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.

Competition in the health insurance industry serves to protect consumers by providing access to affordable care. As Aetna looks to acquire Humana, and Anthem pursues Cigna, the proposed health insurance mergers have raised concerns over whether consolidation will reduce competition. A recent article in the New York Times highlights both sides of the debate.

With the goal of lowering health care costs, many policymakers and health care delivery systems are looking to change the way doctors are paid by focusing on quality of care. One innovative approach has been to shift incentives from a fee-for-service (FFS) payment model to a pay-for-performance (P4P) arrangement, under which doctors are rewarded for improving their quality of care. However, to date the financial incentives may not have triggered practices to change individual physician compensation policies. A recent Washington Post Wonkblog article reports findings from a study by former HCFO grantee Andrew Ryan, Ph.D., University of Michigan, on physician compensation in accountable care organizations (ACOs).

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.

The growing number of consumers using less traditional methods for accessing their health care is prompting many hospital systems to explore expanding their walk-in clinics and online access. Additionally, many hospital systems are exploring new ways to provide less expensive but still high quality care and are making investments in new ways to measure patient outcomes. A recent article in The New York Times highlights how the Cleveland Clinic is responding to these changes.

A recent article in USA Today explores potential reasons for price variation across geographic locations and highlights how consumers can use this information to make better decisions about their health care. Price transparency will be the focus of an upcoming summit sponsored by the Robert Wood Johnson Foundation, March 16-18, in Washington, DC.

A recent Health Affairs Blog post explored the dramatic increase in the percent of commercial sector payments tied to value. Recent and ongoing HCFO-funded work provides insights into the challenges and opportunities of these value-based payment arrangements.

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.

With the proliferation of narrow network plans on the new exchanges and more broadly in Medicare Advantage and commercial plans, consumers are being steered to health care coverage that offers lower prices, through reduced premiums, but limited choice. Anecdotal evidence to date suggests that the exchange networks are narrower than consumers anticipated, which may leave them vulnerable to the financial burden of out-of-network care for services not adequately covered within network...