Robert Berenson, M.D. and Jonathan Sunshine, Ph.D.

Robert Berenson, M.D., Institute Fellow in the Health Policy Center of the Urban Institute, and Jonathan Sunshine, Ph.D., part-time Senior Fellow in the Health Policy Center of the Urban Institute, are currently the co-principal investigators on a HCFO study examining why Medicare Advantage (MA) plans’ contracted payments to hospitals tend to mirror reimbursements paid under traditional fee-for-service (FFS) Medicare rather than the much higher payment rates usual in contracts for commercial insurance plans. Through key informant interviews and a meeting that convenes relevant experts and stakeholders, the researchers will try to identify (1) why payment parity occurs, (2) under what circumstances it might not occur, and (3) any insights for policymaking to address growing hospital pricing power in the non-Medicare commercial market (e.g. policies that limit negotiated payments or out-of-network payments to a certain percentage above Medicare rates). The goal of this project is to inform policy discussions of current market dynamics and future potential long-term reforms of Medicare.

Dr. Berenson is a long-time expert in health care policy, particularly Medicare, with experience as a researcher, policymaker, administrator, and practicing physician.  He has served in senior positions in two administrations, and helped organize and manage a successful preferred provider organization.

Dr. Berenson is a graduate of the Mount Sinai School of Medicine and is on the faculty at the George Washington University Schools of Medicine and Public Health and the Fuqua School of Business at Duke. He is a board-certified internist who practiced for 20 years, the last 12 in a Washington, D.C. group practice.  He is also a Fellow of the American College of Physicians. From 1998-2000, he directed Medicare payment policy and private health plan contracting in the Centers for Medicare and Medicaid Services.  During the Carter administration, he served as an Assistant Director of the White House Domestic Policy Staff and was a member of the Obama transition team. In 2009, Dr. Berenson became a commissioner of the Medicare Payment Advisory Commission (MedPAC) and served as vice-chair for two years.

Dr. Sunshine is a health economist and health services researcher with over 30 years’ experience in policy-related research and policy analysis. He was educated at Columbia University and Oxford University (England), receiving his Ph.D. from Columbia in 1972.  He served as the Senior Director for Research at the American College of Radiology and as an adjunct professor at the Yale University School of Medicine.  Dr. Sunshine worked at the U.S. Office of Management and Budget, where he helped formulate national health insurance proposals during both Democratic and Republican administrations, as well as at the Physician Payment Review Commission, a predecessor to MedPAC.  As a self-employed consultant, he has done work for the RAND Corporation, the National Center for Health Statistics, the National Institute of Mental Health, the Blue Cross and Blue Shield Association, Project Hope, hospitals, PPOs, and physician practices.

For more information about Robert Berenson, M.D., and a list of his publications, please see http://www.urban.org/health_policy/about/berenson.cfm?page=1

For more information about Jonathan Sunshine, Ph.D., please see http://www.urban.org/health_policy/about/sunshine.cfm?page=1