High Deductibles Broke the U.S. Health Insurance System

Welcome to the latest #DataRX Report, a weekly digest of interesting news and trending topics in the healthcare industry. Every Friday we're pulling together the best articles and insights to keep payors and providers informed, engaged and up to date on the headlines that are impacting the industry.  

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Sky-High Deductibles Broke the U.S. Health Insurance System
High deductible health plans have not delivered on the anticipated strategy of driving us to be better consumers of healthcare. Quite often, these plans leave patients on the hook for thousands of dollars and, as a result, many are avoiding or have reduced the amount of medical care they use, including preventative care. Find out more about the problem here.

Prescription for Payors

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Highmark BCBS Saves $260M Using Value-Based Reimbursement
Highmark’s True Performance Program measures primary care providers on their ability to deliver the right care at the right time within the best setting. Providers then receive performance-based incentives for their results. Find out the results Highmark has achieved. 


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Patient-Centered Medical Home Has Saved Payer $1.2B Since 2011
CareFirst’s patient-centered model organizes primary care providers into teams that work together to coordinate care. Last year, CareFirst saw a $223M reduction in care costs by dropping hospital readmissions 41.3%, shortening stays in the hospital by 19.4% and having fewer initial admissions to the inpatient setting by 13.7%. Learn more about how CareFirst has saved over $1 billion in the last seven years.


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Can Retail Clinics Improve Patient Access, Reduce Costs for Payers?
Consumers choose retail clinics over primary care providers for their convenient hours, convenient locations and because no appointment is necessary. Payers prefer retail clinics because it cuts down on costs compared to urgent care and the ED. Could this be a broader solution to the woes of the industry?

Prescription for Providers

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Transforming Health Care from the Ground Up
This Harvard Business Review articles focuses on two examples of bottom-up innovation in health care delivery. The University of Mississippi Medical Center created a TelEmergency network to increase patient access in rural areas and Iora Health created a new business model that doubled down on primary care creating major savings in secondary and tertiary care. Read how these two health systems are transforming.

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Intermountain Alliance to Address Social Determinants of Health
Up to 60% of a patient’s health can be influenced by the social determinants of health. Intermountain Healthcare is investing $12 million in programs coordinating community care services in two Utah cities to address the social determinants of health. Learn more about the plans here. 
Asian baby drinking water

A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.
For many patients and parents, the emergency room may be the only option (due to day of the week or timing) but it comes with a hefty--and often outrageous--price. This time, Vox digs in to the “trauma fees” costed families thousands of dollars without even being treated for trauma.

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