Subscribe to The Pulse

Health Costs

Cost is a big question, and here’s an answer

Millions of Americans have no health insurance. Millions of others have health coverage that includes high deductibles.

Both these groups often have to pay upfront for the whole cost of a medical procedure or a visit to a doctor. And these prices can have wide variation, even within a single community.

Healthcare CostYet there’s little if any information publicly available that helps such individuals compare prices.

Three major health insurers are doing something about that. UnitedHealthcare’s parent company, along with Humana and Aetna, are leading an industry initiative
to make medical price information available to consumers on the Internet.

The independent nonprofit Health Care Cost Institute will create and administer this online portal, expected to be available in January.

Separately, a health care website Monday rolled out some price information for people who “self-pay” — or have no insurance — in various markets around the country.

Georgia consumers can find out what the estimated self-pay price is for procedures at facilities run by the hospital chain HCA on clearhealthcosts.com. full story

Hepatitis C: The high cost of a cure

Probably the biggest ethical dilemma now confronting the health care world involves two expensive new drugs to treat hepatitis C.

The issue boils down to a tradeoff between efficacy and cost.

iStock_000017543934SmallOne drug, Sovaldi, has a 90 percent cure rate for newly infected patients – much better than previously available treatments for hepatitis C. It also costs $84,000 for a 12-week treatment – basically $1,000 per day.

The second drug, Olysio, is about $66,000 for a 12-week treatment, but is approved for fewer types of patients.

Some patients face even longer treatment periods – and higher costs.

Georgia Medicaid covers the drugs, though with some restrictions, for its 1.6 million beneficiaries. In March, Georgia’s Drug Utilization Review Board recommended that Medicaid add Sovaldi and Olysio as “non-preferred,” and needing a state approval in each case.

In April, 107 Medicaid patients were taking Sovaldi, at a cost of  roughly $3 million per month to the program, though the state will receive a rebate that will lower that cost.

Still, physicians say the use of these two drugs is a breakthrough. “It really transformed treatment for hepatitis C,’’ Dr. Anjana Pillai, an Emory transplant hepatologist, told GHN on Tuesday. full story

State seeking more choice in 2015 health plan

State officials said Tuesday that they plan to increase the number of insurers and health plan options for state employees and teachers next year.

The State Health Benefit Plan (SHBP) has been a target of fierce criticism since Jan. 1. That’s when changes to its benefit design, plus the use of just one insurer, sparked widespread complaints about a lack of choice of insurance plans and higher health care costs.

Sarah Lesley and her daughters joined a Capitol rally in February against the change in the state health plan.

Sarah Lesley and her daughters joined a Capitol rally in February over the state health plan.

Now, though, the Department of Community Health is asking for proposals for a second statewide insurer to offer a high-deductible health plan, a Medicare Advantage plan for retirees, and a statewide HMO.

The current single insurer for SHBP, Blue Cross and Blue Shield of Georgia, would retain its health reimbursement arrangement plans and Medicare Advantage plans, plus add a statewide HMO option for the 2015 plan year. A third insurer would offer a fully insured in-network-only option for metro Atlanta, under the Community Health plan.

“SHBP is looking to enhance member choice in the 2015 plan year,” said DCH Commissioner Clyde Reese in a statement

The State Health Benefit Plan covers 650,000 state employees, teachers, other school personnel, retirees and dependents. With those numbers, the plan’s members can be a political force in an election year such as this one. When many of them began to complain about this year’s plan, and some began to organize, the state moved swiftly to amend it. full story

FTC seeks more time on Phoebe decision

The Federal Trade Commission on Monday requested 60 days beyond a previous deadline to decide whether to sign off on its 2013 antitrust settlement with an Albany hospital system.

Monday was the FTC’s deadline to finalize the agreement with Phoebe Putney Health System. But in a filing in U.S. District Court, the agency asked the court for more time.

In the filing, the FTC asked the court to give it until June 13 — or until 30 days after a state agency determines whether a potential divestiture of the Albany hospital that Phoebe Putney acquired in 2011 would require regulatory approval — whichever date is earlier.

The state agency’s decision could be pivotal to whether the FTC goes through with the settlement or resumes its legal battle in the high-profile antitrust case. full story

FTC may revive Phoebe fight, seeks state guidance

Georgia’s high-profile hospital antitrust saga may not be over after all.

The Federal Trade Commission is asking a state agency whether a potential divestiture of the Albany hospital that Phoebe Putney acquired in 2011 would require certificate-of-need regulatory approval.

Phoebe Putney Memorial Hospital

Phoebe Putney Memorial Hospital

Last August, the FTC and Phoebe Putney Health System announced they were settling the agency’s long-running antitrust suit over the hospital acquisition, and that the deal would allow Phoebe to keep control of the former Palmyra Medical Center.

But that deal has not yet been finalized. And the FTC, in a letter Monday to the Georgia Department of Community Health, indicated that the legal opinion by state officials may make a difference in whether it goes through with the settlement.

The letter noted that the FTC gave preliminary agreement to the settlement based on its understanding that the state’s certificate-of-need (CON) laws — which limit the number of health care facilities in the state — would prevent a breakup of the merged hospitals.

But now the possibility of undoing the merger appears to be more than hypothetical. A potential buyer for the former Palmyra has come forward, the FTC letter said. full story

  • Sign up for our mailing list.