Publications

While the United States has made great progress in reducing the number of uninsured children, coverage remains fluid for the many children who transition between public and private insurance. In a HCFO-funded study, Thomas Buchmueller, Sean Orzol, and Lara Shore-Sheppard analyzed the relationship between a child’s health insurance stability and a child’s access to medical care.
 

Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation’s Choosing Wisely initiative. The researchers used Medicare data from 2006 to 2011, to created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examine geographic variation across hospital referral regions (HRRs).

Questions are arising about the impact of hospital value-based purchasing on clinical quality and patient experience. It is important for the medical community to understand the impact of this program.

Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experience serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. The researchers designed and evaluated a decision exercise that allowed cancer patients and family members to choose Medicare benefits for advanced cancer patients.

The Choosing Wisely initiative encourages physicians, patients, and other health care stakeholders to engage in conversations about medical tests and procedures that may be unnecessary and, in some instances, cause harm. Drawing on HCFO-funded work, Carrie H. Colla and colleagues examined the prevalence, geographic variation, and Medicare spending associated with selected tests identified as low-value by specialty societies participating in the initiative.
 

The growing cost of providing health benefits is prompting some large employers to modify the ways they offer coverage to their employees.  Experts say these changes are part of a larger trend in which employers are replacing their defined health benefit (i.e. coverage through a specific health plan) with defined contributions that employees can use to purchase insurance products of their choice. A recent article in the Washington Post explores the strategies employers are considering for promoting choice and controlling costs in the context of health reform, including the use of private exchanges.

Public acceptance of a role for policy in reducing the use of low value care in the United States is tenuous but increasing with growing awareness of the burden that health care spending places on federal and state budgets and with patients’ increasing exposure to health care costs. In recent years, the American Board of Internal Medicine Foundation’s Choosing Wisely program, the U.S. Preventive Services Task Force, and the National Quality Forum have advanced the dialogue about low-value care by identifying services that deserve that label.

Several factors influence a patient’s choice of health care providers, including cost and quality. Increasingly, health plans, employers, and other payers are creating tiered provider networks to help guide patients’ decisions about care providers.

The American College of Rheumatology, through the Choosing Wisely initiative, identified measuring bone densitymore often than every 2 years as care “physicians and patients should question.” The researchers measured the prevalence and described the geographic variation of short-interval (repeated in under 2 years) dual-energy X-ray absorptiometry tests (DXAs) among Medicare beneficiaries and estimated the cost of this testing and its responsiveness to payment change.

Concern is growing over escalation in the improper and avoidable use of emergency departments by patients who did not receive appropriate care from their physicians. It is important to understand the costs of preventing these incidents at the medical group practice level.