Commercial insurance prices were 78% higher in hospital outpatient settings compared with ambulatory surgical centers in 2024, according to a Health Affairs study published in October.
The analysis, led by researchers at Brown University, examined 2024 pricing data for UnitedHealthcare, Cigna, and Blue Cross Blue Shield plans.
Five things to know:
1. The study found commercial prices for 13 common outpatient procedures averaged $1,489 (78%) higher in HOPDs than ASCs. For comparison, Medicare rates were 97% higher in HOPDs for the same procedures.
2. The analysis included 31,239 unique payer-provider contracts (18,160 for HOPDs and 13,079 for ASCs) across 3,644 facilities (1,939 HOPDs and 1,705 ASCs). Procedures analyzed represented about two-thirds of all outpatient procedures nationally.
3. Cigna had the lowest price differentials among the three payers, paying an average of $2,338 per procedure at HOPDs compared to $3,572 for UnitedHealthcare and $3,060 for BCBS. If UnitedHealthcare and BCBS paid Cigna’s average HOPD rates, researchers estimated they would save about $1.4 billion annually.
4. Cigna achieved lower rates primarily through selective contracting, including only 14% of HOPDs in applicable markets versus 72% for BCBS and 80% for UnitedHealthcare. For ASCs, Cigna’s network breadth (70%) was comparable to its competitors. After adjusting for provider fixed effects, Cigna’s lower prices were explained mostly by network design, not greater negotiating leverage.
5. The study concluded that site-of-care payment gaps are substantial in commercial insurance, mirroring Medicare’s reimbursement structure but at a higher dollar scale. The researchers said payers could meaningfully reduce costs by narrowing HOPD networks or pursuing site-neutral strategies, though employer demand for broad networks may limit such efforts.
