/
It ’ s  Still the  Prices Stupid with Four It ’ s  Still the  Prices Stupid with Four

It ’ s Still the Prices Stupid with Four - PowerPoint Presentation

MsPerfectionist
MsPerfectionist . @MsPerfectionist
Follow
342 views
Uploaded On 2022-08-04

It ’ s Still the Prices Stupid with Four - PPT Presentation

Vignettes Illustrating the Pricing Problem For Consumers Gerard Anderson PhD Professor Main Findings Despite many restructurings of the US and other health systems prices remain the primary reason why the US spends more ID: 935902

prices pay cost wanted pay prices wanted cost drug drugs chronic hospital private amish hopkins medicare conditions care million

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "It ’ s Still the Prices Stupid with ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

It’s Still the Prices Stupid with Four Vignettes Illustrating the Pricing Problem For Consumers

Gerard Anderson, PhD,

Professor

Slide2

Slide3

Main FindingsDespite many restructurings of the US and other health systems - prices remain the primary reason why the US spends more

on

health

care than any other country

On key measures of health care resources per capita (hospital beds, physicians, and nurses), the US still provides significantly fewer resources compared to other industrialized countries

The main difference from 15 years ago is the growing differential between public and private sector prices in the US

Private sector prices are approximately double the public prices

Hospitals and physicians will adjust their costs to the revenues they receive so as private sector prices increase so do costs

Slide4

How Higher Prices Affect ConsumersFour vignettes can explain how consumers are effected by high prices

Helping Amish negotiate what they will pay for a premature baby

Is my anesthesiologist in network?

Paying for ultra expensive drugs

Paying for drugs while having multiple chronic conditions

What can be done in each case?

Slide5

The AmishAn Amish leader has a member whose child was born prematurely and incurred a $1.2 million hospital charge

The Amish do not believe in insurance and always pay their bills in full

He believed the bill was much too high and wanted to know what an insurer would pay

I ended up negotiating the Medicaid rate for him with the hospital CEO

80% discount

Solution - Hospitals and physicians should not be permitted to charge 5 times what it cost to provide care or what they routinely accept from insurers

Slide6

ColonoscopyI had a routine colonoscopy at Hopkins

I knew the hospital and gastroenterologist were in network

Hopkins could not tell me the name of anesthesiologist because they are assigned that morning

Anesthesiologists have have highest markup over what Medicare pays and the most OON

Most likely to be owned by private equity

She walked in when I was about to have the procedure, which is the perfect time to interview an anesthesiologist over price and credentials

Limit OON bills to a percent of Medicare

Slide7

SpinrazaA Hopkins physician who is worked his entire career on children with muscular atrophy came into my office

He told me there is a new drug on the market whose cost is $750,000 in the first year and $350,000 in subsequent years

People in East Baltimore cannot afford even minimal cost sharing

What can he do?

Hopkins allocates $4 million to help a few babies get the drug

Now there is a new drug for muscular atrophy that is a cure but cost $1.6 million

The challenge is promoting R&D while making the drugs affordable to both patients and

payors

The US should pay similar rates to other countries and limit price increases post launch like other countries

Slide8

Multiple Chronic Conditions 20% of Medicare beneficiaries have 5+ chronic conditions

They take an average of 16 different drugs per year and incur large bills for prescriptions

The Medicare program has coverage gaps at the beginning , in the donut hole, and the beneficiary pays 5% in the catastrophic phase

For the beneficiary dependent solely on social security drug cost can be 25% of their income

A cap on OOP spending at $2000 is needed

Slide9

Role of the ConsumerThe Amish leader simply wanted to pay what was reasonable

I wanted to pay the doctor the in network rate

The doctor wanted the patient to pay something the patient could afford for the drug

The social security recipient with multiple chronic diseases wanted to pay a reasonable portion of their income for drugs