New Models Of Payment: Cutting Out The Insurer, Or Can I Have A Lower Price For That?

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This is the third part in our series of new models of payment in the health-care marketplace, touching employers and individuals. The first part is here, and the second part is here.

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By Jeanne Pinder

We’ve been writing about new models of payment for health care by employers. So individuals might ask: How does this affect me?

As employers are starting to turn away from insurance companies and contract directly with providers, individuals are, too.

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Wide Price Variations Underscores Hospital Market

hosoitalbillWithin individual communities, prices vary widely, even after accounting for differences in the complexity of services provided. The highest-priced hospital typically is paid 60 percent more for the same inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient services, with the highest-priced hospital typically paid nearly double the lowest-priced hospital, according to the study.”

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Value Based Insurance

walmart“These large firms have shopped around and compared the value of all national medical centers, choosing to send their employees to those able to provide the best care at the lowest cost and setting an example for other self-insured companies to follow in their footsteps……………..Bundled payment systems facilitate transparent and simplified reimbursement structures, eliminating the risk inherent to procedures with high cost variability and reducing administrative costs………”

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