A new analysis by Avalere finds that causes of health insurance premium increases in 2016 generally mirror the distribution of healthcare spending in the individual and small group market. Specifically, inpatient and outpatient hospital services are modestly driving premium increases, while physician and other professionals make up less than their expected portion of premium growth. Prescription drugs' contribution to 2016 premium increases is roughly in line with their costs in 2014. Overall, premiums for 2016 will rise an average of $25.26 per month, with $5.44 of that increase caused by outpatient hospital services.

In recent years, several new U.S. Food and Drug Administration-approved, direct-acting antiviral medications to treat the chronic hepatitis C virus (HCV) have entered the market. Because of the potential impact on health plan and pharmacy budgets, researchers have conducted economic analyses, including cost-effectiveness analyses, to understand the value of the new medications.

A new Avalere analysis finds fewer insurers are offering preferred provider organization (PPO) networks on exchanges in 2016. Specifically, from 2014 to 2016, the percentage of plans offering PPO networks dropped from 39 percent to 27 percent. This represents a 31 percent decline over the three year period. Meanwhile, use of health maintenance organization (HMO) and exclusive provider organization (EPO) networks has increased. In general, PPOs include a wider network of providers and cover more out-of-network care than HMOs and EPOs.¹

David Brancaccio of American Public Media's Marketplace Morning Report interviewed Dan Mendelson after Valeant Pharmaceuticals International ended its relationship with Philidor Rx Services.

New analysis from Avalere Health examines the 2016 Federal Exchange Premium File. According to HHS, more than 8 in 10 (86 percent) of current enrollees can find a lower premium plan in the same metal level by returning to the exchange and shopping for 2016. As a result, tables and figures below examine the lowest cost options in two metal levels:

The third annual open enrollment period for exchanges will kick off on November 1. As patients and the healthcare industry prepare for the 2016 plan year, below are critical questions for the future of exchanges:

There is increasing consensus that comprehensive transformation of the healthcare system cannot be achieved without the engagement of patients, their families, and healthcare consumers. One stream of thought is that arming consumers with actionable cost and quality data could activate them as partners in controlling healthcare costs, which are expected to grow from 17.4 percent of the U.S. economy in 2013 to 19.6 percent in 2024.¹ Although evidence remains mixed, some studies have shown that when patients are given easily digestible cost- and quality-of-care data, they choose high-value options.^2,3

Avalere Health partnered with the Advanced Medical Technology Association (AdvaMed) to evaluate the impact of innovative technology adoption on Medicare spending. The analysis found that, on average, Medicare spending for the most technology-intense hospitals matched the national rate for all other hospitals. However, top technology hospitals have a higher percentage of hospitals with spending rates that are lower than the national average.

Network design is playing a central role in health benefit design and health policy debates. The goals of enhancing clinical quality and improving the patient experience, while lowering the total cost of care, are increasingly at the forefront of these discussions. Our latest research finds that tiered and narrow network insurance designs are becoming more prevalent, particularly, in the exchange market.

The Affordable Care Act (ACA) created health insurance exchanges to enhance competition and make health insurance more affordable and accessible for individuals and families. Specifically, exchanges are online portals where individuals and small businesses can shop among qualified health plans (QHPs) that meet certain benefit and coverage standards. As of June 30, 2015, 9.9 million individuals nationwide were enrolled in exchanges.

According to a new Avalere analysis of data from the Centers for Medicare & Medicaid Services (CMS), premiums for standalone prescription drug plans (PDPs) will increase and the number of PDPs available in 2016 will decrease. Conversely, Medicare Advantage (MA) premiums will decrease in 2016, and the number of MA plans on the market will increase, despite years of Affordable Care Act payment reductions.