Health Plan Weekly

The Purchaser Business Group on Health (PBGH) has launched a value-based care initiative, starting in the Puget Sound region of Washington state, in which employer-sponsored plans directly contract with primary care provider groups. Elizabeth Mitchell, PBGH’s president and CEO, says the organization plans to roll out the advanced primary care-driven network model in other markets next year and beyond.  

The Boeing Co., eBay Inc. and other PBGH members in the Puget Sound region are participating in the program. Those companies all have self-insured plans and have removed all cost-sharing for their members who visit three primary care provider groups in the area. The companies chose those practices based on meeting certain quality and patient care standards, according to Mitchell, who adds that more providers could join in the future. 

In 2023, U.S. health care spending increased 7.5% to $4.9 trillion, up from 4.6% growth in 2022, according to new research from CMS published on Dec. 18 in Health Affairs. This translates to $14,570 per person and a 17.6% share of the gross domestic product (GDP), the researchers said. Several factors contributed to this growth, including the use of higher intensity services and increased Affordable Care Act marketplace and Medicaid enrollment. 

Perhaps the biggest increase in spending came from hospital services, which grew a whopping 10.4% in 2023 vs. 3.2% in 2022. This explosion of growth came not from inflation and higher health care prices, but greater demand for higher-intensity services, an increase in outpatient Medicare services, and post-pandemic rebounds after utilization dipped in 2020. In fact, price growth was stable from 2022 to 2023 at 2.8% and 2.7%, respectively. While inflation does influence prices — which increased 2.6% from 2020 to 2023 vs. 1.4% from 2016 to 2019 — price growth in the medical sector lags the general economy, said Anne Martin, lead study author from the CMS Office of the Actuary. 

With a suspect now charged in the killing of UnitedHealthcare CEO Brian Thompson, the fierce debate continues over what the crime has revealed about simmering dissatisfaction with the U.S. health insurance system. 

Luigi Mangione, a 26-year-old Ivy League graduate from a prominent Maryland family, was captured on Dec. 9 in Altoona, Pennsylvania, after being recognized in a McDonald’s restaurant. Mangione is facing a murder charge related to Thompson’s Dec. 4 death. Police said the 50-year-old executive was gunned down by a shooter who was “lying in wait” outside the Midtown Manhattan hotel where UnitedHealth Group, the parent company of UnitedHealthcare, was set to hold its annual Investor Day conference.