Publications

Many organizations are developing health care price information tools for consumers. However, consumers may avoid low-price care if they perceive price to be associated with quality. In a HCFO-funded study, Carolin Hagelskamp and David Schleifer of Public Agenda conducted a nationally representative survey to examine whether consumers perceive that price and quality are associated and whether the way in which questions are framed affects consumers’ responses.

Conventional wisdom among policymakers and health insurers is that retail clinics may reduce health care spending by substituting for more costly visits to physician offices or emergency departments. However, given their convenience and lower price, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In his HCFO-funded study, Ateev Mehrotra, M.D., M.P.H., Harvard Medical School, and colleagues assessed whether retail clinic visits for low-acuity conditions represented substitution for more expensive care or new utilization of health care services, and whether the visits subsequently reduced health care spending.

Policymakers and health insurers generally view retail clinics as a delivery model that may reduce health care spending by substituting for more costly visits to physician offices or emergency departments (EDs). However, given their lower price and convenience, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In a study funded by the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) initiative, Ateev Mehrotra, M.D., M.P.H., Harvard Medical School, and colleagues assessed whether retail clinic visits for low-acuity conditions represented substitution for more expensive care or new utilization of health care services, and whether they subsequently reduced health care spending.

Nonprofit and for-profit hospitals respond differently to reductions in Medicare payments; thus, studies of the impact of legislated Medicare payment cuts on care of the uninsured should account for differences in hospital ownership in communities. In her HCFO-funded study, Jennifer Mellor, Ph.D., College of William and Mary, examined the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of Medicare's Outpatient Prospective Payment System.

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. In her HCFO-funded study, Valerie Lewis, Ph.D., and researchers created composite measures of preventive care quality to examine associations of ACO characteristics with performance.

Drawing on HCFO-funded work, this issue brief shares key findings regarding public health insurance eligibility and premiums for children and families. HCFO grantees E. Kathleen Adams, Emory University, and Patricia Ketsche, George State University, conducted a comprehensive analysis of the effect of state expansions targeting parents and children from 1999 to 2012, along with the effect that accompanying premiums and subsidies had on family coverage decisions.

Practicing telemedicine is fundamentally different from conducting a face-to-face encounter. In addition to physical separation and its implications for examination, telemedicine automatically brings into the relationship a third partner—the organization providing the technology and setting the parameters of the e-visit. Drawing on HCFO-funded work, this Viewpoint discusses some of the promises of and pitfalls presented by telemedicine and their implications for medical education.

In the past few years, private exchanges offering employer-sponsored health coverage—available from competing insurers—have emerged among both large and small employers. Despite the marked potential of private exchanges, their growth has been slower than expected, raising public policy and regulatory questions. This study evaluated the potential benefits and drawbacks of private multi-carrier exchanges.

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.