PayerFusion Healthcare Insights Roundup – April

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May 4th, 2013

Healthcare Fraud Examples

Health care fraud costs the country over $80 billion a year according to the FBI. While the majority of healthcare providers are honest, some purposely abuse the healthcare system for financial gain.


Healthcare Waste by Category

The amount of healthcare waste totaled $765 billion and 30% of the $2.5 trillion spent on healthcare delivery in 2009. The Institute of Medicine categorized waste into six general categories, from excessive administrative costs to unnecessary services.


Alternatives to The ER

Health insurers and employers are dedicating more time and resources toward educating and incentivizing their members to make better choices when accessing medical services. It’s estimated that more than $18 billion a year could be saved if patients with non-emergency conditions visited more appropriate care settings.


Growth of the Medical Tourism Industry

The Medical Tourism industry is growing at an exponential rate.  Healthcare consumers are more invested in their care and are willing to travel in search of greater healthcare options, better quality and lower costs.


Kaiser’s March 2013 ACA Tracking Poll

The Kaiser Family Foundation recently released their March 2013 Tracking Poll on the Affordable Care Act. The poll findings show that most Americans are unclear how the health law will affect them and don’t realize their state’s decision on Medicaid Expansion.


The Decline of Employer Sponsored Health Benefits

The availability of employer-sponsored insurance has fallen by about 10% in the past decade. Reports suggest the decline in employer-sponsored insurance is based on declining  job availability and a sharp increase in the cost of insurance premiums.


Greater Patient Engagement for Lower Costs

Patient engagement improves health outcomes and care coordination while reducing cost of care. Patients with low engagement typically choose inappropriate care settings, practice poor treatment compliance and avoid early health risk signs, which lead to high and unnecessary costs.


2013 Medical Cost Trend: Growth Deflators

Medical Cost Trend rose only 7% in 2011 and 7.5% in 2012, considerably slow growth over the past few years. PwC Health Research Institute projects medical costs will increase about 7.5% for 2013, the fourth year in a row of relatively flat growth.


2013 National Scorecard on Payment Reform

The first annual national scorecard on payment reform indicates that only about 11% of healthcare payments are tied to quality performance indicators. This must be doubled by 2020 to meet the goal The Catalyst for Payment Reform set for 20% of private payer payments to be tied to performance metrics.


Strengthening Affordability and Quality in America’s Healthcare System

The Partnership for Sustainable Healthcare recently released the report, Strengthening Affordability and Quality in America’s Healthcare System.  While healthcare spending has grown at a slow rate in recent years, it is important to transform our health system into a long-term affordable and high quality system.



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