HCFO Year in Review

Publication Date:

January 17, 2013

In 2012, the Robert Wood Johnson Foundation (RWJF) celebrated 40 years of improving health and health care. At its 40th Anniversary Connections Conference, Foundation leadership underscored the many reasons for RWJF’s success. Among these is that the Foundation is an evidence-based organization. As RWJF Vice President David Colby noted, “it is our grounding.” President & CEO Risa Lavizzo-Mourey looked forward to the next 40 years, identifying opportunities for future investment. These included addressing the challenges of health care spending and delivery system innovation. She also noted the great potential of the power of data and the growing number of tools designed to monitor, track and disseminate health information.

HCFO has proudly contributed to the Foundation’s distinguished history. The work we accomplished in 2012 affirms RWJF’s reputation as an evidence-based organization and positions the program well to respond to the Foundation’s future goals.

Supporting Researchers

Grantmaking

The work starts here with those who produce timely, policy-relevant research. The seven grants funded in 2012 address important issues stemming from the implementation and roll-out of health reform.

Examining Employers’ Use of Massachusetts’ Health Insurance Exchange to Inform Best Strategies Nationally Under the Affordable Care Act, Mark A. Hall, J.D., Wake Forest University Health Sciences
Assessing the Impact of States’ Authority to Review Health Insurance Rates on the Cost of Premiums, Richard M. Scheffler, Ph.D., Regents of the University of California at Berkeley
How Do Changes in Medicare’s Hospital Payment Rates Affect the Volume of Admissions?, Tracy Yee, Ph.D., Center for Studying Health System Change
Towards Episode-Based Payment in Ambulatory Care, Harold Luft, Ph.D., Palo Alto Medical Foundation for Health Care, Research and Education
Informing Policymakers on the Impact on Emergency Care of California’s Ban on Balance Billing, Yaa Akosa Antwi, Indiana University
Using Prostate Cancer to Study Whether Payment Rates and Market Structure Influence Treatment Choice for Medicare Beneficiaries, Jack Hadley, Ph.D., The Rector and Visitors of George Mason University
Exploring Hospital Pricing Under Medicare Advantage and Traditional Medicare to Generate Lessons for Medicare Costs and Policy Options, Robert Berenson, M.D., and Jonathan Sunshine, Ph.D., Urban Institute

Webinars

We believe strongly in our commitment to supporting the field, including the development of new and diverse researchers. In that vein, HCFO conducted webinars in 2012 focused on the use of traditional and new data sources and tools important to research on health care financing and organization topics.

“The Health and Retirement Study: The Best Data Source You’re Not Using”

The Health and Retirement Study (HRS) is a major panel providing data for researchers seeking to explore issues related to the health, decisions, choices and behaviors of individuals as they age. HCFO hosted a webinar on best practices for obtaining and using HRS data. The event featured HCFO researchers Andrew Sfekas and Helen Levy. The webinar recording and materials can be accessed online.

“Leveraging Mobile Health (mHealth) Solutions for Health Services Research (HSR) – 4 Part Series”

This webinar series was on opportunities to leverage mHealth tools to meet the practical needs of health services researchers. The four webinars were designed to provide useful insights into the array of available tools, the process of adoption, and the ultimate analysis and application of data generated using these tools. An archive of this series is available online.

Informing Policymakers

The Affordable Care Act requires that Medicare implement a value based payment modifier program, which is based on physician performance and designed to improve quality and efficiency. In 2012, HCFO sponsored a meeting of experts, whose input was designed to assist policymakers in grounding the development and implementation of the program in a strong evidence base. The meeting discussion was captured in a report published by HCFO.

Linking Researchers and Policymakers

Seeking Policymaker Input on Grants

A hallmark of HCFO is its investment in policy-relevant research. In reviewing proposals, a primary consideration for funding is whether the study is timely and likely to inform actionable policy. While we have a good understanding of issues likely to be of interest to policymakers in the near term, it occurred to us that soliciting input from decisionmakers at the start of a grant would only make the study more useful upon completion.

We tested this theory in 2012 when we connected grantee Mark Hall, J.D., Wake Forest University, with state decision makers. As part of his grant, Hall planned to interview individuals in Massachusetts knowledgable about small business participation in the Massachusetts Connector. HCFO staff invited state decision makers, working with the RWJF State Network program, to provide input to Hall on the questions they would most like to have answered. A second discussion was held at the mid-point of the grant. This was a unique opportunity for states to inform a research project and for the grantee to conduct a study that would be most useful to the end users of the findings. HCFO will continue to look for ways to make those early connections at the start of a grant.

Grantee Briefings

A HCFO activity lauded by both researchers and policymakers is the grantee briefing. The briefings are designed to ensure that policymakers are aware of important research, even before those studies are published. Policymakers are invited to an “early look” at evidence that can help inform their decision-making. The grantees receive feedback from attendees on future analyses and ways to strengthen manuscripts. The briefings also serve as a connection point, identifying the “go-to” experts for policymakers on various topics.

In 2012, two HCFO grantees participated in briefings:

Niteesh K. Choudhry, M.D., Ph.D., Factors Influencing the Success of Value-Based Insurance Design Programs, November 16, 2012
Bradley Herring, Ph.D., Exploring the Impacts of Hospital-Market Concentration on Price Competition in Insurance Markets, November 28, 2012

In-person Meetings with Policymakers

In addition to grantee briefings convened at AcademyHealth, HCFO staff is working to connect grantees more directly with policymakers. This year, Bradley Herring, Ph.D., met with Congressional Budget Office staff at their offices and presented findings from his study examining the effects hospital concentration on insurance market prices. The setting facilitated candid, in-depth discussion about Herring’s methodology and preliminary findings. Herring received positive feedback on the value of the study to inform decision-making, along with suggestions on additional analyses to consider.

Study Snapshots

In an effort to make findings from HCFO-funded projects more accessible to our policy audience, we launched the “Study Snapshot” publication series. These one-page documents capture the key findings from a study and describe the complexities of the research. We released two Snapshots in 2012:

HCFO Findings Briefs

In addition to the Snapshots, HCFO staff publishes Findings Briefs, which are designed to reach a broad range of audiences. In this publication, staff summarizes the work of a grantee and discusses important policy implications of the study findings. In 2012, we produced the following briefs:

Trends in Retail Clinic Use Among the Commercially Insured, February 2012
Time is Money: Outpatient Waiting Times and Health Insurance Choices of Elderly Veterans in the United States, March 2012
The Effect of Health Information Technology on Quality in U.S. Hospitals, April 2012
Pay-for-Performance Programs to Reduce Racial/Ethnic Disparities: Limitations of a One-Size Fits All Approach, May 2012
Reducing Prenatal Smoking: The Role of State Policies, July 2012
Impact of Prior Authorization on Medication Adherence and Health Service Use by Patients with Bipolar Illness in Medicaid, September 2012
In Health Care Spending, Americans Who Make the Least Contribute the Greatest Share of Income, October 2012
Encouraging Generic Use Can Yield Significant Savings, November 2012
Program Features and Targeting Are the Keys to Successful Medicare Care Coordination Interventions, December 2012

Grantee Publications

The high quality of HCFO grantees’ work is most clearly demonstrated in their peer-reviewed publications. In 2012, grantees published 14 articles in a variety of journals.

Reid RO, Ashwood JS, Friedberg MW, Weber ES, Setodji CM, Mehrotra A. Retail Clinic Visits and Receipt of Primary Care. J Gen Intern Med. 2012.
Hall, M. Employers’ Use of Health Insurance Exchanges: Lessons from Massachusetts. 2012.
Hoadley JF, Merrell K, Hargrave E, Summer L. In Medicare Part D plans, low or zero copays and other features to encourage the use of generic statins work, could save billions. Health Aff. 2012;31(10):2266-75.
Taylor DH. Medicare as Insurance Innovator: The Case of Hospice. Am J Hosp Palliat Care. 2012.
He D, Mellor JM. Hospital volume responses to Medicare's Outpatient Prospective Payment System: evidence from Florida. J Health Econ. 2012;31(5):730-43.
Kralewski JE, Dowd BE, Xu YW. Medical groups can reduce costs by investing in improved quality of care for patients with diabetes. Health Aff. 2012;31(8):1830-5.
Brown RS, Peikes D, Peterson G, Schore J, Razafindrakoto CM. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients. Health Aff. 2012;31(6):1156-66.
Peikes D, Peterson G, Brown RS, Graff S, Lynch JP. How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings. Health Aff. 2012;31(6):1216-26.
Adams EK, Markowitz S, Kannan V, Dietz PM, Tong VT, Malarcher AM. Reducing prenatal smoking: the role of state policies. Am J Prev Med. 2012;43(1):34-40.
Farley JF, Wansink D, Lindquist JH, Parker JC, Maciejewski ML. Medication adherence changes following value-based insurance design. Am J Manag Care. 2012;18(5):265-74.
Kronick R, Gilmer TP. Medicare and Medicaid spending variations are strongly linked within hospital regions but not at overall state level. Health Aff. 2012;31(5):948-55.
Hadley J, Reschovsky JD. Medicare spending, mortality rates, and quality of care. Int J Health Care Finance Econ. 2012;12(1):87-105.
Weissman JS, Hasnain-Wynia R, Weinick RM, et al. Pay-for-performance programs to reduce racial/ethnic disparities: what might different designs achieve?. J Health Care Poor Underserved. 2012;23(1):144-60.
Galbraith AA, Soumerai SB, Ross-Degnan D, Rosenthal MB, Gay C, Lieu TA. Delayed and forgone care for families with chronic conditions in high-deductible health plans. J Gen Intern Med. 2012;27(9):1105-11.

Conclusion

The 2012 lesson for HCFO is that the many facets of the program combine to ensure that strong evidence is available to inform policies to improve health and health care. Going forward, we will build on the program’s 20+ year history, enhancing those products and services that are most effective and creating new and innovative ways to support the producers and users of health services research.