Health Care Cost Data Sources
Health Care Cost Data - Vermont
Every year Vermont’s Joint Fiscal Office (JFO) provides policy overviews to the Legislature, including health care issues.
At the start of a new session, JFO provides a primer on health care. Here is the 2021 version of the Health Care System and Health Care Finance (COVID-19 was a separate briefing, this reflects 2019 data).
The Georgia Health Policy Center provides their legislature with a book of common health care policy terms, linked here.
The Green Mountain Care Board provides publicly available analysis and data tools.
Vermont Rate Review - Annual review of commercial insurance plan rates. The Essential Health Benefits (EHB) Benchmark Plan sets the starting point for what plans need to cover.
Vermont 1115 Waiver - The State’s agreement with the federal government about what they will match for Medicaid coverage and what flexibility the state has within the plan. Updates on benefit revisions or additions are found in the Global Commitment Register.
Vermont’s All-Payer Model Contract - Establishes a framework for ACOs operating in Vermont.
HCP LAN - framework for value-based care development
National Association of ACOs (NAACOS)
Calculating Vermont’s Total Cost of Care (note, this is a 2019 episode and some policies may have changed) - Part 1 (VHCURES) & Part 2 (TCOC)
Health Care Cost Data - National
Centers for Medicaid & Medicare Services (CMS)
Medicare Approval of Coverage - For an example of how Medicare adjusts its coverage every year, see the annual proposed changes to CMS’ Physician Fee schedule (linked here is CY22), details on the current Physician Fee Schedule, and commentary from MedPac (the Medicare Payment Advisory Commission).
National Association for State Health Policy (NASHP)
Kaiser Family Foundation, which analyzes national trends and policy considerations, including for:
The Commonwealth Fund similarly provides health care system information including reports on:
Reports on Health Care Costs & Benefits related to Food Access
In each of the program review areas for FAHC, we have incorporated funding-related reports as relevant. Below are examples of some general reports. To go with the general reports, we have a general summary of factors to consider.
When evaluating health care cost data, it is important to ask:
Who is bearing the costs / savings (individual patients, health care practices, private payers, public payers)
Over what time period are these costs / savings observed
Is the assessment for general population trends or individual health care utilizers
What is the underlying rate of growth in costs being considered
What is a true cost / cost savings and what is a cost shift (the basic example in the food is medicine world would be shifting the cost of federal nutrition programs onto health care)
What are the underlying assumptions about health care or food system investments before any evaluation of marginal costs / marginal benefits (for example, has there been a public investment in referral systems? Establishment of a care coordinators system? Referrals for Medical Nutrition Services?)
An important complication to keep in mind is that the majority of health care plans in Vermont are controlled by the federal government as both regulator and payer - in particular, Medicare, Medicaid, and the military health care system. Within these policy structures, a few key items:
Negotiations with the federal government about health care payment encompass both the federal dollars available and the extent of state-level flexibility for spending those dollars.
Flexibility is more easily gained for what is called a “risk bearing” entity - an organization that accepts downside risk if their innovative health care concepts fail to perform as expected. (Note that state governments cannot be considered risk bearing entities for this purpose).
CMS can grant flexibility within the parameters of the underlying health care statute; anything that goes against that underlying statute requires Congressional approval. For example, as of this writing (2022) it is still being debated whether CMS has the authority reimburse federally-qualified health centers (FQHCs) for providing telehealth services.
Reports:
Centers for Medicare & Medicaid Services (CMS) Accountable Health Communities innovation model examining the health quality and cost changes related to better managing health-related social needs (HRSNs) for Medicare & Medicaid beneficiaries. (See also our interview with CMS about this project)
Accountable Communities for Health are local partnerships across sectors to support the overall health of a community. George Washington University’s Milken Institute of Public Health supports a Funders Forum on Accountable Health to share lessons learned and opportunities for funding this work. Their Wellness Fund brief features an example from NEK Prosper.
National Academies of Sciences, Engineering & Medicine - Report on Integrating Social Care into the Delivery of Health Care (2019). Executive summary of the financing section is here.
Similar concepts are covered in Budgeting to Promote Social Objectives - A Primer on Braiding and Blending, Brookings Institute (2020). And Braiding and Blending Funding Streams, National Academy for State Health Policy (2016)
Medicaid and SCHIP Coverage of SDOH Screening and Interventions - National Association of Community Health Centers (NACHC) issue brief (2022) and Medicaid and CHIP Payment and Access Commission (MACPAC) report on Financing Strategies to Address the Social Determinants of Health in Medicaid (2022).
The Rockefeller Foundation’s July 2021 report on the True Cost of Food in the U.S. traces the impacts of food system decisions on health, health care, and the associated costs.
National Association of Insurance Commissioners & Center for Insurance Policy Research -Food as Medicine White Paper (2018) - Places food and nutrition in the context of reducing individuals’ annual health care expenses.