Almost 24 million Americans with employer-sponsored coverage spent a large portion of their income on healthcare costs.
Thursday, May 23, 2019

Even With Employer-Sponsored Coverage, Premiums Continue to Hamper Millions

A new study from the Commonwealth Fund found that nearly 24 million Americans with health insurance through their employer spent a significant portion of their personal income on healthcare costs between 2016 and 2017.

On average, households spent $2,200 annually on premiums, while median out-of-pocket costs were $800, with the median spending amount for both combined metrics totalling $3,700 per year.

On the high end of the spectrum, families spent more than $8,000 on premiums and more than $5,000 on out-of-pocket costs, with some households spending more than $12,000 per year on premiums and out-of-pocket costs combined.

Some additional financial news from the end of last week: JPMorgan is slated to buy InstaMed for $500 million and Haven COO Jack Stoddard stepped down after nine months with the joint healthcare venture.

Another reminder: Our 2019 CFO Exchange held at the American Club in Kohler, Wisconsin from August 7 - 9, is getting closer! 

If you're the CFO of a health system and interested in attending, follow the link here for an invitation. 
 

Lead story
13.3M Americans Spent More than 10% of Income on Premiums
Almost 24 million Americans with employer-sponsored coverage spent a large portion of their income on healthcare costs.
 
 
analysis
Medicare Advantage Dual Eligibles Have Fewer ER Visits Than Those Under FFS
  • Dual eligible MA beneficiaries had 42.1% less emergency room visits than their FFS counterparts.
     
  • Avalere attributed the cost differential to higher spending on inpatient and outpatient services under FFS, while physician services and tests were higher under MA.
analysis
Insurers Paid California Hospitals Twice as Much as Medicare
  • Private insurers paid hospitals in California 209% above what Medicare did in 2015 and 2016, according to the West Health Policy Center (WHPC).
     
  • Both Stanford University Hospital and Sharp Memorial Hospital topped the average by paying above 270%.
     
  • Timothy A. Lash, president of WHPC, said the study and the recent RAND report show that hospitals "continue to price-gouge" self-insured health plans.
Sponsored
Back to Basics with BP Measurement
Minimizing waste through process improvements is not new to healthcare. What about clinical outcomes? Looking at inefficiencies in workflows could help improve outcomes and lower costs, and blood pressure measurement provides an ideal starting place.
analysis
Private Insurance Accounted for Nearly Half of Prescription Drug Spending in 2017
  • Retail prescription drug spending totalled $333 billion, with private insurers accounting for $140 billion.
     
  • Meanwhile, Medicare Part D and Medicaid spending combined to total $134 billion.
     
  • Average annual out-of-pocket prescription drug spending leveled out for both private insurers and Medicare Part D between 2007 and 2016.
analysis
SSM Health Achieves $200M Net Income in Q1
  • The St. Louis-based health system ended Q1 2019 with nearly $2 billion in total operating revenues.
     
  • SSM ended Q1 with nearly $42 million in net cash provided by operating activities, though it posted losses in both net cash used in investing activities, $57.5 million, and net cash used in financing activities, $1.8 million.
analysis
CMS: Decision on CAR-T Therapy Coverage Delayed But 'Forthcoming'
  • CMS announced a delay in its final national coverage determination on certain innovative and expensive cancer treatments, but signaled that "a decision is forthcoming."
     
  • The therapies have price tags as high as $425,000, which some say is a worthwhile investment.
     
  • Others said making such a national determination would be premature for a burgeoning area of medicine.
revenue cycle
Payers, Providers Butt Heads on Surprise Billing Solutions
 
 

Must Reads
 

Final Notes

If you have any tips, story ideas, thoughts, calendar items, press releases, criticisms, corrections, or general advice, send them my way at jobrien@healthleadersmedia.com.

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I will see all of you on May 30, enjoy Memorial Day weekend!

That's all, folks.

Jack O'Brien
Finance Editor