Publications

In a tiered network, health insurers sort providers into tiers based on cost and quality performance, and patients have a financial incentive (they pay lower cost-sharing) to see a provider in a higher performing tier. Cost-efficiency is typically gauged using episode-level costs and utilization, while quality is judged through claims-based process measures, external certification, and, in some cases, use of health information technology. Drawing on HCFO-funded work, this article assesses whether patient choice of physician or health plan was affected by physician tier-rankings.

An article in MedPage Today describes potential changes to the Affordable Care Act's (ACA) medical loss ratio (MLR) requirement in light of the administrative and technical challenges insurers faced during the implementation of health insurance marketplaces. HCFO-funded work has examined the relationship between MLRs and the stability, or destabilization, of insurance markets as well as the potential impact of the ACA MLR requirement on insurers and enrollees in the individual market in each state.

Although health care is one of the largest industries in the United States, 73% of US residents who are ill have difficulty obtaining nonemergency care on nights, weekends, and holidays. Commercial e-visit websites—companies without bricks-and-mortar clinics that use the internet to connect patients to clinicians whom they never meet in person—may address the need for accessible, convenient care. Drawing on HCFO-funded work, this viewpoint explores the potential benefits and challenges of using e-visit websites and possible ways in which the websites, policymakers, and clinicians can respond to these challenges.

Patients suffering from chronic medical conditions and chronic pain are increasingly turning to palliative care as a way to relieve their symptoms and manage their care. In a recent New York Times article, columnist Jane E. Brody explains the benefits of using palliative care to treat chronic pain and the challenges that our medical system faces in making this type of care more widely utilized.

Healthcare payment reform is becoming one of the most important issues debated by healthcare policymakers, payers, providers, and purchasers. Architects of new payment models point out that the traditional fee-for-service model encourages the use of unnecessary medications and procedures while capitation promotes stinting on care and poses financial challenges to smaller provider groups.

A large body of research suggests that geographic variation accounts for the differences in Medicare spending. In this editorial, Reschovsky reviews findings from his HCFO-funded study and other work to demonstrate that while there are clear variations in clinical practice across geographic areas, the degree of variation and the importance of geography have been overstated.

Medicaid comprises a significant portion of state budgets and is expected to grow as states expand coverage under the Affordable Care Act.  Given this projected growth, understanding Medicaid’s financing structure, its burden on taxpayers, and any unintended consequences of the federal matching grant is particularly important.

In the past year, national news stories have focused a lot of attention to the prices charged for health, underscoring how much prices for a given health care service can vary, sometimes within a given health care setting, and how difficult it can be to determine actual prices paid...

Concern is growing over escalation in the improper and avoidable use of emergency departments (ED) by patients who did not receive appropriate care from their physicians. HCFO grantee John Kralewski and colleagues used a national sample of 212 medical group practices during 2009 to examine practice characteristics influencing the inappropriate use of EDs and ambulatory care sensitive hospital admissions rates by patients.

The ABIM Foundation’s Choosing Wisely campaign launched in 2011, and it spurred conversations between physicians and patients about the appropriateness of select tests and treatments, providing an opportunity to reduce low-value care. Drawing on HCFO-funded work, this commentary explores the practical utility of the Choosing Wisely recommendations in identifying and reducing waste in the U.S. health care system.