Publications

The complex financing system that supports health care spending in the US makes estimation of the incidence of financing both daunting and important. In this study, the researchers compute and describe the final incidence of financing health care to provide assumptions for benchmarking and assessment of the equity implications of financing health care in the future.

Efforts to inject greater price transparency into healthcare continue to gain momentum. Public Agenda, with support from the Robert Wood Johnson Foundation, recently conducted a national survey to explore the knowledge, behaviors and attitudes of consumers regarding price information in healthcare.

Under the Hospital Readmissions Reduction Program, hospitals are financially penalized for higher-than-average thirty-day readmission rates for Medicare patients. A new study examined the possibility that hospitals strategically avoided the readmissions penalty—a would-be unintended consequence of the program that could offset some of the intended savings to Medicare.

Physician practices are increasingly integrating with hospitals. Using 2007-2012 medical claims from a continuously enrolled national sample of traditional Medicare beneficiaries and commercially insured individuals from Truven Medicare and Commercial databases, the researchers analyzed trends in cardiologist-hospital integration.

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. The researchers empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey.

The Medicare Hospital Readmissions Reduction Program (HRRP), an initiative of the Affordable Care Act, imposes considerable financial penalties on hospitals with excess thirty-day readmissions for patients with selected high-volume conditions. The researchers investigated the intended impact of the program by examining changes in thirty-day readmissions among Medicare patients admitted for three conditions targeted by the program in New York State, compared to Medicare patients with other conditions and with privately insured patients, before and after the program’s introduction.

Cost sharing, often seen in the form of copayments, coinsurance, and deductibles, is commonly used to reign in health care spend¬ing. While the intent of cost sharing is to promote greater patient engagement around value-based health care choices, it can lead to patients avoiding necessary medications or services. Value-based insurance design plans (VBID) plans reduce this effect by limiting or eliminating cost sharing for medications and services that offer patients a high value return on their health.

Reducing excess readmissions is top of mind among all hospitals in Cleveland. Administrators at the Cleveland Clinic, MetroHealth System and University Hospitals understand the financial implications of patients returning within 30 days of discharge.

As Americans shoulder more of their health care costs, a new study suggests that many are hungry for price information. Yet, despite widespread interest in health care prices, several hurdles stand in the way of making health care price information more accurate, comprehensive, and readily available to consumers.

In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. The researchers used a difference-in-differences analysis of Medicare fee-for-service claims, to compare Medicare spending for beneficiaries attributed to Pioneer ACOs (ACO group) with other beneficiaries (control group) before (2009 through 2011) and after (2012) the start of Pioneer ACO contracts, with adjustment for geographic area and beneficiaries’ sociodemographic and clinical characteristics.