Joint Economic Committee Issues Testimony From Johns Hopkins Medicine
"Thank you Chairman Paulsen, Ranking Member Heinrich and other esteemed committee members for inviting me to speak on the important topic of health care. I am here today as health policy scholar and a practicing primary care physician in
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"Growth in the 3 sectors identified above in descending order (prescription drugs, hospital services, and ambulatory services) can also be summarized as a problem around cost (distinct from price which often doesn't reflect what a patient pays) and resource utilization. Cost and resource utilization vary wildly depending on where you live in the country; below are publicly available costs for the same procedure on similar patients in the state of
Actual Costs for Hip Replacement on the Same Patient, Same Procedure, in Different Hospitals
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Costs of Care: Additional Drivers
"Drivers of cost, in addition to hospital costs illustrated above, include services provided by providers in offices as well as other goods, such as prescription drugs. Office- based services can differ by site of service with Hospital-Based outpatient facilities generally more expensive than those that are independent or freestanding. Prescription drugs, particularly drugs which have few alternatives or represent a breakthrough treatment (such as Hepatitis C, Non-Small Cell
"ways to decrease their financial burden (HSAs, etc) but the
Resource Utilization: The Care We Receive
"In terms of resource utilization, look no further, than the fact that our utilization of services in health care is not evenly distributed; according to the
- Team based care- still a difficult concept in current siloed, Fee for Service (FFS) care
- Targeted care coordination programs with patient based navigators
- Telehealth and remote monitoring services
- Aggressive primary care
- Addressing patients' behavioral health and social determinants needs
- Early introduction of palliative care
"There are additional factors that lead to increased resource utilization including provider practice patterns, cost sharing or cost shifting to patients (also reinforced by the RAND Health Insurance Experiment) as well as complex provider networks that often leave patients with out of network charges that were unknown to the patient.
Improvements to Current HSAs
"In addition to Health Savings Accounts, a growing number consumers are in High-deductible health plans that are also paired with a tax-free health savings account (HSA-HDHP), which represent a growing percentage of plans offered on the individual and group market. HDHPs have defined minimum deductibles and maximum out-of-pocket limitsiii. As of 2016, 20.2 million Americans were enrolled in such plans, which represents a 16% increase from 2014.iv Employers, in particular, are increasingly offering HSA-eligible HDHPs as a way to expand coverage options, lower their health care spending, and promote proactive consumer engagement.
"Guided by the
"High deductible plans should adopt a more flexible benefit design offering more protection for certain medical services through a value-based insurance design plan structure. A targeted strategy exploring coverage for certain high-value, clinically-indicated health services prior to meeting the deductible will produce more value than current plans.
"Expanding the
Conclusion
"Healthcare spending consumes one in every
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