Healthcare Business Week in Review: Managing Heart Disease; Insurance Reform; Hospital Charge Disparities

Friday, September 13th, 2013
This post was written by Cheryl Miller


Nearly one in three Americans die of cardiovascular disease (CVD), including heart disease and stroke, each year, according to the latest Vital Signs report from the CDC. In 2010 alone, more than 200,000 deaths from CVD occurred, with more than half happening to people younger than 65 years of age.

Most CVD can be managed or prevented in the first place by addressing risk factors, such as reducing blood pressure and cholesterol and quitting smoking, CDC officials say, and they offer a list of recommendations for providers, communities and health departments for reducing the death rates.

Contrary to reports that individual health insurance policy costs will jump steeply under the ACA, there will be no widespread premium increase, according to a RAND analysis of 10 states and the United States.

There will be widespread differences in individual policy costs from state to state, however, as well as an increase in health insurance coverage and higher enrollment among people who purchase individual policies.

RAND researchers predicted how the ACA will likely change cost and coverage patterns in both the individual market and small group market in 10 states, including Florida, Kansas, Louisiana, Minnesota and New Mexico. Costs will be influenced by a specific range of individual factors, including age, tobacco use, geographic location, family size and amount of coverage purchases.

Geographic diversity is at the root of another study from the Center for Studying Health System Change (HSC). According to the report, hospital prices for privately insured patients — especially for outpatient care — are much higher than Medicare and vary widely within and across communities.

Within individual communities prices vary widely, even after accounting for differences in the complexity of services provided. The highest-priced hospital typically is paid 60 percent more for the same inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient services, with the highest-priced hospital typically paid nearly double the lowest-priced hospital, according to the study.

In contrast to hospital prices, prices for PCP services generally are close to Medicare rates and vary little within markets, the study found. Prices for specialist physician services, however, are higher relative to Medicare and vary more within and across markets.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material to develop prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health in our Health Risk Assessments e-survey by October 15, 2013 and get a FREE executive summary of the compiled results.

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