• Sat. Mar 2nd, 2024

Unpacking the 80th Percentile Rule in Alaska: Can Premera’s Networking Model Lower Health Care Costs?


Feb 13, 2024
The Complicated World of Health Care: A Letter to the Editor – Anchorage Daily News

Jim Grazko’s commentary, “Repealing 80th percentile rule is vital to Alaska,” argues that the only way to reduce health care costs in the state is for insurers like Premera to bring them into the network and control how much they will pay. He emphasizes the difference between price and cost, with insurers focusing on the price they pay and health care providers concerned with the cost of providing care.

Grazko compares Premera Alaska’s health care costs to those in Washington but fails to provide information on what other commercial insurers are currently paying. He also mentions Medicaid and Medicare, but does not offer specific comparisons to commercial insurance products.

Sandra Heffern argues that repealing the 80th percentile will not be an easy solution to reducing Alaska’s high health care costs. She points out that health care pricing and costs are complicated, and providers strive to provide high-quality care for Alaska patients.

Heffern suggests that an all-payer claims database would help better understand who is paying for what. However, she acknowledges that this may not be an easy solution as Alaska lacks the infrastructure to collect or analyze this data.

Grazko’s point is that it would be difficult for Premera to compare amounts paid for health care across multiple payers in Alaska due to its lack of structure. He invites others to share their thoughts by submitting letters@adn.com or via web browser, asking writers to disclose any personal or professional connections with the subjects of their letters, and letters being edited for accuracy, clarity, and length.

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