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Niall Brennan: "‘It’s the Prices, Stupid’: How sky-high prices are crippling our health care system"


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Niall Brennan's slides from the Center for Health Journalism webinar, "‘It’s the Prices, Stupid’: How sky-high prices are crippling our health care system," 12.6.17

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  • This study makes a critical distinction: prices and actual costs of health care services bear almost no relationship to each other. Pricing is not a scientific, analytical process... its what the market will bear, and what they need to do to agree to "discounts" when negotiating with plans ....and still make money.
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Niall Brennan: "‘It’s the Prices, Stupid’: How sky-high prices are crippling our health care system"

  1. 1. Health Care Prices in the United States Niall Brennan President Health Care Cost Institute @N_Brennan December 6, 2017 1
  2. 2. Why was HCCI founded?  Prior to HCCI’s formation:  Access to payer data was piecemeal with researchers primarily relying on Medicare data for research and analysis  There was little to no transparency in health care pricing/prices  HCCI was founded to:  Promote independent, nonpartisan research and analyses on the causes of the rise in U.S. health spending  Inform the public policy process and assist in developing new solutions to long-term problems confronting the health care system 2 Any informed debate about health care reform relies on access to data from commercial payers
  3. 3. HCCI Data Holdings  Commercial Claims  Years 2008-2015  ~50 million individuals per year  Employer-sponsored, individual and Medicare Advantage (Part C)  All 50 states and D.C.  Updated annually  De-identified, HIPAA and anti- trust compliant  Medicare fee-for-service claims (via the Qualified Entity Program)  Years 2012-2015  Parts A & B (100%)  Part D (~40%)  Additional years of current contributors’ data  2016 data is currently being constructed and is expected to be available in January 2018  2016 Medicare claims will be available in February 2018  Administrative data from additional payers  State APCDs  Medicaid and CHIP Current Future
  4. 4. HCCI Data Coverage • 2015 Coverage Map of HCCI ESI Claims Data
  5. 5. HCCI Research and Reports Issue briefs, academic publications, and blog posts released throughout the year All HCCI reports are free and available online Annual cost and utilization report released in the fall
  6. 6.  HCCI’s current academic partners include:  HCCI has also facilitated data access and research support through external funding partnerships: Academic Research 6
  7. 7. WSJ Exclusive 7 August 31, 2017
  8. 8. Collaborations With Media 8 1,500,000+ impressions on Twitter!
  9. 9. Spending per Person - 2016 9 Inpatient $1,032 Professional $1,821 Outpatient $1,507 Prescription Drugs $1,030 Total: $5,407
  10. 10. Spending per person over time  How is health care spending distributed in the commercially insured population?  HCCI examined health care spending for commercially insured individuals (under 65) with continuous coverage from 2014-2015 10 NEJM Catalyst Blog Featuring this Data is Imminent
  11. 11. Recent Trends in Health Care Pricing • Analyzed data from 2012 -2016 • Highest cumulative price growth = brand skin and mucous membrane agents, 153% • Highest average price in 2016 = $41,702 for inpatient surgery (and that price grew 30% from 2012-16) – Every inpatient category (except hospice and SNF) grew by at least 18% over the timeframe • More notables: – Outpatient ER price grew by 31.5% (2016 average price = $1,917) – Administered drugs grew by 41.7% (2016 average price = $581) – 5 of our 9 brand drug classes’ price grew more than 100% – Generic cardio drugs went down to $0 (avg. price in 2015 and 2016) • The only generic drug class that is increasing in price is skin and mucous membrane agents, which rose by 100% (avg. price from $3 to $6) 11
  12. 12. ER Spending 12
  13. 13. We Can Help……maybe • We are a small non-profit with limited resources • That being said we are willing to work with news organizations on the right stories • We will also be making more datasets available online for you to download and analyze yourself • Don’t forget there are other great data resources out there especially CMS datasets that allow you to understand and decompose Medicare spending 13