Grantee Publication

Mark A. Hall, a professor of law and public health in the Division of Public Health Sciences at Wake Forest University Medical School, is conducting a qualitative analysis on public policy issues related to private exchanges in order to inform state and federal officials and other policy actors about the current state and potential future of private health insurance exchanges, including possible measures to improve their benefit or mitigate negative effects.

Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. Using regression analysis, the researchers estimated the relationship between changes in physician-hospital integration in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending.

Control outcomes and exposures can improve internal validity of nonrandomized studies by assessing residual bias in effect estimates. The researchers reviewed examples of control outcomes and exposures from prior studies in Google Scholar and Medline.

Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available. In order to describe both the linkage of laboratory results data to Medicare claims and the completeness of these results data, the researchers obtained information about laboratory orders and results for all Medicare fee-for-service beneficiaries in 10 eastern states in 2011.

The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. The researchers identified changes in states’ rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA’s enactment, and linked these changes to the Centers for Medicare and Medicaid Services’ (CMS) criteria for an effective rate review program.

States have varying degrees of review authority over health insurance carriers’ rates, including prior approval authority over proposed rates and requirements for loss ratios, the proportion of premium revenues spent on medical claims. The Affordable Care Act (ACA) requires carriers in certain categories of health insurance to provide public justification for rate increases of 10 percent or more. The researchers collected data on how states changed their rate review authority and requirements in the years immediately after enactment of the ACA.

The policy community generally has assumed Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. After surveying senior hospital and health plan executives, the researchers found, however, that MA plans nominally pay only 100–105 percent of traditional Medicare rates and, in real economic terms, possibly less.

Medical group practices are central to many of the proposals for health care reform, but little is known about the relationship between practice-level characteristics and the quality and cost of care. In this study, the researchers found that practice characteristics influence costs indirectly through a set of statistically significant relationships among screening and monitoring measures and avoidable utilization.
 

Parity in mental health benefits rectifies unfairness in health insurance coverage and reduces financial risk for those with mental illness. However, increased coverage for mental illness has been seen as creating inefficiencies and increasing total spending, based largely on results from the RAND Health Insurance Experiment conducted in the 1970s. Newer evidence suggests that cost control techniques associated with managed care give health plans alternatives to discriminatory coverage for containing costs. We review both eras of research on mental health insurance and conclude that comprehensive parity implemented in the context of managed care would have little impact on total spending.

 

Non-Hispanic whites are significantly more likely to have health insurance coverage than most racial/ethnic minorities, and this differential grew during the 1990s. Similarly, wealthier Americans are more likely to have health insurance than the poor, and this difference also grew over the 1990s. This paper examines the role of provider competition in increasing these disparities in insurance coverage.