Helping make the health care system work for you

Health Highlights: Capping drug costs, crowdsourcing colonoscopy prices

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As we head into Memorial Day weekend, here are the top stories you should read about your money and your health. Plus, one important story you shouldn't miss.

Covered California votes to cap specialty drug costs for some

Covered California has become the first state health exchange in the nation to impose a cap on out-of-pocket costs for specialty drugs. The action is intended to make expensive, life-saving drugs more affordable for people who buy insurance through the state exchange.
Beginning in 2016, people who purchase most Silver, Gold and Platinum plans through Covered California will pay up to $250 per specialty drug prescription per month. Consumers enrolled in Bronze plans, which have lower premiums, will pay up to $500 per prescription per month, after meeting a $500 pharmacy deductible.


The return of #PriceCheck: Share the cost of your colonoscopy

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If you're a regular reader of this blog, you know that it's possible - but challenging - to shop around for affordable, high-quality health care. You also know that this is becoming more of a necessity, as more people enroll in high-deductible health plans and are responsible for more of their health costs.

Knowing all that: Wouldn't it be great if there was a way that you could more easily find out what health facilities in your area charge for certain medical procedures? Wouldn't it be fun if you could contribute to that database of information?

Well, I have great news: This week, KPCC - with our friends at KQED - is re-launching #PriceCheck. As you might remember, we're crowdsourcing the cost of certain medical procedures through this project. You can search for prices in your area and you can add your own.


Health Highlights: Free birth control, high deductibles, quit smoking for cash

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This week's top consumer health stories demonstrate, once again, that money shapes a lot of our health care decisions. Read on!

Free contraceptives must be free, Obama administration tells insurers

This week, the Obama administration clarified the Affordable Care Act's contraceptive mandate: Health plans must offer at least one option for every type of prescription birth control free of charge to consumers, Phil Galewitz reports for NPR.

The ruling follow reports that many insurers were not providing no-cost birth control for all prescription methods. The law requires that preventative services - including birth control and well-woman visits - be covered without out-of-pocket expenses, like copays or deductibles.

While insurers must offer at least one version of all 18 FDA approved contraceptives for free, the Department of Health and Human Services says plans may still charge fees to encourage individuals to use a particular brand or generic.


High deductibles force people to skip care, study finds


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If you've felt as if your high deductible was preventing you from getting needed health care, you're not alone. A new report finds that among Americans with private insurance, one in four didn't get needed care last year because they couldn't afford it.

But the report from the Washington, D.C.-based nonprofit consumer group Families USA cautions that skipping care is hardly a cost-saving measure for consumers. It calls on insurers and policymakers to develop more affordable plans that cover certain types of tests and treatments before the deductible is met.

"Not getting recommended follow-up care to treat an illness or not taking needed medications can result in people facing avoidable, more serious health problems and more expensive health care costs down the road," the authors write.


Cedars-Sinai uses electronic records to spur improved, lower cost care

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Last week, I told you about Sutter Health's efforts to orient its doctors toward more cost-conscious, high-quality care.

As you might remember, the Northern California health system is gathering doctors and, using data culled from electronic health records, comparing individual doctors' practice patterns. It's an attempt to get doctors to change their behavior by exposing them to their peers' success at providing high quality care at a lower cost. 

Today, I have another cool model to share!

Cedars-Sinai Health System in Los Angeles has chosen another route toward higher-quality, lower-cost care: It's incorporated a set of best-practice guidelines into its electronic health system. Essentially, the system alerts physicians when they attempt to order a procedure or medication that could be unnecessary or harmful. This often spurs them to reconsider their decisions, according to Cedars officials.