Chapter 3: Employers Get to Work on Health Care

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34  article: “How Employers Are Fixing Health Care,” Harvard Business Review, March, 2019, https://hbr.org/cover-story/2019/03/how-employers-are-fixing-health-care.

34  Health Affairs: “Self-Insured Employers Are Using Price Transparency To Improve Contracting With Health Care Providers: The Indiana Experience,” Health Affairs, October 7, 2019, https://www.healthaffairs.org/do/10.1377/hblog20191003.778513/full/.

35  Rosen Hotels & Resorts: https://www.rosenhotels.com/.

35  RosenCare: https://www.rosencare.com/.

35  employer insurance premiums: “Average Annual Single Premium per Enrolled Employee for Employer-Based Health Insurance,” Kaiser Family Foundation, 2018, https://www.kff.org/other/state-indicator/single-coverage/.

36  was updated: Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, 2nd ed. (New York: Basic Books, 2017), https://www.amazon.com/Social-Transformation-American-Medicine-Profession/dp/0465093027/.

37  Haven: https://havenhealthcare.com/.

37  Lisa Woods: “The Future of Healthcare with Lisa Woods, US Strategy and Design for Walmart,” Thrive Global, February 18, 2020, https://thriveglobal.com/stories/the-future-of-healthcare-with-lisa-woods-senior-director-of-strategy-and-design-for-u-s-benefits-at-walmart/.

37  her and company CEO Doug McMillon: “World’s 50 Greatest Leaders,” Fortune, 2019, https://fortune.com/worlds-greatest-leaders/2019/doug-mcmillon-lisa-woods/.

38  Covera Health: https://www.coverahealth.com/.

38  Grand Rounds: https://grandrounds.com/.

40  wrote in early 2020: “Self-Insured Companies Do No Better on Cost Control,” Axios, January 27, 2020, https://www.axios.com/employers-health-care-insurance-costs-57f06e79-dbb8-4233-898d-f5fd7664d201.html.

42  Crossover Health: https://crossoverhealth.com/.

44  annual outlook: “National Business Group on Health Identifies Six Open Enrollment Trends for 2020,” Business Group on Health, September 25, 2019, https://www.businessgrouphealth.org/who-we-are/newsroom/press-releases/identifies-six-open-enrollment-trends-for-2020.

44  sixteen Walmart COE providers: “The 16 Health Systems to Which Walmart Sends Employees for Care,” Becker’s Hospital Review, May 21, 2019, https://www.beckershospitalreview.com/strategy/the-16-health-systems-where-walmart-sends-employees-for-care.html.

44  Optum: https://www.optum.com/.

45  Rally: https://health.werally.com/partner/optum/optum_360/register/.

46  are booming: “2019: The Year We Learned to Love Instability,” Mercer, January 7, 2020, https://www.mercer.us/our-thinking/healthcare/2019-the-year-we-learned-to-love-instability.html.

46  Anthem’s: “Say Hi to Sydney, Anthem’s Mobile App,” Anthem, November 25, 2019, https://www.anthem.com/ca/blog/member-news/sydney-app-anthem-ca/.

46  Aetna’s: “Health is the Real Win,” Aetna, https://www.attainbyaetna.com/.

46  digital health care: “Health on Demand,” U.S. Report, Mercer, February 2020, https://www.mercer.us/our-thinking/health/mercer-marsh-benefits-health-on-demand.html.

49  Motion: https://www.unitedhealthcaremotion.com/.

49  Healthcare Bluebook: https://www.healthcarebluebook.com/.

49  Health Care Cost Institute: https://www.healthcostinstitute.org/.

Chapter 10: What Quality Looks Like

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148  a 2019 survey: 2019 Healthcare Consumer Insight & Digital Engagement Survey, Binary Fountain, September 2019, https://go.binaryfountain.com/2019-healthcare-consumer-insights-survey.html.

148  Consumer Assessment of Healthcare Providers and Systems: https://www.ahrq.gov/cahps/index.html.

149  Healthgrades: https://www.healthgrades.com/.

149  RateMDs: https://www.ratemds.com/.

149  U.S. News & World Report: https://health.usnews.com/doctors.

149  ShareCare: https://www.sharecare.com/.

149  WebMD: https://doctor.webmd.com/.

149  Zocdoc: https://www.zocdoc.com/.

149  Vital Signs: Vital Signs, ProPublica, https://projects.propublica.org/vital-signs/.

149  state-by-state details: “Your Doctor Might Have a Disciplinary Record. Here’s How to Find Out.” ProPublica, updated December 11, 2019, https://projects.propublica.org/graphics/investigating-doctors.

150  recommends: “Using Physician Rating Websites,” Center for Advancing Health, GW Cancer Institute, 2016, https://www.guroo.com/#!insights/Quality/quality-using-physician-rating-websites.

150  a thorough review: Empowering New Yorkers with Quality Measures That Matter to Them, United Hospital Fund, December 2017, https://nyshealthfoundation.org/wp-content/uploads/2017/12/empowering-new-yorkers-with-quality-measures-dec-2017.pdf.

150  Agency for Healthcare Research and Quality: “Get to know the AHRQ Quality Indicators,” Agency for Healthcare Research and Quality       , https://www.qualityindicators.ahrq.gov/.

151  Recommended telehealth care: “Virtual Visits”, United HealthCare, https://www.uhc.com/individual-and-family/member-resources/health-care-tools/virtual-visits.

151  the telehealth transition: “Positioning Virtual Care to Transform Health Benefits,” Mercer, June 4, 2020, https://www.mercer.us/our-thinking/healthcare/positioning-virtual-care-to-transform-health-benefits.html.

151  do not have a primary care physician: “One-Fourth of Adults and Nearly Half of Adults Under 30 Don’t Have a Primary Care Doctor,” Kaiser Family Foundation, February 8, 2019, https://www.kff.org/other/slide/one-fourth-of-adults-and-nearly-half-of-adults-under-30-don’t-have-a-primary-care-doctor/.

152  American Telehealth Association: https://www.americantelemed.org/.

153  American Board of Medical Specialties: https://www.abms.org/.

153  Certification Matters: https://www.certificationmatters.org/.

153  Centers for Medicare & Medicaid Services: https://www.cms.gov/.

154  HHS.gov: https://www.hhs.gov/.

154  Physician Compare: “Physician Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/physiciancompare/.

154  Hospital Compare: “Hospital Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/hospitalcompare/search.html?

154  Nursing Home Compare: “Nursing Home Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/nursinghomecompare/search.html?

154  Hospice Compare: “Hospice Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/hospicecompare/.

154  Inpatient Rehabilitation Facility Compare: “Inpatient Rehabilitation Facility Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/inpatientrehabilitationfacilitycompare/.

154  Dialysis Facility Compare: “Dialysis Facility Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/dialysisfacilitycompare/.

154  Home Health Compare: “Home Health Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/homehealthcompare/search.html.

154  Long-Term Care Hospital Compare: “Long-Term Care Hospital Compare,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/longtermcarehospitalcompare/.

156  Agency for Healthcare Research and Quality: “Major Hospital Quality Measurement Sets,” Agency for Healthcare Research and Quality, https://www.ahrq.gov/talkingquality/measures/setting/hospitals/measurement-sets.html.

156  National Quality Forum: http://www.qualityforum.org/About_NQF/.

157  AHRQ Quality Indicators: https://www.qualityindicators.ahrq.gov/.

157  National Hospital Quality Measures: “Measures,” Joint Commission, https://www.jointcommission.org/measurement/measures/.

157  CAHPS Hospital Survey: “CAHPS Adult Hospital Survey,” Agency for Healthcare Research and Quality, https://www.ahrq.gov/cahps/surveys-guidance/hospital/about/adult_hp_survey.html.

157  ORYX: “ORYX Performance Measurement Reporting,” Joint Commission, https://www.jointcommission.org/measurement/reporting/accreditation-oryx/.

157  The Leapfrog Group: http://www.leapfroggroup.org/.

157  The Advisory Board: https://www.advisory.com/.

157  series of briefs: “How Hospital Quality Ratings Work,” Advisory Board, February 2020, https://www.advisory.com/research/physician-executive-council/resources/2017/metrics-used-in-hospital-quality-rating-programs#CMSstar.

157  evaluated: “Rating the Raters: An Evaluation of Publicly Reported Hospital Quality Rating Systems,” New England Journal of Medicine, August 14, 2019, https://catalyst.nejm.org/doi/full/10.1056/CAT.19.0629.

157  conflicting ratings: “National Hospital Ratings Systems Share Few Common Scores And May Generate Confusion Instead Of Clarity,” Health Affairs, March 2015, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2014.0201.

158  conflicting information for patients: “Consumers’ Interest in Provider Ratings Grows, and Improved Report Cards and Other Steps Could Accelerate Their Use,” Health Affairs, April 2016, https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.1654.

158  IBM/Watson Health: “IBM Watson Health Recognizes Top-Performing U.S. Hospitals and Health Systems,” IBM, June 20, 2020, https://www.prnewswire.com/news-releases/ibm-watson-health-recognizes-top-performing-us-hospitals-and-health-systems-301085296.html.

159  assessed Nursing Home Compare: “Does Nursing Home Compare Reflect Patient Safety in Nursing Homes?” Health Affairs, November 2018, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0721.

159  provides details: “Nursing Home Staffing 2019 Q3,” Long Term Care Community Coalition, https://nursinghome411.org/category/nursing-home-information/staffing/.

159  who has reviewed: “How Are Nursing Homes Doing When It Comes to Staffing? This Tool Helps You Find Out,” Association of Health Care Journalists, January 3, 2020, https://healthjournalism.org/blog/2020/01/how-are-nursing-homes-doing-when-it-comes-to-staffing-this-tool-helps-you-find-out/.

160  of her program: “How to Find a Long-Term Care Ombudsman Program,” National Consumer Voice for Quality Long-Term Care, https://theconsumervoice.org/get_help.

160  National Association of Area Agencies on Aging: https://www.n4a.org/. find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association, https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood.

160  find one near you: “PACEFinder: Find a PACE Program in Your Neighborhood,” National PACE Association, https://www.npaonline.org/pace-you/pacefinder-find-pace-program-your-neighborhood.

160  rules adopted in 2019: “Medicare and Medicaid Programs; Revision of Requirements for Long-Term Care Facilities: Arbitration Agreements,” Federal Register, July 18. 2019, https://www.federalregister.gov/documents/2019/07/18/2019-14945/medicare-and-medicaid-programs-revision-of-requirements-for-long-term-care-facilities-arbitration.

161  lack the fact-based comparative rankings: “Quality measurement lags in the outpatient surgery arena,” Modern Healthcare, April 6, 2019, https://www.modernhealthcare.com/safety-quality/quality-measurement-lags-outpatient-surgery-arena.

161  performance information: “Quality measures developed and tested by the ASC Quality Collaboration,” ASC Quality Collaboration, https://higherlogicdownload.s3.amazonaws.com/ASCACONNECT/1b34f1a1-0180-4005-9507-902fdf8f242e/UploadedImages/ASC_Quality_Collaboration/Documents/2019-Summary-ASC-QC-Measures.pdf.

Chapter 11: Unneeded and Misdiagnosed Care

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170  research found: “Surgery for Blocked Arteries Is Often Unwarranted, Researchers Find,” New York Times, November 16, 2019, https://www.nytimes.com/2019/11/16/health/heart-disease-stents-bypass.html.

170  American Board of Internal Medicine: https://www.abim.org/.

170  Choosing Wisely: https://www.choosingwisely.org/.

171  MedInsight Waste Calculator: “MedInsight Health Waste Calculator,” Milliman, https://milliman-cdn.azureedge.net/-/media/medinsight/pdfs/medinsight-health-waste-calculator.ashx.

171  A study found: “Is Great Information Good Enough? Evidence from Physicians as Patients,” National Bureau of Economic Research, https://www.nber.org/papers/w26038.

171  The authors of the study: “Do as the Doctor Says, Not as He or She Does,” STAT, July 22, 2019, https://www.statnews.com/2019/07/22/doctors-information-personal-health-decisions/.

172  2017 study: “Treating, Fast and Slow: Americans’ Understanding of and Responses to Low-Value Care.” The Milbank Quarterly, March 2017, https://www.milbank.org/quarterly/articles/treating-fast-slow-americans-understanding-responses-low-value-care/.

172  Virginia Center on Health Innovation: https://www.vahealthinnovation.org/.

173  A research study: “Cascades of Care After Incidental Findings in a US National Survey of Physicians,” Journal of the American Medical Association (JAMA), October 16, 2019, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752991.

173  comprehensive study: “Waste in the US Health Care System: Estimated Costs and Potential for Savings,” Journal of the American Medical Association (JAMA), October 7, 2019, https://jamanetwork.com/journals/jama/fullarticle/2752664.

175  study: 2017 Statewide Low Value Services Report, Virginia Center on Health Information, April 2917, http://www.vahealthinnovation.org/wp-content/uploads/2019/04/2017-Statewide-and-Regional-Low-Value-Service-Reports-Final.pdf.

175  2018 analysis: Medicare and the Health Care Delivery System, Medicare Payment Advisory Commission, June 2018, http://www.medpac.gov/docs/default-source/reports/jun18_medpacreporttocongress_rev_nov2019_note_sec.pdf?sfvrsn=0.

176  Connecticut collaboration: “Leveraging Choosing Wisely as a Tool for Achieving Health Equity,” Connecticut Choosing Wisely Collaborative, July 2017, http://nebula.wsimg.com/dab11e19782c29368719396db04d1d01?AccessKeyId=EE1E8CCBEA1024792D71&disposition=0&alloworigin=1.

177  four-page checklist: “Improving Diagnosis in Health Care: Improving Resources for Patients, Families, and Health Care Professionals,” Institute of Medicine, National Academy of Sciences, https://www.nap.edu/resource/21794/DiagnosticError_Toolkit.pdf.

177  National Patient Safety Foundation: https://npsf.digitellinc.com/npsf/.

177  Society to Improve Diagnosis in Medicine: https://www.improvediagnosis.org/.

177  document never got presented: “The Missing Pathology Report.” Society to Improve Diagnosis in Medicine, https://www.improvediagnosis.org/stories_posts/the-missing-pathology-report/.

178  Consumers Advancing Patient Safety: https://www.patientsafety.org/.

178  Patient-Centered Outcomes Research Center: https://www.pcori.org/.

178  Idaho Supreme Court: “SHERIDAN v. John J. Jambura, M.D., David B. Bettis, M.D. and John Does I-V, Defendants.” Supreme Court of Idaho, May 22, 2001, https://caselaw.findlaw.com/id-supreme-court/1364599.html.

179  estimates made twenty years ago: “Patient Safety 15 Years After To Err Is Human – NAM Symposium,” National Academy of Medicine, December 10, 2015, https://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12072015a.

179  2014 study: “The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations,” The BMJ (British Medical Journal), 2014, https://qualitysafety.bmj.com/content/23/9/727.

180  acid reflux or GERD: “Gastroesophageal Reflux Disease (GERD),” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940.

180  Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

181  patient toolkit: “Patient’s Toolkit for Diagnosis,” Society to Improve Diagnosis in Medicine, https://www.improvediagnosis.org/patients-toolkit/.

182  a 2019 study: “Diagnosis Errors Account for One-Third of Severe Harm Malpractice Claims,” Modern Healthcare, July 11, 2019, https://www.modernhealthcare.com/safety-quality/diagnosis-errors-account-one-third-severe-harm-malpractice-claims.

Chapter 12: When You’re in Control, and When You’re Not

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185  2017 research: “One in Five Inpatient Emergency Department Cases May Lead to Surprise Bills,” Health Affairs, January 2017, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.0970?

185  American College of Emergency Physicians: “EMTALA Fact Sheet,” American College of Emergency Physicians, https://www.acep.org/life-as-a-physician/ethics–legal/emtala/emtala-fact-sheet/.

186  are charged more: “Per Visit Emergency Department Expenditures By Insurance Type, 1996–2015,” Health Affairs, July 2018, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2018.0083.

186  2019 research: “The High Cost of Avoidable Hospital Emergency Department Visits,” UnitedHealth Group, July 22, 2019, https://www.unitedhealthgroup.com/newsroom/posts/2019-07-22-high-cost-emergency-department-visits.html.

187  ER Inspector: “Be Prepared: Find the ER You Want to Go to Before an Emergency Happens,” ProPublica, September 19, 2019, https://www.propublica.org/article/prepared-find-the-er-you-want-to-go-to-before-an-emergency-happens.

189  American Ambulance Association: https://ambulance.org/.

190  Urgent Care Association (UCA): https://www.ucaoa.org/.

191  A 2017 study: “Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers,” Annals of Emergency Medicine, February 15, 2017, https://www.annemergmed.com/article/S0196-0644(16)31522-0/abstract.

195  enhanced recovery after surgery: “Enhanced Recovery after Surgery,” American Association of Nurse Anesthetists, https://www.aana.com/practice/clinical-practice-resources/enhanced-recovery-after-surgery.

195  an online checklist: “Which Facility Is Best for My Outpatient Procedure?” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers/outpatient-facility-checklist.

196  Top 10 ASC Outpatient Procedures: “Top Outpatient Procedures at Hospitals vs Surgery Centers,” Definitive Healthcare, July 2019, https://blog.definitivehc.com/top-outpatient-procedures-at-hospitals-versus-ascs.

197  Healthcare Bluebook: https://www.healthcarebluebook.com/.

198  Patients Beyond Borders: https://www.patientsbeyondborders.com/.

198  Joint Commission: https://www.jointcommission.org/.

198  glossary: “Glossary of Terms,” Joint Commission, https://www.qualitycheck.org/glossary/.

198  QualityCheck.org: https://www.qualitycheck.org/.

198  WorldHospitalSearch.org: https://www.worldhospitalsearch.org/.

198  specific procedures: “Benefits of JCI Accreditation and Certification,” worldhospitalsearch.org, Joint Commission International, https://www.worldhospitalsearch.org/the-value-of-jci-accreditation/benefits-of-jci-accreditation-and-certification/.

199  price comparisons: “International Medical Treatment Prices,” Medical Tourism Association, https://www.medicaltourism.com/compare-prices.

200  Narayana Health: https://www.narayanahealth.org/.

200  The story: “The World’s Cheapest Hospital Has to Get Even Cheaper,” Bloomberg Businessweek, March 26, 2019, https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper.

200  coronary thromboendarterectomy: “Pulmonary Thromboendarterectomy,” Cleveland Clinic, https://my.clevelandclinic.org/health/treatments/21024-pulmonary-thromboendarterectomy-surgery.

200  MediBid.com: https://www.medibid.com/.

200  cost calculator: https://www.medibid.com/cost-calculator/.

Chapter 13: Shopping for Health Care

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207  controversial health insurance substitutes: “ ‘Sham’ Sharing Ministries Test Faith of Patients and Insurance Regulators,” Kaiser Health News, May 17, 2019, https://khn.org/news/sham-sharing-ministries-test-faith-of-patients-and-insurance-regulators/.

207  cost calculator: https://www.medibid.com/cost-calculator/.

208  Patient Rights Advocates: https://www.patientrightsadvocate.org/.

208  Cynthia Fisher: “A Powerful Lobbying Tool in the Trump Era: the President’s Ear,” Wall Street Journal, April 17, 2019, https://www.wsj.com/articles/a-powerful-lobbying-tool-in-the-trump-era-the-presidents-ear-11555493400.

208  New Choice Health: https://www.newchoicehealth.com/.

208  ClearHealthCosts: https://clearhealthcosts.com/.

208  Surgery Center of Oklahoma: https://surgerycenterok.com/.

208  KISx Card: https://getkisx.com/.

209  downloads of its chargemaster: “Hospital Standard Charges” (Excel spreadsheet), University of Utah Health, https://healthcare.utah.edu/bill/pdfs/standard-charges-to-publish.xlsx.

210  2,900-item chargemaster: “Intermountain Medical Center Chargemaster” (Excel spreadsheet), Intermountain Healthcare, https://intermountainhealthcare.org/-/media/files/chargemasters/2019-cm/intermountain-medical-center—chargemaster.xlsx?la=en.

211  report from Altarun: “Revealing the Truth about Healthcare Price Transparency,” Altarun, June 2018, https://www.healthcarevaluehub.org/advocate-resources/publications/revealing-truth-about-healthcare-price-transparency.

211  later study by Altarum: “Consumer-Centric Evaluation of Healthcare Price and Quality Transparency Tools,” Altarum, April 19, 2019, https://altarum.org/publications/consumer-centric-evaluation-healthcare-price-and-quality-transparency-tools.

213  popularized by Malcolm Gladwell: Malcolm Gladwell, “Complexity and the Ten-Thousand-Hour Rule,” New Yorker, August 21, 2013, https://www.newyorker.com/sports/sporting-scene/complexity-and-the-ten-thousand-hour-rule.

216  “Find a Fair Price”: “Find Your Fair Price,” Healthcare Bluebook, https://www.healthcarebluebook.com/ui/consumerfront.

217  Health Care Cost Institute: https://www.healthcostinstitute.org/.

217  Healthy Marketplace Index: https://www.healthcostinstitute.org/research/hmi.

218  Guroo.com: https://www.guroo.com/#!

219  FAIR Health: https://www.fairhealthconsumer.org/.

219  Healthcare Common Procedural Coding System: “HCPCS – General Information,” CMS.gov, U.S. Centers for Medicare & Medicaid Services, https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo/index.

219  Procedure Price Lookup Tool: https://www.medicare.gov/procedure-price-lookup/.

220  keeps track: “Interactive State Report Map,” All-Payer Claims Database (APCD) Council, https://www.apcdcouncil.org/state/map.

221  Maryland Health Care Commission: http://mhcc.maryland.gov/.

221  Center for Improving Value in Health Care: https://www.civhc.org/.

222  Illinois Hospital Report Card: http://www.healthcarereportcard.illinois.gov/.

222  Compare Maine: https://www.comparemaine.org/.

222  MNHealthScores: http://www.mnhealthscores.org/.

222  NH HealthCost: https://nhhealthcost.nh.gov/.

222  Oregon Hospital Guide: https://oregonhospitalguide.org/.

222  Hospital Report Cards: “Review and Compare Hospitals Using Hospital Report Cards (2020),” Vermont Department of Health, https://www.healthvermont.gov/health-statistics-vital-records/health-care-systems-reporting/hospital-report-cards.

222  Healthcare Pricing Transparency Report: “Healthcare Pricing Transparency,” Virginia Health Information, https://www.vhi.org/HealthcarePricing/default.asp.

222  Washington State MONAHRQ: http://www.wamonahrq.net/.

222  My Health Wisconsin: http://wisconsinhealthinfo.org/.

223  ViaCord: https://www.viacord.com/.

Chapter 1: Game On

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3  a story: “To Save Money, American Patients and Surgeons Meet in Cancun,” Kaiser Health News, August 12, 2019, https://khn.org/news/to-save-money-american-patients-and-surgeons-meet-in-cancun/.

3  Ashley Furniture Industries: https://www.ashleyfurnitureindustriesinc.com/.

5  A study: “Telehealth: A quarter-trillion-dollar post-COVID-19 reality?,” McKinsey & Company, https://www.mckinsey.com/~/media/McKinsey/Industries/Healthcare%20Systems%20and%20Services/Our%20Insights/Telehealth%20A%20quarter%20trillion%20dollar%20post%20COVID%2019%20reality/Telehealth-A-quarter-trilliondollar-post-COVID-19-reality.ashx.

6  Healthcare Bluebook: https://www.healthcarebluebook.com/.

8  Organisation for Economic Co-operation and Development: Organisation for Economic Co-operation and Development (OECD), Frequently Requested Health Data, November, 2019, http://www.oecd.org/health/OECD-Health-Statistics-2019-Frequently-Requested-Data.xls.

13  recent: Health, United States, 2018, National Center for Health Statistics, Hyattsville, Maryland, 2019, https://www.cdc.gov/nchs/data/hus/hus18.pdf.

Chapter 14: Getting and Paying for Drugs

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225  NeedyMeds: https://www.needymeds.org/.

226  insulin availability and pricing crisis: “The Blame Game: Everyone and No One Is Raising Insulin Prices,” Kaiser Health News, April 10, 2019, https://khn.org/news/the-blame-game-everyone-and-no-one-is-raising-insulin-prices/.

229  Ardon Health: http://ardonhealth.com/.

230  Stelara: https://www.stelarainfo.com/.

230  FundFinder: https://fundfinder.panfoundation.org/.

230  pharmaceutical assistance programs: “Find a Pharmaceutical Assistance Program for the drugs you take,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/pharmaceutical-assistance-program/.

230  RxAssist: https://www.rxassist.org/patients.

230  National Financial Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

231  Several federal prosecutions: “Fourth Foundation Resolves Allegations That It Conspired with Pharmaceutical Companies to Pay Kickbacks to Medicare Patients,” U.S. Attorney’s Office, District of Massachusetts, https://www.justice.gov/usao-ma/pr/fourth-foundation-resolves-allegations-it-conspired-pharmaceutical-companies-pay.

231  GoodRx: https://www.goodrx.com/.

233  Blink Health: https://www.blinkhealth.com/.

233  FamilyWize: https://familywize.org/.

233  WeRx: https://werx.org/.

233  HealthWarehouse: https://www.healthwarehouse.com/.

234  drug shopping test: “Shop Around for Lower Drug Prices,” Consumer Reports, April 5, 2018, https://www.consumerreports.org/drug-prices/shop-around-for-better-drug-prices/.

235  PharmacyChecker.com: https://www.pharmacychecker.com/.

235  in a story: “Shopping Abroad for Cheaper Medication? Here’s What You Need to Know,” Kaiser Health News, August 22, 2019, https://khn.org/news/shopping-abroad-for-cheaper-medication-heres-what-you-need-to-know/.

235  Valisure: https://www.valisure.com/.

235  cipa.com: http://www.cipa.com/.

Chapter 2: Health Insurance: Friend and Foe

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15  subject of a book I wrote: Philip Moeller, Get What’s Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (New York: Simon & Schuster, 2016), https://www.amazon.com/Get-Whats-Yours-Medicare-Maximize/dp/1501124005/.

15  primary reason for its invention: Peter L. Bernstein, Against the Gods: The Remarkable Story of Risk (New York: Wiley, 1998), https://www.amazon.com/Against-Gods-Remarkable-Story-Risk/dp/0471295639/.

17  Patient Protection and Affordable Care Act: Patient Protection and Affordable Care Act, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/where-can-i-read-the-affordable-care-act/.

20  employers need to follow: Federal rules on high-deductible health plans, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/glossary/high-deductible-health-plan/.

21  IRS Publication 969: “Health Savings Accounts and Other Tax-Favored Health Plans,” IRS Publication 969, https://www.irs.gov/pub/irs-pdf/p969.pdf.

22  23andme: https://www.23andme.com/.

22  IRS Publication 502: “Medical and Dental Expenses,” IRS Publication 502, https://www.irs.gov/pub/irs-pdf/p502.pdf.

24  More than one-third: “Health Care Administrative Costs in the United States and Canada, 2017,” Annals of Internal Medicine, January 21, 2020, https://annals.org/aim/article-abstract/2758511/health-care-administrative-costs-united-states-canada-2017.

24  Dignity Health: https://www.dignityhealth.org/.

25  posted a story: “How One Employer Stuck a New Mom with an $898,984 Bill for Her Premature Baby,” ProPublica, November 4, 2019, https://www.propublica.org/article/how-one-employer-stuck-a-new-mom-with-a-bill-for-her-premature-baby.

26  how Medicare covers something: “What Medicare Covers,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/what-medicare-covers.

Chapter 15: How to Fight Back

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243  2019 study: “Claims Denials and Appeals in ACA Marketplace Plans,” Kaiser Family Foundation, February 25, 2019, https://www.kff.org/report-section/claims-denials-and-appeals-in-aca-marketplace-plans-issue-brief/.

244  An American Sickness: Elisabeth Rosenthal, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (New York: Penguin Books, 2017), https://www.amazon.com/dp/B01IOHQ9LO/.

244  Paying Till It Hurts: “Paying Till It Hurts,” New York Times, https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html.

244  a 2017 piece: “Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much,” New York Times Magazine, March 29, 2017, https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html.

245  Alliance of Claims Assistance Professionals: https://www.claims.org/.

247  Medicare’s prices for outpatient surgeries: “Procedure Price Lookup,” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.medicare.gov/procedure-price-lookup/.

249  ClinicalTrials.gov: ClinicalTrials.gov, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services, https://clinicaltrials.gov/ct2/home.

250  related educational materials: “Learn About Clinical Studies,” Clinical Trials.gov, U.S. National Library of Medicine, U.S. National Institutes of Health, U.S. Department of Health and Human Services, https://clinicaltrials.gov/ct2/about-studies/learn.

250  Project Patient Voice: U.S. Food and Drug Administration, https://www.fda.gov/about-fda/oncology-center-excellence/project-patient-voice.

250  reported: “FDA and NIH let clinical trial sponsors keep results secret and break the law,” Science, January 13, 2020, https://www.sciencemag.org/news/2020/01/fda-and-nih-let-clinical-trial-sponsors-keep-results-secret-and-break-law.

250  National Financial Resource Directory: https://www.patientadvocate.org/explore-our-resources/national-financial-resource-directory/.

250  AllTrials.net: https://www.alltrials.net/.

250  a website: “Who’s sharing their clinical trial results?,” FDAAA Trials Tracker, https://fdaaa.trialstracker.net/.

251  cancer patients who filed for bankruptcy: “Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer,” Journal of Clinial Oncology, 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933128/.

251  sweeping study: “Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer,” American Journal of Medicine, June 12, 2018, https://www.amjmed.com/article/S0002-9343(18)30509-6/pdf.

252  National Foundation for Credit Counseling: https://www.nfcc.org/.

252  RIP Medical Debt: https://ripmedicaldebt.org/.

252  a list: “Debt Resources,” RIP Medical Debt, https://ripmedicaldebt.org/debt-resources/.

253  GoFundMe: https://www.gofundme.com/.

253  New Yorker article: “The Hidden Cost of GoFundMe Health Care,” New Yorker, July 1, 2019, https://www.newyorker.com/magazine/2019/07/01/the-perverse-logic-of-gofundme-health-care.

254  ProPublica: “Health Care,” ProPublica, https://www.propublica.org/topics/healthcare.

254  by Vox: “Hospitals Kept ER Fees Secret. We Uncovered Them,” Vox, https://www.vox.com/2018/2/27/16936638/er-bills-emergency-room-hospital-fees-health-care-costs.

254  “Bill of the Month”: “Bill of The Month,” Kaiser Health News, https://khn.org/news/tag/bill-of-the-month/.

254  “Investigations”: “Investigations,” Kaiser Health News, https://khn.org/news/tag/investigation/.

255  that article: “Column: A 20-year-old fights back against her health insurer,” PBS NewsHour, https://www.pbs.org/newshour/health/column-a-20-year-old-fights-back-against-her-health-insurer.

Chapter 4: The Affordable Care Act and Other Health Plans

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51  Kaiser Family Foundation’s: “Featured Affordable Care Act Resources,” Kaiser Family Foundation, https://www.kff.org/tag/affordable-care-act/.

51  2020 ACA primer: “Explaining Health Care Reform: Questions About Health Insurance Subsidies,” Kaiser Family Foundation, January 16, 2020 https://www.kff.org/health-reform/issue-brief/explaining-health-care-reform-questions-about-health/.

51  certain circumstances: “Dates and deadlines for 2020 health insurance,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/quick-guide/dates-and-deadlines/.

51  Preventive health services: “Preventive health services,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/preventive-care-benefits/.

51  Coverage for pre-existing conditions: “Coverage for pre-existing conditions,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/pre-existing-conditions/.

52  Dental coverage in the marketplace: “Dental Coverage in the Marketplace,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/dental-coverage/.

52  Birth control benefits: “Birth Control Benefits,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/birth-control-benefits/.

52  Breastfeeding benefits: “Breastfeeding Benefits,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/breast-feeding-benefits/.

52  Mental health and substance abuse coverage: “Mental Health & Substance Abuse Coverage,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.

52  Emergency services: “Emergency Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/using-marketplace-coverage/getting-emergency-care/.

52  Pregnancy, maternity, and newborn care: “Pregnancy, Maternity, and Newborn Care,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-get-pregnant/.

52  Mental health and substance use disorder services: “Mental Health and Substance Use Disorder Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/.

52  Preventive and wellness services: “Preventive and Wellness Services,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/coverage/preventive-care-benefits/.

53  Federal Poverty Level guidelines: “HHS Poverty Guidelines for 2020,” U.S. Department of Health and Human Services, https://aspe.hhs.gov/poverty-guidelines.

53  a flowchart: “Premium Tax Credit Flow Chart: Are You Eligible?” IRS, https://www.irs.gov/affordable-care-act/individuals-and-families/premium-tax-credit-flowchart-are-you-eligible.

53  Publication 5187: “Affordable Care Act: What You and Your Family Need to Know,” Publication 5187, IRS, https://www.irs.gov/pub/irs-pdf/p5187.pdf.

53  Instructions for Form 8962: “Instructions for Form 8962,” IRS, https://www.irs.gov/pub/irs-pdf/i8962.pdf.

53  Form 8962: “Premium Tax Credit (PTC),” Form 8962, IRS, https://www.irs.gov/pub/irs-pdf/f8962.pdf.

53  summary page: “About Form 8962, Premium Tax Credit,” IRS, https://www.irs.gov/forms-pubs/about-form-8962.

54  ACA navigator: Find Local Help,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://localhelp.healthcare.gov/#/.

54  ACA calculator: Health Insurance Marketplace Calculator, Kaiser Family Foundation, https://www.kff.org/interactive/subsidy-calculator/.

54  an online tool: Income levels and ACA savings, HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/lower-costs/.

54  an online map: “Insurer Participation on ACA Marketplaces, 2014–2020,” Kaiser Family Foundation, https://www.kff.org/private-insurance/issue-brief/insurer-participation-on-aca-marketplaces-2014-2020/.

55  homeless: “How to Claim an Exemption if You Were Homeless,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/homeless.

55  eviction or foreclosure: “How to Claim an Exemption Because You Experienced Eviction or Foreclosure,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/eviction.

55  utility shut-off notice: “How to Claim an Exemption Due to a Utility Shut-off,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/utilities-shut-off.

55  domestic violence: “How to Claim an Exemption if You Experienced Domestic Violence,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/domestic-violence.

55  a death in the family: “How to Claim an Exemption Due to the Death of a Close Family Member,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/death-in-family.

55  a natural disaster: “How to Claim an Exemption Due to Fire, Flood, or Other Disaster,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/disaster.

55  bankruptcy: “How to Claim an Exemption if You Filed for Bankruptcy,” HealthCare.gov, U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/bankruptcy.

55  medical expenses: “How to claim an exemption for unpaid medical expenses,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/owe-medical-expenses.

55  caregiver expenses: “How to claim an exemption due to increased expenses caring for a family member,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/care-for-family.

55  child medical support: “How to claim an exemption for a child who’s medically supported by another party and not eligible for Medicaid or CHIP,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/medicaid-chip-denied.

55  eligibility appeals: “How to claim an exemption if you were uncovered while waiting for a successful appeal.” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/eligible-based-on-appeal.

55  ineligible for Medicaid: “How to claim an exemption if you would have qualified for Medicaid if your state had expanded coverage,” HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/exemptions-tool/#/results/2018/details/secretary-hardship.

56  Healthcare,gov: “Out-of-pocket maximum/limit,” on ACA-covered health expenses,  HealthCare.gov., U.S. Centers for Medicare & Medicaid Services, https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/.

56  struck down: “Obamacare Insurance Mandate Is Struck Down by Federal Appeals Court.” New York Times, December 18, 2019, https://www.nytimes.com/2019/12/18/health/obamacare-mandate.html.

56  3 million people: “Short-term Plans Enrolled 3 Million People, House Committee Finds,” Modern Healthcare, June 26, 2020, https://www.modernhealthcare.com/insurance/short-term-plans-enrolled-3-million-people-house-committee-finds.

57  a guide: “The expansion of short-term limited-duration policies and implications for patients,” Milliman, https://milliman-cdn.azureedge.net/-/media/milliman/pdfs/articles/patient-implications-brief-20200224.ashx?

58  a million people: “New York State Investigates Christian Health Cost-Sharing Affiliate,” New York Times, January 8, 2020, https://www.nytimes.com/2020/01/08/health/christian-health-insurance-subpoena.html.

59  studies regularly find: “VA Health System Generally Delivers Higher-Quality Care Than Other Health Providers,” RAND Corporation, April 26, 2018, https://www.rand.org/news/press/2018/04/26.html.

59  Wounds of War: Suzanne Gordon, Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation’s Veterans (Ithaca, NY: Cornell University Press, 2018), https://www.amazon.com/Wounds-War-Delivers-Veterans-Politics-ebook/dp/B07BTCBP64/ref.

60  extensive survey: “2018 Survey of Veteran Enrollees’ Health and Use of Health Care,” Advanced Survey Design, January 9, 2019, https://www.va.gov/HEALTHPOLICYPLANNING/SOE2018/2018EnrolleeDataFindingsReport_9January2019Final508Compliant.pdf.

61  preferred generic drugs: “2020 Tier 1 Copay Medication List,” Veterans Health Administration, https://www.pbm.va.gov/PBM/Tiered_Copay/Tier_1_CO-PAY_MEDICATION_LIST.pdf.