Investigators at Brown University Describe Findings in Managed Care (Commercial Insurers Paid More for Procedures At Hospital Outpatient Departments Than At Ambulatory Surgical Centers): Managed Care

2025 NOV 18 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Data detailed on Managed Care have been presented. According to news reporting from Providence, Rhode Island, by NewsRx journalists, research stated, “Site neutrality in payment practices has become a salient issue in the US health care debate, as rising prices have brought increased pressure for policy action. Although Medicare has received disproportionate attention, these policies could also apply to commercial insurers, particularly to address payment differentials between hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs).”

The news correspondents obtained a quote from the research from Brown University, “Using 2024 Transparency in Coverage data provided by Clarify Health on commercial prices for three insurers (UnitedHealthcare, Cigna, and BlueCross BlueShield), we compared payments for thirteen common procedures across settings. Overall, in 2024, commercial prices were $1,489 (78 percent) higher in HOPDs than in ASCs, whereas Medicare prices were $633 (97 percent) higher. However, site payment differentials varied substantially across payers: Cigna had the lowest differentials between HOPDs and ASCs ($327), whereas United had the highest ($1,673). Cigna achieved this through provider selection, contracting with only 14 percent of HOPDs in applicable markets compared with an average of 76 percent for United and BlueCross BlueShield. If United and BlueCross BlueShield paid Cigna’s average HOPD rates for these procedures, together they would save approximately $1.4 billion a year.”

According to the news reporters, the research concluded: “Our results suggest that payers can reduce site differentials through provider selection; they also imply that larger insurers with broader networks may continue to reimburse different sites differently in the absence of either government action or a shift in market dynamics.”

This research has been peer-reviewed.

For more information on this research see: Commercial Insurers Paid More for Procedures At Hospital Outpatient Departments Than At Ambulatory Surgical Centers. Health Affairs, 2025;44(10):1291-1297. Health Affairs can be contacted at: Project Hope, 7500 Old Georgetown Rd, Ste 600, Bethesda, MD 20814-6133, USA.

Our news journalists report that additional information may be obtained by contacting Matthew P. Maughan, Brown University, Providence, RI 02912, United States. Additional authors for this research include Andrew M. Ryan, Christopher M. Whaley and Nandita Radhakrishnan.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1377/hlthaff.2025.00297. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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