Publications

2016 has been a year of reflection for HCFO. After nearly 30 years, the final grants funded under the Robert Wood Johnson Foundation’s (RWJF) Changes in Health Care Financing and Organization (HCFO) initiative are coming to a close at the end of December.

A frequently noted effect of the insurance market reforms enacted by the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA) was the emergence of much narrower provider networks than were previously common. In a HCFO-funded study, Mark A. Hall, J.D., Wake Forest University, and Paul Fronstin, Ph.D., Employee Benefit Research Institute, conducted in-depth qualitative research to examine questions around provider networks in employer health plans, particularly the development of narrow networks, which have grown in the individual market under the ACA.

In this HCFO-funded study, the researchers examined the impact of a value-based insurance design (V-BID) program implemented between 2010 and 2013 at a large public employer in the state of Oregon.

Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. Using financial performance data from CMS, Medicare claims, and the National Survey of ACOs, the researchers examined ACO and market factors associated with superior financial performance in Medicare ACO programs.

Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy. The researchers conducted a block randomized controlled trial for one year to examine the effect of displaying paid-price information on test-ordering rates for common imaging studies and procedures within an accountable care organization (ACO).

Price information in combination with insurance benefit design that shares savings when patients choose low-cost health care facilities (e.g., reference pricing) has led to lower spending; however, the impact of price information on patient choices for patients in commercial insurance without such benefit design incentives is largely unknown. In a HCFO-funded study, Anna Sinaiko, Harvard T.H. Chan School of Public Health, and colleagues examined the impact of Aetna’s web-based, real-time, personalized episode-level price transparency tool on choice of health care facility for 8 services.

Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, the researchers examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid).

Commercial virtual visits, new methods by which patients can request live consultations with physicians over the Internet, have become increasingly popular, with one company noting a user base approaching 6 million. However, the relatively new telemedicine companies, which are designed to bridge the gap—physical and otherwise—between providers and patients must be held accountable for the quality of care they provide. In a HCFO-funded study, R. Adams Dudley, M.D., M.B.A., University of California, San Francisco (UCSF) and colleagues performed an audit study to assess the quality of care provided by the eight direct-to-consumer virtual care websites with the highest web traffic.

Little is known about how primary care physicians (PCPs) in routine outpatient practice use paid price information (i.e., the amount that insurers finally pay providers) in daily clinical practice. In this HCFO-funded study, the researchers used semi-structured interviews and qualitative analysis to describe the experiences of PCPs who have had paid price information on tests and procedures for at least one year.

This brief summarizes findings from a study’s evaluation of a large Midwestern health information technology firm that offered their employees a price transparency tool.