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Biologic drugs treat a range of diseases such as cancer, diabetes, retinal diseases, Crohn's disease and many other conditions. Despite accounting for use by just 2% of Americans, spending on biologics is a major driver of drug spending in the United States. Biologics often come with a hefty price tag; for example, the most commonly used biologic drug, Humira, can have out-of-pocket costs that run...

The Health Care Cost Institute (HCCI) in collaboration with West Health conducted an analysis of the high prices that employer-based insurance pays hospital outpatient departments for clinical lab tests. We found that insurers are paying, on average, 3 times more for common lab tests such as blood and urine test when billed by hospital outpatient departments compared to independent laboratories. D...

Building on a commitment to health care price transparency that spans more than a decade, the Health Care Cost Institute is excited to introduce HealthPrices.Org (formerly Guroo), a free health care price transparency tool that shows consumers the average prices for health care services in their local metropolitan area. Access to data on prices can help consumers, employers, and other purchasers o...

According to the most recent year of data available, an estimated 42% of adults have obesity and almost 20% of children are diagnosed with obesity. It is well documented that obesity prevalence and associated health care costs continue to rise. The Kaiser Family Foundation has estimated the average annual health spending for people enrolled in commercial insurance diagnosed with obesity ...

HCCI collaborated with the National Kidney Foundation and The DataFace to develop a national and state-level multi-payer dashboard that examines the current state of Chronic Kidney Disease (CKD) in the US and highlights the gaps in CKD-related care. Our interactive tool allows users to examine the rates of CKD testing and diagnosis among people at-risk for CKD. It also highlights CKD quality of ca...

Menopause is clinically defined as the end of a female's menstrual cycle, but for many, this stage of life is marked by uncertainty and confusion. It is a period where information is vague, experience is poorly understood, and it leaves many women feeling isolated as they navigate the complex changes of aging. Each year, nearly two million women enter menopause, yet there is a significant knowledg...

The amount of health care services people use varies widely across the population and can change year to year. People may require a higher amount of care in one year and fewer services the next. Although "high utilizers" are often discussed, there are people who do not use any services throughout the year. Other than being in good physical health, people may not seek care for a variety of reasons ...

The Lower Costs, More Transparency Act (H.R. 5378) currently before Congress aims to increase price transparency in health care and address the high cost of prescription drugs. One of the provisions of the bill would change the way Medicare pays for physician administered drugs. Currently, Medicare pays a higher price for drugs that are administered in a hospital outpatient setting than drugs that...

Technological medical advancements have shifted an array of procedures previously rendered in inpatient hospitals to ambulatory surgical centers (ASCs). For example, same-day procedures (e.g., cataracts surgery) that do not require an overnight hospital stay and musculoskeletal procedures, such as arthroscopy, are commonly performed at ASCs.  Because they operate independently of brick-a...

Cardiac rehabilitation is a program to help patients with heart events recover and return to normal activities. It is recommended following acute heart events and as a component of addressing chronic heart failure. Despite recommendations from federal agencies, advocacy groups, and national health associations and the documented benefits of cardiac rehabilitation, only 20-30% of people who could b...

10 FAQs about Employer-based Health Plans Recent data from the Health Care Cost Institute (HCCI) show that price growth accounted for more than half the change in per person health care spending from 2017 to 2021. Nearly half of people in the US get health insurance through work, either through their own employer or as a dependent. Accordingly, rising health care spending is a big problem for empl...

The CDC defines Severe Maternal Morbidity (SMM) as 'unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health.' These outcomes are largely preventable and are an important indicator of maternal health care quality. The CDC reports that SMM has steadily increased in recent years, and the consequences are wide-ranging, including detrime...

Health care spending continues to grow, and prices are the primary driver. Without addressing high and growing prices, efforts to make care more affordable will not be successful. One way to understand what is going on with prices in employer-sponsored insurance (ESI) is to compare negotiated rates paid in that market to Medicare payments for the same services. New analysis from the Heal...

The World Health Organization reported that, following the COVID-19 pandemic, there was a 25% increase in the prevalence of anxiety and depression worldwide. Mental health crises following months and years of social isolation and other effects of the pandemic have renewed national interest in mental health care access. Understanding how mental health services, including medications used to treat m...

Building on existing work on telehealth use early in the COVID-19 pandemic among people who get health insurance through work, HCCI examined the use of telehealth services by year through 2021. We examined patterns of telehealth use by modality (synchronous or asynchronous) and state, as well as select measures of area (zip or county)-level social determinants of health as reported in AHRQ's Socia...

The emergency room (ER) is a critical and life-saving source of care for many Americans, but the resulting medical bills that patients receive can be a source of confusion and extreme financial burden. From incredibly high, varying prices to surprise bills resulting from in/out of network confusion, many Americans have no idea what to expect when it comes to the cost of ER services. Poli...

Ambulance services play an essential, life-saving role in the health care system but can also be a source of surprise bills to patients and unexpected high out-of-pocket costs. This HCCI data brief and downloadable data explores the 10-year trends in ambulance prices, utilization, spending, and the frequency of out-of-network billing for the commercially insured - people who get their health ...

Important research is underway to understand the impacts of Long COVID. Studies about the clinical pathways, patient-specific needs, and treatment for Long COVID are highlighting necessary medical care and intervention. To inform public and private decisionmakers' efforts to support and treat patients, this study uses HCCI's unique health care claims dataset to identify the effects of Long CO...

Uterine fibroids can affect up to 80% of women by age 50. Endometriosis affects 1 in 10 women of reproductive age. Together, they are two of the leading conditions among reproductive-aged women causing infertility, chronic pelvic pain, fatigue, nausea, and heavy menstruation. Symptoms of uterine fibroids and endometriosis are also associated with abdominal pelvic pain, heavy and painful menst...

Reproductive and sexual health services play an important role in daily life and wellbeing for many people. These services include preventive services (such as screenings for sexually transmitted infections and reproductive cancers), contraceptive services, and services relating to pregnancy and childbirth. The objective of this report is to provide national and state data on the use of reproducti...

Asthma is the most common chronic condition among children in the U.S. and one of the leading reasons for pediatric emergency room (ER) visits. Schools play an important role in managing asthma among children since kids spend most of their time in school and school buildings may have environmental factors such as poor air quality and mold which can trigger asthma flare-ups. When asthma is uncontro...

The COVID-19 pandemic led to an increase in the use of telehealth services and online asynchronous health communication, commonly referred to as emails. These tools allow patients to ask their physicians and other clinicians questions regarding medication changes, symptoms, and to check in regarding management of chronic conditions. In March 2020, CMS expanded Medicare telehealth billing to includ...

Neonatal Intensive Care Units (NICUs) provide critical, often life-saving, care to over 300,000 infants every year. The specialized care and technology available in NICUs have allowed preterm and otherwise vulnerable babies to survive and thrive even in the face of a host of potentially life-threatening complications and are recognized as contributing to the decline in infant mortality over the pa...

Asthma is the most common chronic condition among children in the U.S. and one of the leading reasons for pediatric emergency room (ER) visits. Schools play an important role in managing asthma among children since kids spend most of their time in school and school buildings may have environmental factors such as poor air quality and mold which can trigger asthma flar...

In June, HCCI staff attended AcademyHealth's Annual Research Meeting (ARM) and ASHEcon. In addition to connecting with other health services researchers, staff presented original research using HCCI's commercial claims dataset. Here's a sampling of HCCI staff presentations:  ASHEcon: Effect of Critical Access Hospital Designation on Inpatient Prices in Employer-Sponsored Insurance Presen...