Category Archives: Uncategorized

When Should Exchange Enrollees Not Shop on Premium Price?

CoveredOpen enrollment began November 15th for consumers looking to purchase or renew health insurance on the Affordable Care Act’s state and federal marketplaces. While the second time around is likely to go more smoothly than the first, Drew Altman of the Kaiser Family Foundation reminds us that challenges still remain.

One of these challenges is the relatively complicated way the financial assistance consumers receive is calculated. Individuals and families that previously enrolled in marketplace plans will be automatically re-enrolled unless they choose a different plan. However, because the benchmark product used to calculate their initial level of financial assistance may have changed, the monthly cost to the consumer may also change.

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Physician-Hospital Integration in California

An article in this week’s JAMA examines the effect vertical integration between hospitals and physician groups has on spending.

Provider consolidation throughout the 1990s and 2000s has been well documented and is largely believed to be a significant factor in the steady price increases experienced throughout both decades. A 2012 paper from Catalyst for Payment Reform does an excellent job of providing background, documenting the rise in market concentration of hospitals, and laying out potential solutions.

While a significant portion of the literature has focused on consolidation among hospitals, there has also been a dramatic increase in the number of physicians and physicians groups employed by hospitals — essentially vertical integration. The author’s analysis seeks to provide data on what effect this level of vertical integration is having on expenditures in California.

The article finds that in 2012 physician-owned physician groups had mean expenditures of $3,066 per patient per year, versus $4,312 per patient per year for hospital-owned physician groups. After patient heath, regional variation, and organizational characteristics were controlled for the differential dropped, but was still significant: an additional $435 for local hospital owned groups and $704 for multi-hospital groups.

While physician-hospital integration is frequently seen as being associated with better quality, these results show it also comes with significantly higher costs.

Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost

CA NP Cover

Granting full practice authority to nurse practitioners is one of the most effective steps that states can take to increase the supply of primary care while maintaining high quality and driving down costs.

Together with the Bay Area Council Economic Institute and through the generous support of AARP and the Robert Wood Johnson Foundation we took a look a what granting full practice authority to nurse practitioners means for states in dollars and cents. The first in a series of five, this brief quantifies the benefits to access, quality, and cost for the State of California that would stem from granting nurse practitioners full practice authority.

The results are eye-opening.

Happy Holidays

It’s been a busy year here at Healthy Systems Project, and we’re ready for a few well-deserved days off. Before we go, here’s some of what we’ve been up to:

Our CEO, Micah Weinberg, discussing California’s exchange with the UC Irvine’s Center for Health Care Management and Policy at The Paul Merage School of Business

Talking early enrollment figures with Fox News’ Happening Now

Micah on the twists and turns still ahead for the ACA in The Washington Post

Finally, our latest publication, a look into the key issues of Sacramento’s proposed Entertainment and Sports Complex for the Office of Sacramento City Council Member Steve Hansen

With that, we’ll see you in 2014!

– Healthy Systems Project