Hospital Prices in Medicaid Managed Care

Marr, Jeffrey; Wang, Yang; Xu, Jianhui; Bai, Ge; Anderson, Gerard; Meiselbach, Mark K.

doi:10.1001/jamanetworkopen.2023.44841

JAMA Netw Open

2023

DOI: 10.1001/jamanetworkopen.2023.44841

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Hospital Prices in Medicaid Managed Care

Jeffrey Marr,

Yang Wang,

Jianhui Xu

et al.

Abstract: This cross-sectional study uses hospitals’ self-disclosed pricing information to characterize Medicaid managed care hospital prices.

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2024

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Commercial insurers' market power and hospital prices in Medicaid managed care

Wang,

Marr,

et al. 2024

Health Services Research

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ObjectiveTo examine the relationship between insurers' commercial market power and negotiated prices in Medicaid Managed Care (MMC) plans for hospital care.Data SourcesMMC prices from hospital‐disclosed price transparency data as of July 2023 compiled by Turquoise Health, insurance enrollment information from the 2021 Clarivate InterStudy enrollment data.Study DesignLog‐transformed linear regression with hospital and procedure fixed effects estimating the within‐hospital MMC price variation as a function of insurers' commercial market share quartile and MMC market share for 15 common outpatient hospital services.Data Collection/Extraction MethodsA total of 39,049 MMC price samples measured at hospital‐procedure‐MMC insurer level are merged with county‐insurer level market share data.Principal FindingsAround 25% of price variation in MMC plans are driven by within‐hospital factors. Compared with MMC insurers from the lowest commercial market share quartile (<0.8%), those from the highest commercial market share quartile (>17%) are associated with negotiating 4.6% (95% confidence interval: [2.8%–6.4%], p < 0.001) lower MMC prices for outpatient hospital care, including 3.6% (p < 0.05) for medical/surgical procedures, 3.6% (p < 0.01) for radiology, and 6.7% (p < 0.001) for emergency department visits.ConclusionsMMC insurers with substantial commercial market share negotiate lower MMC prices for multiple outpatient hospital services.

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Commercial insurers' market power and hospital prices in Medicaid managed care

Wang,

Marr,

et al. 2024

Health Services Research

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Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021

Hanson,

McCarthy,

Molloy

et al. 2024

Health Affairs

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Hospital Prices in Medicaid Managed Care

Abstract: This cross-sectional study uses hospitals’ self-disclosed pricing information to characterize Medicaid managed care hospital prices.

Cited by 2 publications

References 2 publications

Commercial insurers' market power and hospital prices in Medicaid managed care

Commercial insurers' market power and hospital prices in Medicaid managed care

Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021

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