Group items tagged

As Dr. Rushika Fernandopulle states, “they are putting wings on cars and calling them airplanes.” Instead, creative physicians such as Dr. Fernandopulle have developed models such as Iora Health that are built from the ground up NOT to optimize around billings, but to optimize around health. Iora Health has proven that they can deal with the toughest patient populations and reduce costs while greatly improving outcomes

"Look at any of the long-term projections for the federal budget or for state budgets," said Alan Weil, executive director of the National Academy for State Health Policy. "If we don't bring down health care costs, we're either going to be paying a whole lot more in taxes or we're going to stop spending money on other things we care about."

"It has to end eventually," said Larry Levitt, senior vice president of the Kaiser Family Foundation, "because we can't have an economy driven entirely by health care."

it was the first company we had seen that flattened out clinical data and matched it with administrative data.”

But one example he gives would be around transparency in hospital practices, identifying trends that would be used compare the costs of one hospital caring for a particular patient with another system in the context of the clinical stream to see what each one is doing differently.

Every health system is in the business of protecting their doctors,” said Miller.

Medicare covers all those treatment options. By law, it can't consider price when making coverage decisions. Nor can it insist that a new technology be significantly better than existing ones or encourage doctors or patients to seek less-costly alternatives. And once Medicare starts writing checks, private health plans generally follow, distorting the usual market mechanisms, says Arthur Kellermann, a physician and senior policy analyst at Rand Corp.

Another big driver of health-care costs is technology. In almost every other industry, innovation generally makes things more efficient and less costly. But in health care, it often brings higher costs with little added value.

Premium prices are influenced by many factors, including what insurers guess their costs will be, a region’s labor costs and how much hospitals and other facilities charge. Competition between insurers is also a significant factor.

While some of the lowest cost plans are in the “bronze” tier of coverage, such plans generally have higher annual deductibles and co-payments than a silver plan.  Also, the silver plans reduce some costs for subsidy-eligible consumers, which could reduce their exposure to big bills if they fell seriously ill.

“Although premiums are generally the first and last thing discussed when comparing plans, out-of-pocket costs may be an equally or even more important consideration, particularly for those with significant health care needs.”