Americans Are Eager for Price Information, New Survey Finds

March 26th, 2015

Most insured Americans pay health care deductibles and coinsurance, with cost-sharing rates that seem to be continually increasing. At the same time, millions of uninsured people face unpredictable and often high charges for medical care.

In other words, Americans have a significant amount of “skin in the game” when it comes to health care. That said, it’s not easy for most people to find out how much their health care will cost—let alone to find lower-priced care. The opacity of health care prices is one major reason for this. Despite the fact that so many Americans must pay for so much of their medical care out of pocket, easy access to accurate price information remains far from routine.

This month, Public Agenda, with support from the Robert Wood Johnson Foundation, released the results of a national survey finding that 56 percent of American adults say they have tried to find out their out-of-pocket costs (excluding a copay) before getting the care they needed, or have tried to find out how much their insurance would pay a doctor or hospital. In other words, despite the opacity of price information, the majority of Americans have at least tried to find out how much their care would cost.

The survey also found that the majority of Americans do not believe that higher prices are typically a sign of better quality. Together, these findings suggest that Americans are open to looking for better-value care. Read the rest of this entry »

Partnering for Palliative Care in California

March 25th, 2015

Health care provider organizations, payers, and the health policy community increasingly recognize the deficiencies in care for people with serious illness and for those approaching the end of life. While medical advances have provided great benefit to some, many people with serious illness still often experience physical and emotional distress, as well as lack of alignment between their personal values and goals and the medical care they receive.

Multiple studies have shown that specialized palliative care services address these needs in a way that usual care does not. With a focus on defining and adhering to patients’ goals of care, managing pain and symptoms, addressing psychosocial and spiritual issues, and coordinating care among multiple providers and settings, palliative care improves the quality of life and experience of care for people with advanced illness, while also lowering costs by helping patients stay in the care setting of their choice (typically their home).

Despite robust evidence of the benefits of palliative care, growth of these services has been stunted by the lack of sufficient, defined funding streams. Only some members (typically physicians or advance practice nurses) of interdisciplinary palliative care teams can bill for their services; one study found that billing covers less than half of outpatient palliative care service costs.

While some health care organizations are moving toward accountable care models with global payment, where the cost of palliative care services can be offset by the avoidance of unwanted care, this movement has not kept up with the need for more palliative care services. Without a sustainable payment model, the potential of palliative care to address essential care needs cannot be realized. And without palliative care, the complex challenges faced by people with serious illness will not be adequately addressed.

To address these challenges, the California HealthCare Foundation (CHCF) has supported a planning process for ten teams of payer and provider organizations committed to strengthening and spreading palliative care services in California through innovative partnerships. These payer/provider teams represent the diverse entities invested in providing palliative care: the providers include large academic medical centers, regional hospitals (including a children’s hospital), hospices, and medical groups, while the payers include national insurers, regional insurers, a Medicaid managed care plan, and a medical group that is “at-risk” financially for a portion of its population. Read the rest of this entry »

What Kind Of Advance Care Planning Should CMS Pay For?

March 19th, 2015

Currently, Medicare does not offer a paid benefit for advance care planning (ACP). As a result, health care providers who want to assist Medicare enrollees with ACP do so voluntarily and neither they, nor their institutions, are compensated for their time and efforts. This is not only an unfair expectation on individual practitioners or health institutions, it is also medically and ethically unsound. Fortunately, two recent events have the potential to reshape the landscape of advance care planning in the U.S.

Cultural And Policy Evolution In Advance Care Planning

On September 17, 2014, the Institute of Medicine (IOM) published Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. The report is built on two basic premises: Read the rest of this entry »

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