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Research Headlines

Care Coordination in Medicare: What Works and for Whom? [1]

Americans today are living longer than at any point in the nation’s history.  In a recent article in The Washington Post, Ezra Klein notes how this phenomenon and the prevalence of chronic illnesses is both challenging the U.S. health care system.

May 2013
HCFO

Americans today are living longer than at any point in the nation’s history.  Discoveries in the twentieth century largely eliminated infectious diseases as a significant contributor to American death rates, and more recent advances are helping people live with conditions that were once certainly fatal.  In a recent article [2] in The Washington Post, Ezra Klein notes how this phenomenon and the prevalence of chronic illnesses is both c

Grants: 
Can Disease Management Control Costs? [3]
Topic: 
Coordination of Care [4]

Caring for Patients with Wise Resource Choices [5]

Reducing health care costs dominates current health policy discussions, raising important questions about who is responsible for bending the cost curve. A recent article in The Boston Globe explores the challenges providers face in becoming better stewards of health care resources.

April 2013
HCFO

Reducing health care costs dominates current health policy discussions. A key question in these discussions is who is responsible for bending the cost curve? Steven Brill’s article [6] in Time magazine examined the roles of manufacturers, hospital administrators, and health care providers.

Grants: 
Examining the Choosing Wisely List of Tests and Treatments with Uncertain or Low Value as a Way to Reduce Waste in the U.S. Health Care System [7]
Topic: 
Costs and Cost Containment [8]
Topic: 
Medicare [9]
Topic: 
Organization and Supply of Care [10]
Topic: 
Provider Payment and Behavior [11]
Topic: 
Quality of Care [12]

Understanding the Effects of Balance Billing on Quality of Care [13]

The cost of providing employer-sponsored insurance coverage continues to rise, and new legislation requires employers with at least 50 employees to offer affordable coverage or face a financial penalty. Employers are responding in a variety of ways to rein in their health expenditures while complying with these new regulations.

March 2013
HCFO

The cost of providing employer-sponsored insurance coverage continues to rise, and new legislation requires employers with at least 50 employees to offer affordable coverage or face a financial penalty. Employers are responding in a variety of ways to rein in their health expenditures while complying with these new regulations. One such option is to contract with payers who offer more fixed reimbursement rates.

Grants: 
Informing Policymakers On the Impact on Emergency Care of California's Ban on Balance Billing [14]
Topic: 
Access [15]
Topic: 
Insurance Coverage [16]
Topic: 
Legal and Regulatory Environment [17]
Topic: 
Quality of Care [12]

Retail Health Clinics Continue to Grow in Popularity [18]

Reducing health care costs and addressing the issue of primary care physician shortage are two issues at the forefront of the health policy discussion. Some have suggested that retail health clinics, or walk-in medical clinics located in pharmacies, superstores, and workplaces, could potentially address both of these issues.

February 2013
HCFO

Reducing health care costs and addressing the issue of primary care physician shortage are two issues at the forefront of the health policy discussion. Some have suggested that retail health clinics, or walk-in medical clinics located in pharmacies, superstores, and workplaces, could potentially address both of these issues. These clinics, a type of “disruptive innovation” in care delivery, are quickly gaining popularity.

Grants: 
The Impact of Retail Clinics on Overall Utilization of Care [19]
Topic: 
Access [15]
Topic: 
Acute Care [20]
Topic: 
Costs and Cost Containment [8]
Topic: 
Organization and Supply of Care [10]

Small-Employer Responses to ACA Provisions Extending Employee Insurance Coverage [21]

One of the principal aims of the Affordable Care Act (ACA) is to expand access to affordable insurance coverage. Currently, individuals who receive employer-sponsored health insurance predominantly work for large employers. As such, small employers are a specific target in the ACA to expand access to coverage for their employees.

January 2013
HCFO

One of the principal aims of the Affordable Care Act (ACA) is to expand access to affordable insurance coverage. Currently, individuals who receive employer-sponsored health insurance predominantly work for large employers. As such, small employers are a specific target in the ACA to expand access to coverage for their employees.

Grants: 
Examining Employers' Use of Massachusetts' Health Insurance Exchange to Inform Best Strategies Nationally Under the Affordable Care Act [22]
Topic: 
Insurance Coverage [16]
Topic: 
Legal and Regulatory Environment [17]

Increasing Smoking Bans Improves Health [23]

Smoking bans have become increasingly prevalent in public spaces including workplaces, bars, and restaurants. In a recent article in USA Today, Liz Szabo highlighted findings from several studies that describe the contribution of these policies toward significant health improvements.

December 2012
HCFO

Smoking bans have become increasingly prevalent in public spaces including workplaces, bars, and restaurants. In a recent article in USA Today [24], Liz Szabo highlighted findings from several studies that describe the contribution of these policies toward significant health improvements.

Topic: 
Consumer Behavior [25]
Topic: 
Legal and Regulatory Environment [17]

Medicare Penalty for Excess Hospital Readmissions [26]

A recent article in The Denver Post discusses the CMS Hospital Readmissions Reduction Program, which penalizes hospitals with excess readmissions by withholding up to one percent of Medicare payments in the first year.

November 2012
HCFO

In an effort to reduce preventable and costly hospital readmissions, the Affordable Care Act (ACA) created the CMS Hospital Readmissions Reduction Program [27].  Starting October 1, 2012, Medicare will penalize hospitals with excess readmissions for heart attacks, heart failure and pneumonia within 30 days of discharge, withholding up to 1 percent of Medicare payments to hospitals for such readmissions.

Grants: 
How Do Changes in Medicare's Hospital Payment Rates Affect the Volume of Admissions? [28]
Grants: 
Impact of State Medicaid Policy Changes on Nursing Home Hospitalization [29]
Topic: 
Benefit Design [30]
Topic: 
Costs and Cost Containment [8]
Topic: 
Insurance Coverage [16]
Topic: 
Legal and Regulatory Environment [17]
Topic: 
Medicare [9]

Undocumented Immigrants Under Health Care Reform: A Growing Share of the Uninsured [31]

As policymakers plan for major coverage gains under the Patient Protection and Affordable Care Act, there is increasing awareness of the groups that will be left out of health care reform.  Among these groups are undocumented immigrants, who are excluded from participation in exchanges, enrollment in the expanded Medicaid program, and other initiatives aimed at helping the uninsured gain coverage.

October 2012
HCFO

As policymakers plan for major coverage gains under the Patient Protection and Affordable Care Act (ACA), there is increasing awareness of the groups that will be left out of health care reform.  Among these groups are undocumented immigrants, who are excluded from participation in exchanges, enrollment in the expanded Medicaid program, and other initiatives aimed at helping the uninsured gain coverage.  As Nina Bernstein reports in

Topic: 
Vulnerable Populations [32]

Assessing the Implications of the Medical Loss Ratio (MLR) Requirement [33]

Individuals and businesses across the country received checks from their health insurance companies this summer under a provision in the Patient Protection and Affordable Care Act that targets insurers’ use of premium dollars.  Minimum medical loss ratios (MLRs) require insurers to spend a certain percentage of premium revenue on health care claims and quality improvement activities. 

September 2012
HCFO

Individuals and businesses across the country received checks from their health insurance companies this summer under a provision in the Patient Protection and Affordable Care Act (ACA) that targets insurers’ use of premium dollars.  Minimum medical loss ratios (MLRs) require insurers to spend a certain percentage of premium revenue on health care claims and quality improvement activities.  Under the ACA, insurers that do not meet new MLR standards must rebate the portion of premium dollars that exceeds the target.  An article by Ken Alltucker in

Topic: 
Insurance Coverage [34]

Medicare Observation Stays: When is a Hospitalization Not a Hospitalization? [35]

A recent USA Today article by Susan Jaffe examines hospitals’ growing use of observation stays in lieu of fully admitting Medicare patients. This phenomenon has drawn the attention of journalists and consumer advocates because of the significant consequences of observation stays for beneficiaries’ out-of-pocket costs.

July 2012
HCFO

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Links:
[1] http://www.hcfo.org/publications/care-coordination-medicare-what-works-and-whom
[2] http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/28/if-this-was-a-pill-youd-do-anything-to-get-it/
[3] http://www.hcfo.org/grants/can-disease-management-control-costs
[4] http://www.hcfo.org/topics/coordination-care
[5] http://www.hcfo.org/publications/caring-patients-wise-resource-choices
[6] http://www.time.com/time/magazine/article/0,9171,2136864,00.html
[7] http://www.hcfo.org/grants/examining-choosing-wisely-list-tests-and-treatments-uncertain-or-low-value-way-reduce-waste-u
[8] http://www.hcfo.org/topics/costs-and-cost-containment
[9] http://www.hcfo.org/topics/medicare
[10] http://www.hcfo.org/topics/organization-and-supply-care
[11] http://www.hcfo.org/topics/provider-payment-and-behavior
[12] http://www.hcfo.org/topics/quality-care
[13] http://www.hcfo.org/publications/balance-billing-providers-respond-lower-reimbursement-new-insurance-plan
[14] http://www.hcfo.org/grants/informing-policymakers-impact-emergency-care-californias-ban-balance-billing
[15] http://www.hcfo.org/topics/access
[16] http://www.hcfo.org/topics/insurance-coverage
[17] http://www.hcfo.org/topics/legal-and-regulatory-environment
[18] http://www.hcfo.org/publications/retail-health-clinics-continue-grow-popularity
[19] http://www.hcfo.org/grants/impact-retail-clinics-overall-utilization-care
[20] http://www.hcfo.org/topics/acute-care
[21] http://www.hcfo.org/publications/small-employer-responses-aca-provisions-extending-employee-insurance-coverage
[22] http://www.hcfo.org/grants/examining-employers-use-massachusetts-health-insurance-exchange-inform-best-strategies-nation
[23] http://www.hcfo.org/publications/increasing-smoking-bans-improves-health
[24] http://www.usatoday.com/story/news/nation/2012/10/29/smoking-bans-heart-attacks-strokes/1664193/
[25] http://www.hcfo.org/topics/consumer-behavior
[26] http://www.hcfo.org/publications/medicare-penalty-excess-hospital-readmissions-0
[27] http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html/
[28] http://www.hcfo.org/grants/how-do-changes-medicares-hospital-payment-rates-affect-volume-admissions
[29] http://www.hcfo.org/grants/impact-state-medicaid-policy-changes-nursing-home-hospitalization
[30] http://www.hcfo.org/topics/benefit-design
[31] http://www.hcfo.org/publications/undocumented-immigrants-and-health-care-reform-implications-coverage
[32] http://www.nytimes.com/2012/07/27/nyregion/affordable-care-act-reduces-a-fund-for-the-uninsured.html?_r=3&emc=tnt&tntemail0=y&
[33] http://www.hcfo.org/publications/assessing-implications-medical-loss-ratio-mlr
[34] http://www.azc<div class=
[35] http://www.hcfo.org/publications/medicare-observation-stays-when-hospitalization-not-hospitalization
[36] http://www.hcfo.org/taxonomy/term/13/all
[37] http://www.hcfo.org/taxonomy/term/13/all?page=1
[38] http://www.hcfo.org/taxonomy/term/13/all?page=3