A recent study by the Rand Corporation (https://www.rand.org/pubs/research_reports/RRA1144-2.html)
Hoosiers Pay More Than Three Times the Medicare Reimbursement Rate for Health Care
The Rand study, conducted from 2020 to 2022, is a comprehensive analysis of medical claims data from a diverse population of privately insured individuals and hospitals across the United States. This study’s findings, which identify hospitals and hospital systems by name, are particularly significant, a departure from previous studies. This change allows for a more direct comparison of hospital prices, making the study’s findings even more impactful and informative.
State reporting metrics for total facility charge vs. what Medicare reimburses- (https://dashboard.sagetransparency.org/) Sage Transparency Tool provides a view of hospital prices:
- Indiana- 341%
- Ohio- 296%
- Illinois- 266%
- Kentucky- 261%
- Michigan- 211%
The report shows that Indiana’s hospital costs are well above those of the surrounding states. The Sage Transparency report has a large amount of data, and one exciting report is the Hospital Quality Reliability Scores. The tool breaks down data by the hospital on Overall Medical, Surgical, and hospital Care.
Why is the Data Important?
If you or a loved one needs a surgical procedure, knowing if the facility has a good score should be part of your decision about where to receive care.
With employer health coverage, this data could be used in plan development and employee communications. If a member chooses a facility with a lower score for a surgical procedure, this could lead to a higher complication rate, creating a significant cost to the group plan. Informing members of Sage reporting tool could also lead to a better treatment outcome. Better treatment outcome is a win-win for the members and the employers.
Recently, a new group health insurance product was released in Indiana, which provides members with clear cost transparency. As a group health plan sponsor, an employer is responsible for delivering cost-effective options to their employees. That option is now available in the Hoosier state.
The Rand Study and Sage Transparency tool reinforces our need to address Indiana’s healthcare costs. We now have an option to do that at the member level.
