The Trouble with Hospital Pricing
Summary and Conclusion Hospitals’ provisions for doubtful accounts have been rising (Exhibit 1); we believe this is in large part due to falling collection rates on the self-pay portion of…
SSR Index of Current-Quarter Healthcare Demand Growth: Initial 1Q14 Estimates
We expect 1Q14 health services demand growth (y/y, nominal) of 3.6%, the product of 2.6% growth in intensity demand and 1.0% growth in nominal pricing (Exhibit 1). Our estimate of…
Harvest Time for the Bill Collectors? The ACA’s Narrow Hospital Networks May Spur Demand for Revenue Cycle Management (RCM) Services
Research Method and Key Findings We compared hospital networks for health plans sold on the Affordable Care Act’s (ACA’s) health insurance exchanges (HIEs) with hospital networks for comparable[1] plans sold…
Your (HIE-based) Plan Doesn’t Cover That: A Comparison of Drug Formularies On and Off the Health Insurance Exchanges
Summary and Conclusions The prescription drug formularies of health plans sold on the Affordable Care Act’s (ACA’s) public health insurance exchanges (HIEs) are significantly more restrictive than the drug formularies…
Adverse Selection on the HIEs – It’s Not (Just) About the Federal Website
Health insurance exchange (HIE) enrollment levels through December 28 remain quite low. States operating their own exchanges enrolled 1.0M persons, equivalent to 7.4% of these states’ adjusted uninsured populations (Exhibit…
Drug Benefit Chicken: An Analysis of Benefit Designs on the Health Insurance Exchanges
Summary To get a sense of what drug coverage will look like across plans offered on the health insurance exchanges (HIEs), we analyzed the drug benefits of all Silver[1] plans…
MRK v. AMGN: A Comparison of R&D Productivity
Summary and Conclusion In light of the recent change in MRK’s R&D leadership, and evidence[1] that the company may be planning a significant change in its approach to R&D, we…
SSR Index of Current-Quarter Healthcare Demand Growth: Interim 4Q13 Estimates
We expect 4Q13 health services demand growth (y/y, nominal) of 3.5%, the product of 2.3% growth in unit demand and 1.2% growth in nominal pricing (Exhibit 1). Our nominal pricing…
Why Adverse Selection is Likely on the HIEs: A Simple Model of Enrollment Behavior
What enrollment patterns are required for premiums to meet or exceed claims paid on the health insurance exchanges (HIEs), and can we reasonably expect these patterns to emerge? We showed…
Higher Premiums – and Higher Deductibles: An Analysis of Health Plans on Offer in 2014
Summary To better understand how the Affordable Care Act (ACA) may have affected price / value relationships in the market for individually purchased coverage, we’ve compared premiums (by age), deductibles,…