Research Shows Effects of Policies on Care Costs and Use

Lab leaders often read about national and state policies. But effects of them may be harder to discover. The Health Care Cost Institute (HCCI) was motivated to find answers. Six recently released research reports—ranging from cancer treatment spending and nurse practitioners to opioid use and more—show impact of national and state policies on health care costs and utilization, an HCCI statement pointed out. For labs, the information is significant because it suggests the importance of developing testing services that are of the greatest value to payers, physicians and patients.

Studies were conducted by independent researchers using HCCI’s claims data for more than 50 million people insured by Aetna, Humana and UnitedHealthCare. Of the six reports, the topics of consolidation effects on cancer costs and use of nurse practitioners in primary care may be of most interest to lab leaders. Consolidation among providers drives up cancer treatment spending, according to a University of Chicago analysis. Findings include: consolidation among outpatient oncology providers and hospitals intensified during 2010 and 2011; greater provider consolidation results in increased spending on outpatient prescription drug-based cancer treatment; driving the rise are facility fees hospital outpatient departments charge payers.

Prices for primary care services fell by 1 to 4%, but spending on care increased, noted a study by the University of California San Francisco that explored effects of laws in states from 2008 to 2012 allowing nurse practitioners to treat patients without supervising physicians. Higher total health care costs may be a result of stepped-up volume in services, stemming from greater access to care, the researchers said.

The other four studies found: Opioid use and emergency room visits decrease when patients with low back pain are given unrestricted access to physical therapy, according to a study by the University of Washington involving six northwest states. Patients paid less out-of-pocket for physician and outpatient visits, hospital and pharmacy care as compared to other patients, study findings suggest.

When patients have an incentive to choose low-cost, reference-based pricing for colonoscopy, per-procedure costs fall 8.5%, a study by the University of California Berkeley shows. Researchers estimate the U.S. can save $95 million annually on medical spending if just three insurers—Aetna, Humana and UnitedHealthCare— adopted reference-based colonoscopy programs.

Telehealth services claims increased from 1,246 in 2009 to 2,558 in 2013, but they are reimbursed 40% less than non-telehealth care, noted research conducted at the University of Nebraska Medical Center.Visits to mental health providers did not increase despite passage of the Mental Health Parity and Addiction Equity Act, research by the University of Colorado School of Medicine found. The HCCI, established in 2011, promotes independent research and analysis on U.S. health spending causes and increases.

Takeaway: Claims data from more than 50 million insured Americans were used by HCCI to develop six studies about health insurance and impact of new policies ranging from consolidation to nurse practitioners and telehealth. For labs, research suggests importance of showing value to payers.