Issue 38

2024 Year-in-Review

Thank you for another productive year of meetings, discussions, collaboration, and networking! 

To explore highlights of the past year, including key meetings, projects, and initiatives, check out our 2024 Year in Review presentation.

If you missed a meeting or need to revisit any materials, visit our website for links to all of our past slide decks and resources.

---

Refreshed Data in Sage Transparency

On December 17th Sage Transparency was updated with data from RAND 5.1 (see the next section for details), CMS Hospital Quality and Patient Experience Star Ratings, CMS Hospital Readmission Penalties, and Quantros Hospital Quality Reliability Scores.

---

Recent Presentations

In November, Gloria Sachdev was invited to present for the following organizations where she shared market and policy ideas to advance transparency, affordability, and competition:

• November 12th: National Association of Health Data Organizations
• November 20th: Georgetown University
• November 22nd: Connecticut Office of Health Strategy

On December 10th, RAND Corporation released an update to round five of its employer-led price transparency study. This update incorporates additional claims data and refinements to their original analysis. Highlights include:

• In 2022, employers and private insurers paid an average of 254% of what Medicare would have paid for the same inpatient and outpatient hospital services at the same facilities (including both facility charges and related professional claims).
• State-level median prices have remained stable across the past three study rounds: 254% of Medicare in 2018 (Round 3, 2016–2018 data), 246% in 2020 (Round 4, 2018–2020 data), and 253% in 2022 (Round 5.1 — this study, 2020–2022 data).
• The new data includes trends in emergency service pricing at the state and national levels between 2018 and 2022.

Use the link below to download the updated report and supplemental data.

Each year, we are proud to honor outstanding individuals and organizations who are working to improve our healthcare systems. Please join us in congratulating both recipients on this well-deserved recognition. These trailblazers are truly making an impact and inspiring change across the country!

2024 EFI Dave Kelleher Leadership Award

Schweitzer Engineering Labs

Pamela Colley, Senior Public Affairs Manager
Chris Foutch, Senior Finance Supervisor

The amazing team at Schweitzer Engineering Labs (SEL) was awarded the 2024 Dave Kelleher Leadership Award for their dedication to advancing healthcare price transparency. SEL has demonstrated exceptional leadership through various initiatives, including establishing direct contracting, addressing price variations, leveraging claims data to eliminate hidden fees, and optimizing prescription drug management. Their support of market and policy initiatives that align payments with the value of services sets an example of the leadership this award celebrates.

---

2024 Healthcare Innovation Award

Mark Cuban

Mark Cuban was awarded the 2024 Healthcare Innovation Award for his groundbreaking work with the Mark Cuban Cost Plus Drug Company, PBC. His transparent, no-nonsense approach to prescription drug manufacturing and pricing is revolutionizing the healthcare industry. By eliminating traditional middlemen like PBMs, Cost Plus Drugs has enhanced transparency and fostered trust among consumers and employers by providing access to safe, affordable medications.

---

Employers:

• US Employers Prioritize Wellbeing but Miss the Mark with Employees (WTW)
• Small Businesses Search for Affordable Health Care (Matter of Fact)
• Why the U.S. Healthcare System is so Much Worse than its Peers (Harvard Business Review)

---

Hospitals:

• Is Hospital Market Concentration Related to Medical Debt? (Urban Institute)
• Virtual Hospital-at-Home Could Offer Alternative to CMS Waiver (Modern Healthcare)
• Indiana Hospitals Pull Merger Application After Pushback Over Monopoly Concerns (KFF)
• 25 Largest Health Systems by Hospital Beds (Beckers)

---

Providers & Physicians:

• Fact Sheet: Nursing Faculty Shortage (AACN)
• The Bad News Behind the Rise in Locum Tenens (MedScape)
• OrthoIndy and Indiana Hand to Shoulder Center Announce Alignment (OrthoIndy)

---

Conglomerates:

• Justice Department Sues UnitedHealth Over Amedisys Deal (Beckers)

---

Insurance:

• UnitedHealth Pays its Own Physician Groups Considerably More than Others, Driving Up Consumer Costs and its Profits (STAT)

---

Pharmacy:

• Same Drug, 2,200 Different Prices (WSJ)
• U.S. Patent Office Pulls Controversial Rule to Curb Pharma Patent Abuse (STAT)
• How a Duty To Spend Wisely on Worker Benefits Could Loosen PBMs’ Grip on Drug Prices (KFF)

---

Policy:

• CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS)
• New York Targets PBMs with New Transparency, Competition Rules (Modern Healthcare)
• Reporting of Health Care Entity Mergers and Acquisitions (IN.gov)
• Make America Healthy Again: 6 Healthcare Positions of RFK Jr. (Beckers)
• Hospital Payment Cap Simulator (Brown University)

---

Public Health

• Seven Key State-Level Strategies for Supporting Community-Level Harm Reduction (NASHP)
• States Ranked by Preterm Birth Rates (Beckers)
• The Maternity Care Project

---

Other Healthcare News

• View of U.S. Healthcare Quality Declines to 24-Year Low (Gallup)
• Everyone’s Mad at Health Insurers, But ‘There’s Plenty of Blame to Go Around’ (TradeOffs)
• It’s a Big Thing: Medical Spread Pricing. So, Let’s Talk About Contract Transparency, With Cynthia Fisher (Relentless Health Value)