parts of the medical community argue that low-income patients can easily land back in the hospital for reasons outside of the hospitals' control (such as patient inability to afford medication), thus unfairly penalizing hospitals. Understandably, putting additional financial strain on hospitals that serve low-income patients raises the question of whether those communities will face reduced access (e.g. if some of those hospitals close).

The question in this discussion is one of risk-adjustment (with low-income patients having worse health outcomes on average than higher-income patients). The new policy evaluates each hospital in the context of one of five peer groups. It will be interesting to see how long this framework of five peer groups holds. Perhaps some providers will argue for a rural vs. urban distinction, or ask for some other type of risk-adjustment.

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There is a Wall Street Journal article that has been making the rounds on the internet last week. The article cites a few cases where payers (whether large self-insured employers or insurance companies) tried to exclude certain individual providers from some plans and were stymied by the terms of seemingly unrelated contracts. For example, Walmart ask to remove the 5% of providers with the worse quality scores from its networks, and found that it was unable to do so. The article attributes the inability for payers to selectively modify specific networks to the market dominance that health systems often enjoy, allowing them to force clauses that prohibit such modifications. As long as the payers contract with those health systems (and the payers often cannot avoid doing so), the payers are obligated to include all individual clinicians in all plans.

There is a Wall Street Journal article that has been making the rounds on the internet last week. The article cites a few cases where payers (whether large self-insured employers or insurance companies) tried to exclude certain individual providers from some plans and were stymied by the terms of seemingly unrelated contracts. For example, Walmart ask to remove the 5% of providers with the worse quality scores from its networks, and found that it was unable to do so. The article attributes the inability for payers to selectively modify specific networks to the market dominance that health systems often enjoy, allowing them to force clauses that prohibit such modifications. As long as the payers contract with those health systems (and the payers often cannot avoid doing so), the payers are obligated to include all individual clinicians in all plans.

Interestingly, the providers will frame this as consumer choice, saying that patients should have access to the full range of providers within a health system. What that response omits is what happens if patients want to achieve lower monthly premiums by having a restricted network? Where is patient choice in that case?

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Dr. Jose Baselga made news recently when media reported that he failed to disclose millions of dollars of income that he had received from companies. As the chief medical officer of a prestigious cancer center, and as a prominent researcher, Dr. Baselga was in the position to influence treatment guidelines.

Dr. Jose Baselga made news recently when media reported that he failed to disclose millions of dollars of income that he had received from companies. As the chief medical officer of a prestigious cancer center, and as a prominent researcher, Dr. Baselga was in the position to influence treatment guidelines.

The New York Times published an opinion piece that explains why conflicts of interest can be detrimental to scientific understanding and the health of society. Apparently, policy changed in the 1980s, opening up opportunities for researchers to earn additional income through royalties, and that policy change has made researchers far more vulnerable to the influence of companies. The opinion piece cited a study that shows that studies whose conclusions about antidepressants were negative often were not published or were spun to convey a more positive outcome. We believe that transparency and disclosure are helpful, although a lack of enforcement might make current policies inadequate.

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