Study Snapshot

Questions are arising about the impact of hospital value-based purchasing on clinical quality and patient experience. It is important for the medical community to understand the impact of this program.

Concern is growing over escalation in the improper and avoidable use of emergency departments by patients who did not receive appropriate care from their physicians. It is important to understand the costs of preventing these incidents at the medical group practice level.

During the late 1990s and early 2000s, pay-for-performance (P4P) programs grew in popularity. Given P4P’s increasing popularity, it is important to understand whether P4P is actually associated with improving quality.

In November 2013, the HCFO initiative convened health care practitioners, administrators, health services researchers, and policy experts from private sector and government agencies to discuss the implementation status of Medicare’s Hospital Readmissions Reduction Program (HRRP). The HRRP has focused hospitals’ attention on improving efficiency and quality, yet refinements to the program are needed to address implementation challenges.

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.

While large geographic variation in Medicare costs is widely recognized, the size and source of the variation has been subject to debate. This study examined and compared alternative approaches to case-mix adjustment to inform geographic variation estimates and draw policy inferences.

There is a growing demand for primary care as provisions of the Affordable Care Act seek to expand accessibility of health services. This study examined the relationship between utilization of a retail clinic and primary care relationships and found that patients who visited a retail clinic were less likely to seek care from a primary care physician in the future.

Millions of uninsured Americans rely on hospital emergency departments for medical care.  These patients receive hospital bills based on inflated “billed charges” that bear little relationship to the actual market prices paid by insured patients.

Millions of uninsured Americans are potentially one major illness away from financial catastrophe. When faced with a major illness, individuals without health insurance may need to draw on multiple financial resources, including retirement savings, to cover medical bills.

Substituting generics in place of more costly brand-name alternatives has the potential to lower drug spending for health plans. This study examined benefit and formulary design in Medicare Part D plans to determine their impact on generic drug use for cholesterol medication (statins) and to estimate potential savings to Medicare from generic substitution.