- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Reference Prices May Have Limited Potential for Savings, Report Says
Reference prices, a health benefit strategy that requires patients to pay costs above a set price, may save employers and patients money, but their potential may be limited-perhaps even more so under the Patient Protection and Affordable Care Act.
Reference prices, a health benefit strategy that requires patients to pay costs above a set price, may save employers and patients money, but their potential may be limited—perhaps even more so under the Patient Protection and Affordable Care Act.
The California Public Employees' Retirement System and WellPoint subsidiary Anthem adopted a $30,000 reference price for scheduled hip and knee surgeries in 2011. The switch saved CalPERS $2.8 million that year and prompted some hospitals to drop their prices to be competitive, according to a newly released paper by the Center for Studying Health System Change.
But it may be difficult to repeat those results elsewhere, wrote the center's Amanda Lechner, Rebecca Gourevitch and Paul Ginsburg. Meanwhile, the financial incentive that reference prices create to avoid high-priced hospitals may be undermined by the Affordable Care Act.
Read the full story here: http://bit.ly/1kjemmn
Source: Modern Healthcare
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
Read More
AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
Listen
Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
Listen
ACA Dependent Coverage Extension and Young Adults’ Substance-Associated ED Visits
September 15th 2025This study examines the impact of the Affordable Care Act (ACA) on substance-associated emergency department (ED) visits among young adults, revealing reduced alcohol-associated visits but unchanged opioid-associated visits.
Read More
