Research Headlines

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. Over the last 12 months, we’ve worked to translate the findings from our final grantees and spent time reflecting on the lessons we’ve learned to move actionable evidence that can improve health and health care into the hands of decision makers who need it most.

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. During a recent Senate Judiciary Committee hearing on health insurance consolidation and its impact on consumers, the chief executives of Aetna and Anthem remained confident that the deals would enhance competition and reduce costs for consumers.

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. In theory, the new payment model incentivizes doctors to keep patients healthy with fewer tests, procedures, and appointments.

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. But as reported in a recent NPR article, reducing readmissions is particularly challenging for providers like MetroHealth and University Hospitals, which serve large numbers of low-income patients.

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.

The cost of surgery and other medical procedures varies widely across the country and can even vary within the same city. In a recent USA Today article, Jayne O’Donnell and Laura Unger provide an overview of the variation in prices across geographic locations, discuss why the variations in pricing may exist, and highlight how consumers can use this information to make better decisions about their health care.

Policymakers and health care delivery systems are increasingly looking to price transparency as a promising approach for controlling health care costs.  Much of this attention has focused on effective strategies for providing price and quality information to consumers who may use it to make more cost-conscious decisions about where, how, and when to seek care.  Yet as a recent article in The New York Times explains, health care consumers aren’t the on

Pay-for-performance (P4P), value-based purchasing, and incentive-based payment are approaches to reward high-value care while constraining costs. In a recent Health Affairs Blog post, Suzanne Delbanco described the findings from the Catalyst for Payment Reform’s 2014 National Scorecard on Payment Reform, which tracks the status of the private sector’s progress from volume to value-oriented payment.

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.

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.