Study Snapshot

This executive summary provides an overview of the discussion from a May 2016 meeting where RWJF grantees presented some of the key findings from their research on the use and impact of price data in health care to a panel of experts actively engaged in developing and using health care price information.

Accountable Care Organizations (ACO) emerged as a novel payment model to create a coordinated health system whereby providers contract together to take collective responsibility for managing the cost and quality of care for a population of patients. Preventive care is critical to ACO success. Evaluating ACOs’ strategic choices in terms of their organizational structure and early performance provides an avenue to a better understanding of the factors behind preventive care quality. In a HCFO-funded study, Valerie Lewis, Ph.D., of Dartmouth College and colleagues conducted a cross-sectional study examining Medicare Shared Savings Program and Pioneer ACO Program participants and the association between preventive care quality performance and ACO characteristics to inform strategies for preventive care quality management.

Conventional wisdom among policymakers and health insurers is that retail clinics may reduce health care spending by substituting for more costly visits to physician offices or emergency departments. However, given their convenience and lower price, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In his HCFO-funded study, Ateev Mehrotra, M.D., M.P.H., Harvard Medical School, and colleagues assessed whether retail clinic visits for low-acuity conditions represented substitution for more expensive care or new utilization of health care services, and whether the visits subsequently reduced health care spending.

In the past few years, private exchanges offering employer-sponsored health coverage—available from competing insurers—have emerged among both large and small employers. Despite the marked potential of private exchanges, their growth has been slower than expected, raising public policy and regulatory questions. This study evaluated the potential benefits and drawbacks of private multi-carrier exchanges.

The policy community generally has assumed that Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. In a HCFO-funded study, Robert Berenson, M.D., Jonathan Sunshine, Ph.D., Emily Lawton, Urban Institute; and David Helms, Johns Hopkins Bloomberg School of Public Health, interviewed senior hospital and health plan executives to understand the negotiating dynamics between MA plans and hospitals, first to confirm that MA plans do pay hospitals at or near traditional Medicare payment rates and then to explain why.

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.

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.

Increasingly, health plans, employers, and other payers are developing tiered provider networks, which rank and stratify providers according to cost and quality performance. In a HCFO-funded study, Meredith Rosenthal, Ph.D., and Anna Sinaiko, Ph.D., from the Harvard School of Public Health examined the effect of a three-tiered network on patients’ choice of physician or health plan.

In 2012, the ABIM Foundation announced the Choosing Wisely initiative under which more than 60 specialty societies have developed lists of five evidence-based recommendations of tests and treatments that physicians and patients should question and discuss. In a HCFO-funded study, Carrie Colla, Ph.D., and colleagues created claims-based algorithms to examine 11 services identified on one or more Choosing Wisely lists.

While the United States has made great progress in reducing the number of uninsured children, coverage remains fluid for the many children who transition between public and private insurance. In a HCFO-funded study, Thomas Buchmueller, Sean Orzol, and Lara Shore-Sheppard analyzed the relationship between a child’s health insurance stability and a child’s access to medical care.