In the News: October 19–25

Maryland Unveils Online Price Transparency Tool

The Maryland Health Care Commission is paving the way toward price transparency for its health care consumers. As health care costs rise and high-deductible insurance plans gain popularity, this independent regulatory agency is launching a website that allows price comparisons among different providers for hip replacements, knee replacements, hysterectomy and vaginal delivery.

The tool’s users can take an active role in shopping for their care by comparing the costs of procedures across the state, as well as quality metrics like readmission and complication rates. Interestingly, the market impacts are unclear. While price transparency may incent providers to lower procedure prices, quality transparency could guide consumers to choose more expensive options.

As health care consumers become more equipped to shop around, Sg2 is excited to offer pricing strategy support to our members.

Significant Gender Difference Discovered in Controlled Hypertension

A recent CDC report outlining hypertension prevalence and control among adults in the US from 2015 to 2016 found an overall hypertension prevalence of 29%, without significant difference among men (30.2%) and women (27.7%). While the proportion of controlled cases steadily increased to 53.1% in 2010, only 48.3% of cases were reported controlled in 2016.

The report described a significant difference in the number of controlled cases of hypertension among adult men and women (45.7% vs 52.5%, respectively). A closer look revealed the driver behind this disparity was within the 18–39 year age group, in which 62.6% of hypertensive women were controlled, compared to only 15.5% of men.

This finding reveals high demand in a targeted market. Proper screening and prevention may equate to savings in your cardiovascular service line. To learn more about improving cardiovascular screening and prevention programs, read the FAQ: Screening and Prevention Programs in Cardiovascular Care.

Despite Slowing Enrollment, State Spending on Medicaid to Increase

A recent Kaiser Family Foundation report found that in fiscal year (FY) 2017 growth in state Medicaid spending was 3.5%, up from 2.4% in FY 2016, despite a national slowdown in Medicaid enrollment. For FY 2018, states anticipate Medicaid spending to increase by a projected 5.2% due to the high cost of prescription drugs and increases in payment rates for certain provider groups.

States indicated that they could face budget challenges due to reductions in disproportionate share payments going into effect, Congress not reauthorizing the Children’s Health Insurance Program and potential restructuring of Medicaid financing.

Sg2 believes that changes in Medicaid that add financial pressure to state budgets may disproportionately impact certain populations, such as children. To learn more about policy changes’ effect on pediatric services, read the Sg2 FAQ: Impact of Policy Changes on Pediatrics.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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