Health Care Prices in the United States

Niall Brennan

President

Health Care Cost Institute

@N_Brennan

December 6, 2017

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Why was HCCI founded?

Prior to HCCI’s formation:

Access to payer data was piecemeal with researchers primarily

relying on Medicare data for research and analysis

There was little to no transparency in health care pricing/prices

HCCI was founded to:

Promote independent, nonpartisan research and analyses on the

causes of the rise in U.S. health spending

Inform the public policy process and assist in developing new

solutions to long-term problems confronting the health care

system

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Any informed debate about health care reform relies on access to

data from commercial payers

HCCI Data Holdings

Commercial Claims

Years 2008-2015

~50 million individuals per year

Employer-sponsored, individual and Medicare Advantage (Part C)

All 50 states and D.C.

Updated annually

De-identified, HIPAA and anti-trust compliant

Medicare fee-for-service claims (via the Qualified Entity Program)

Years 2012-2015

Parts A & B (100%)

Part D (~40%)

Additional years of current contributors’ data

2016 data is currently being constructed and is expected to be available in January 2018

2016 Medicare claims will be available in February 2018

Administrative data from additional payers

State APCDs

Medicaid and CHIP

Current Future

HCCI Data Coverage

• 2015 Coverage Map of HCCI ESI Claims Data

HCCI Research and Reports

Issue briefs, academic publications, and

blog posts released throughout the year

All HCCI reports are free and available online

Annual cost and utilization

report released in the fall

HCCI’s current academic partners include:

HCCI has also facilitated data access and research support through external funding partnerships:

Academic Research

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WSJ Exclusive

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August 31, 2017

Collaborations With Media

81,500,000+ impressions on Twitter!

Spending per Person - 2016

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Inpatient

$1,032

Professional

$1,821

Outpatient

$1,507

Prescription

Drugs

$1,030

Total: $5,407

Spending per person over time

How is health care spending distributed in the commercially insured population?

HCCI examined health care spending for commercially insured individuals (under 65)

with continuous coverage from 2014-2015

10NEJM Catalyst Blog Featuring this Data is Imminent

Recent Trends in Health Care Pricing

• Analyzed data from 2012 -2016

• Highest cumulative price growth = brand skin and mucous membrane agents, 153%

• Highest average price in 2016 = $41,702 for inpatient surgery (and that price grew 30% from 2012-16)– Every inpatient category (except hospice and SNF) grew by at

least 18% over the timeframe

• More notables:– Outpatient ER price grew by 31.5% (2016 average price =

$1,917)

– Administered drugs grew by 41.7% (2016 average price = $581)

– 5 of our 9 brand drug classes’ price grew more than 100%

– Generic cardio drugs went down to $0 (avg. price in 2015 and 2016)

• The only generic drug class that is increasing in price is skin and mucous membrane agents, which rose by 100% (avg. price from $3 to $6)

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ER Spending

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We Can Help……maybe

• We are a small non-profit with limited resources

• That being said we are willing to work with news

organizations on the right stories

• We will also be making more datasets available

online for you to download and analyze yourself

• Don’t forget there are other great data resources

out there especially CMS datasets that allow you

to understand and decompose Medicare

spending

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