Health Research Institute (sorted by title): Payers

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The Health Research Institute of PricewaterhouseCoopers provides new intelligence, perspective and analysis on trends affecting all health-related industries, including healthcare providers, pharmaceuticals, health and life sciences and payers.

10Minutes on health reform under Obama
160 million Americans receive their health insurance benefits through their employer. However, in the coming year many employers could face major changes as the Obama administration attempts to reform the system. The reforms could curb the rising cost of healthcare purchased by government and private employers by introducing new programs and regulations. Controlling costs would benefit private employers, which on average pay 80% of the cost of worker health benefits and may also be saddled with large retiree health benefit liabilities.

Behind the numbers: Healthcare cost trends for 2008
The nation's employers can expect a return to single-digit increases in health benefit expenses in the year ahead. Unlike health plan premium forecasts, medical cost trends reflect the underlying numbers for actual medical costs by plan design. They are used by private insurers and employers to compare health plan costs year over year, ultimately to set premium levels and design the benefit packages that will be offered to employees in the fall.

Behind the numbers: Medical cost trends for 2009
From one year to the next, healthcare costs for employers and their workers always go up. Yet, for the past five years there's been some positive news. The growth rate has been dropping. However, that trend will level off in 2009, according to employers and health plans. The new Health Research Institute (HRI) report, "Behind the numbers: Medical cost trends for 2009", addresses the cyclical nature of the healthcare industry and provides insights into the conflicting factors that are contributing to both cost increases and savings. See Behind the numbers: Medical cost trends for 2009.

Behind the numbers: Medical cost trends for 2010
Medical costs are expected to increase in 2010 by 9%, which is slightly less than recent years; 9.2% in 2009 and 9.9% in 2008. However, these rates still significantly outpace real incomes and the rate of inflation. Reacting to higher medical costs as the economy recovers will require innovative approaches to deal with workers and healthcare stakeholders. This year's report addresses cost trends for the coming year, the impact the recession and promise for reform have had on the healthcare industry, and how businesses are reacting to higher medical costs.

Beyond the sound bite: November 2007 review of presidential candidates' proposals for health reform
Healthcare is one of the top domestic concerns in the upcoming presidential election. The current health care system is not built to last, and the 2008 presidential election is poised to see a significant push for major health reform. The direction it goes depends largely on the next President.

Closing the seams: Developing an integrated approach to health system disaster preparedness
A disaster occurs every week in the US, and the numbers are increasing. Yet despite increased federal and state funding since 2001 and lessons learned following 9/11 and natural disasters like large-scale hurricanes and floods, disaster planning in the healthcare arena remains sporadic, disconnected and under-funded. See more

Creating a climate of innovation: The health industry's most challenging paradox
Innovation is one paradox of healthcare - tremendous strides forward within a system that overall doesn't work well. Can innovation transform healthcare? The annoyingly complex answer is that it does and it doesn't. Effective incremental, sector and local innovations are everywhere, but the breakthroughs that would make the entire health system workable remain elusive.

Healthcare policy in an Obama administration: Delivering on the promise of universal coverage
President Barack Obama has pledged to implement multiple changes in our health care system with the goal to increase access and affordability of health care in the United States. This report recognizes the difficulty in developing such reforms in light of current market conditions, the implications reforms could have and provides five suggestions to make health care more affordable. To find out more about how the President proposes to implement changes to the existing health care system and the possible impact of such reforms read, Healthcare policy in an Obama administration: Delivering on the promise of universal coverage.

HealthCast 2010: Smaller world, bigger expectations
Consumerism, E-business and genomics will be the disruptive drivers of this decade, according to this 1999 global research report that included a mix of policy makers, health system executives, employers, physicians, insurers and medical supply vendors from the US, Europe, Canada and Australia. This report looks at those disruptive drivers and the way they'll affect providing and paying for healthcare in the future.

HealthCast 2020: Creating a sustainable future
In this groundbreaking report, HealthCast 2020, the Health Research Institute looks at solutions and responses from around the world to the globalization and industrywide convergence of healthcare. What insights, best practices and policy lessons can be learned from experiences in various countries to create a globally sustainable health system? Who, or what, is driving the solutions?

HealthCast tactics: A blueprint for the future
Building on HealthCast 2010, this 2002 report recommends tactics that successful health systems and payers should consider employing over the next three to five years. Among the tactics are pay-for-performance, predictive modeling, and renewing capital plants, all of which are strongly affecting the industry today. The report draws on a survey of more than 650 top executives of hospital systems, payers, governments, medical supply vendors, physician groups and employers.

Jammed access: Widening the front door to healthcare
This report from the Health Research Institute (HRI), Jammed access: Widening the front door to healthcare*, addresses how we can increase access to care without increasing costs. The report focuses on three key obstacles that adversely impact accessibility: crowded points of entry; a system that is confusing to navigate; and individuals who inevitably fail to act on their health early. Jammed access: Widening the front door to healthcare* provides solutions and recommendations for the problems facing the healthcare industry.

Keeping score: A comparison of pay-for-performance programs among health plans
In order for providers to improve quality and make sustainable changes in the delivery of care, they must have specific incentives to do so. Pay-for-performance programs are an important tool to link financial payment with quality improvement. If P4P is to succeed in significantly moving the needle on quality, we ultimately need an all-payer approach, wherein providers face the same metrics and incentives for all their patients, regardless of their insurance coverage.

Paying for performance: Incentives and the English health system
Many countries are looking at ways to reform their healthcare payment systems around performance. The English system for paying primary care physicians is the only one in the world that bases a significant portion of physicians’ pay on quality metrics. For that reason, this “pay for performance” (P4P) system is worthy of study, and the PricewaterhouseCoopers Health Research Institute (HRI) report shows what is working well, what needs further refinement and what should be considered when implementing pay for performance methodologies. The learnings from this go far beyond the English system.

Proposals to policy: A national conversation on healthcare reform
Susan Dentzer, editor-in-chief of Health Affairs and health correspondent of The NewsHour with Jim Lehrer, moderated a panel of healthcare experts, economists and lawmakers as they discussed President Obama's health care reform proposals. This broadcast was recorded from the National Press Club, Washington, D.C. on November 20, 2008.

Rock and a hard place: An analysis of the $36 billion impact from health IT stimulus funding
By injecting $36 billion in health IT through the stimulus fund, the federal government hopes to create a digital healthcare infrastructure that reduces costs and improves quality. Hospitals and physicians that want the stimulus money will find they have little choice but to comply with the new requirements or suffer future shortfalls in Medicare reimbursement.

Take care of yourself: Employers embrace consumerism to control healthcare costs
With double digit health insurance cost increases affecting the business bottom line, employers are turning to consumerism and consumer-directed healthcare to provide a solution. This research report gets behind this trend to find out how employers are coping with rising healthcare costs and the promise that consumerism may bring.

The price of excess: Identifying waste in healthcare spending
More than half of the $2.2 trillion spent annually on healthcare in the US could be considered wasteful, according to an analysis published by PricewaterhouseCoopers’ Health Research Institute. Defensive medicine, such as redundant, inappropriate or unnecessary tests and procedures, was identified as the biggest area of excess, followed by inefficient healthcare administration and the cost of care necessitated by conditions such as obesity, which can be considered preventable by lifestyle changes.

The quality conundrum: Practical approaches for enhancing patient care
This 200-page book is a compilation of thought-provoking essays by PwC and industry experts on quality in provider, payer, pharmaceutical and employer organizations in the US and around the world. It explores the barriers that have made healthcare quality improvements difficult to achieve, and outlines a clear path to progress. Take a journey through the healthcare system from the patient's perspective.

The trends and benefits of providing healthcare quality data
In this latest HealthBrief, PwC discusses the results of a recent survey of top executives at large US-based multinational companies. The focus of the HealthBrief is on healthcare quality data that firms provide to their employees as a way to influence the utilization of healthcare through better education of their employees on cost and quality issues and improvement of their own health behaviors.

Top eight health industry issues in 2008
Health organizations face a pivotal year in 2008 as they anticipate the wildcard outcome of the presidential election. Meanwhile, they must prepare for impending changes — pharmaceutical and life sciences companies are adapting to a new safety agenda from the FDA including the agency's expanded authority over post-market drug safety. See more

Top nine health industry issues in 2009
In 2009, external forces will compel health industry organizations to react to new financial realities, regulations, and technology. Chief among those forces will be the effects of the economic crisis, a new president and Congress, and financial and technology companies looking to extend their reach into the health industry. PricewaterhouseCoopers' report from the Health Research Institute (HRI) identifies nine significant issues that will shape the health industry in 2009. To find out more about these nine issues and their implications read, Top nine health industry issues in 2009.

What employers want from health insurers – now
Studies show that most employers are satisfied with their health benefits and want to continue providing these benefits to their employees. However, employers' expectations of their health insurers are changing, and while many studies in the past have examined the relationship between employees and their employer-sponsored benefits, less is known about employers and what they want from insurance carriers. To find out more about the evolving attitudes US employers have regarding health insurers read, What employers want from health insurers - now.

Working towards wellness: Accelerating the prevention of chronic disease
The rising prevalence of chronic diseases is a global issue that affects the productivity and competitiveness of employers. The Health Research Institute partnered with the World Economic Forum on research that examines the impact of chronic disease on multinational employers and recommends a framework for developing, launching and maintaining wellness programs in different territories.

You get what you pay for: A global look at balancing demand, quality, and efficiency in healthcare payment reform
As the pressure to control health spending increases, payers, governments, and providers are compelled to scrutinize the quality and amount of care they'll be able to deliver in the future. Health leaders around the world see the health payment system as one of the best tools in managing this challenge and achieving sustainability. However, with less than 40% of those same leaders ranking their existing payment system as good, every country has room to improve and can benefit from shared best practices. See You get what you pay for: A global look at balancing demand, quality, and efficiency in healthcare payment reform.