Findings Brief

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HCFOBriefOct2013Final.pdf [2]

Large geographic variations in Medicare costs have long been documented; however, the size and source of this variation has been the subject of dispute.  There are many factors that influence spending per Medicare beneficiary, including, perhaps most importantly, a patient’s health status. Consequently, casemix adjustment, or controlling for area population health, is critical to developing Medicare geographic cost variation estimates.

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HCFOFindingsBriefSept2013FINAL.pdf [9]

For millions of uninsured Americans, hospital emergency departments (EDs) are one of the few options for medical care, both urgent and non-urgent.  Yet this care may come at a significant price.  Unlike their insured counterparts, uninsured and other “self-pay” patients receive hospital bills based on “billed charges.”  These charges have risen rapidly over time and now bear little relationship to the actual market prices paid by insured patients.  For the uninsured, high billed charges may translate into a potentially overwhelming financial burde

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HCFOBriefMay2013FINAL.pdf [12]

The Medicare Outpatient Prospective Payment System (OPPS) was established by the Balanced Budget Act of 1997 and went into effect on August 1, 2000. The OPPS was an attempt to simplify and reduce Medicare payments for hospital outpatient services by creating a new fee schedule. In a Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program-funded study, Daifeng He, Ph.D., and Jennifer Mellor, Ph.D., studied the effects of the OPPS on how much outpatient care is provided by Florida hospitals and who pays for it.

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HCFO Brief April 2013 FINAL.pdf [15]

Over the past two decades, a wave of hospital mergers and acquisitions has resulted in many highly concentrated hospital markets across the United States.  This phenomenon has raised concerns that consolidated hospitals are using their increased bargaining power to secure higher prices from health plans, thereby adding to the nation’s already unmanageable health care costs.  For their part, hospitals and other health care providers point out that consolidation among health plans has also occurred in recent years.  Hospitals warn that health plans’ power to drive d

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HCFO Brief March 2013 FINAL.pdf [19]

Medication adherence is critical to the management of chronic conditions. Yet, many patients forgo medication when confronted with unmanageable or rising medication costs, a phenomenon termed cost-related nonadherence. Value-based insurance design (VBID) is a benefit design strategy that aims to align patient cost sharing with the value of a particular clinical service, often by eliminating or reducing copayments for effective treatments.

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HCFO Findings Brief December 2012.pdf [23]

Policymakers seeking to slow the growth in Medicare spending are increasingly exploring care coordination interventions involving beneficiaries with multiple chronic conditions.  In a HCFO-funded study, Randall Brown, Ph.D., Deborah Peikes, Ph.D., and colleagues at Mathematica Policy Research took a closer look at the programs in the Medicare Coordinated Care Demonstration in order to assess which interventions worked and for whom.  The researchers found that while the 11 programs they examined did not reduce hospitalizations among enrollees overall, four of the programs were succ

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HCFOBriefNovember2012FINAL.pdf [27]

Rising prescription drug costs continue to be an issue of importance to patients, health insurers, and the federal government. One popular cost containment solution is encouraging the use of generic drugs over brand-name drugs. In general, utilization of generic medication is increasing in the United States. In addition to being lower cost, generic drug utilization is associated with increased medication adherence, which can lead to fewer hospitalizations and emergency department visits.

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HCFO Brief October 2012 FINAL.pdf [31]

Health care costs consume a growing percent of the U.S. gross domestic product, and economic literature has demonstrated that ultimately individuals pay these costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a HCFO-funded study, Patricia Ketsche, Ph.D., Kathleen Adams, Ph.D., and colleagues explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

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HCFO Brief Sept 2012_FINAL.pdf [36]

Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy.  Prior authorization is most effective in drug classes with high substitutability. However, for certain conditions, like mental health disorders, drugs are not always readily substitutable. In a HCFO-funded study, Christine Y. Lu, Ph.D., Stephen B.

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HCFOBriefJuly2012FINAL.pdf [41]

Despite the evidence linking smoking with poor birth outcomes and long term negative health effects for both mothers and children, pregnant women continue to smoke.  One goal of the federally-supported Healthy People 2020 is to reduce the prevalence of cigarette smoking during pregnancy to 1 percent. While most states have instituted more restrictive smoking policies during the past several years, the challenge for policymakers is to identify the right mix of strategies to achieve significant and lasting results. In an HCFO-funded study, E.