Oct 5, 2018

Axios Vitals

Good morning ... Vitals has largely been a Kavanaugh-free zone lately, because the health care implications of his nomination really haven't changed since the beginning.

But my colleague Kim Hart has written a deep, probing piece about the conversation all of this has started — a conversation that's bigger than the politics of this moment. Bigger than 2018, bigger than 2020, probably even bigger than a lifetime seat on the Supreme Court. It's good and worthy and I hope you'll read it.

1 big thing: Out-of-network coverage is disappearing


One reason surprise medical bills are going up: Coverage for out-of-network care is going down, according to the Robert Wood Johnson Foundation.


  • Just 29% of insurance plans in the individual market provide any benefits for out-of-network providers. That’s down from 58% a mere three years ago.
  • Coverage is also declining in the market for small businesses, but not nearly as dramatically — 64% of small-group plans offer some out-of-network coverage, down from 71% in 2015.
  • Those small-group numbers are probably roughly in line with where things stand among large employers’ plans.

Why it matters: The burgeoning controversy over surprise hospital bills stems partly (though not exclusively) from the bills patients receive when they’re treated by an out-of-network provider — even without their knowledge, often within an in-network facility.

  • Out-of-network coverage has obviously never been as generous as in-network coverage (that’s the whole point of creating a network), but as insurers pull back even further, more patients will likely find themselves on the hook for even bigger bills.
2. Medical device prices are really high, too

The prices of hospital procedures, doctor visits and prescriptions are a lot higher in the U.S. than other high-income countries, and a new Health Affairs study shows that holds true for medical devices, too.

By the numbers: Roughly 6% of U.S. health care spending goes toward medical devices, or about $200 billion annually, my colleague Bob Herman notes.

  • Two researchers studied what hospitals in the U.S., U.K., France, Italy and Germany paid for various heart implants, which make up a big portion of the medical device market.
  • Depending on the type of stent or pacemaker, U.S. hospitals paid anywhere from two to six times more than the country that paid the lowest prices (often Germany).

Between the lines: Prices likely differed based on a country’s tech-based regulation, but also on how much market power medical device companies had.

“Variation within countries suggests that manufacturers exploit varying levels of willingness-to-pay and bargaining power between buyers to charge different prices across hospitals and increase profits,” the researchers wrote.

3. Fitbit data cited in murder charges

Data from a murder victim's Fitbit helped police substantiate charges against her suspected killer — the latest intersection between personal health care tech and law enforcement.

The details, as reported by the New York Times:

  • "[The victim] had been wearing a Fitbit fitness tracker, which investigators said showed that her heart rate had spiked significantly around 3:20 p.m. on Sept. 8, when [the suspect] was there."
  • "Then it recorded her heart rate slowing rapidly, and stopping at 3:28 p.m., about five minutes before [the suspect] left the house."
  • "Investigators obtained a search warrant and retrieved the Fitbit data with the help of the company’s director of brand protection."
4. Insurer will give naloxone to employers

Photo: Richard Lautens/Toronto Star via Getty Images

Blue Cross and Blue Shield of Massachusetts is providing naloxone — the drug used to revive people who have overdosed on opioids — to a handful of large employers in the state. And it could ultimately give the drug to every employer it covers, Modern Healthcare reports.

  • The initial round of employers includes a construction company, local governments and Blue Cross itself.
  • The insurer has 800 naloxone kits ready to go for the pilot program.

“Before launching the pilot, Blue Cross conducted 507 interviews with consumers, half of whom had personal experiences with opioid addiction through family members or friends," Modern Healthcare writes. “The interviews yielded tips such as keeping the kits small — the size of a makeup kit rather than a toolbox. People also indicated they wanted the kits to include gloves.”

Go deeper: Service workers are on the front lines of the opioid crisis.

5. Nobody likes private exchanges

Did you know there are privately administered insurance exchanges, similar to the Affordable Care Act’s, for large employers? If not, it may be because they are deeply unpopular.

Driving the news: A mere 5% of employers with at least 50 employees and a health plan take advantage of a private exchange, according to the Kaiser Family Foundation's annual survey of employer coverage.

Between the lines: Employers are confident they can get a better deal by negotiating directly than by shopping on a pre-established market.

Flashback: Back in 2015, Accenture estimated that 40 million Americans would be covered through private exchanges this year.