Findings Brief

Commercial virtual visits, new methods by which patients can request live consultations with physicians over the Internet, have become increasingly popular, with one company noting a user base approaching 6 million. However, the relatively new telemedicine companies, which are designed to bridge the gap—physical and otherwise—between providers and patients must be held accountable for the quality of care they provide. In a HCFO-funded study, R. Adams Dudley, M.D., M.B.A., University of California, San Francisco (UCSF) and colleagues performed an audit study to assess the quality of care provided by the eight direct-to-consumer virtual care websites with the highest web traffic.

During the past decade, preventive care in medicine has become a national priority. 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 ACOs’ success. In a HCFO-funded study, Valerie Lewis, Ph.D., of Dartmouth College and colleagues conducted a cross-sectional study examining Medicare Shared Savings Program (MSSP) and Pioneer ACO Program participants and the association between preventive care quality performance and ACO characteristics. Their goal was to inform strategies for preventive care quality management.

During the past decade, increases in health insurance premiums have exceeded the rate of inflation, particularly in the individual and small group markets, with significant variation among states. The federal rate review regulation in the Affordable Care Act (ACA) requires health insurance carriers to file and publicly justify proposed rate increases of 10 percent or more. In a HCFO-funded study, Richard Scheffler, Brent Fulton, Ann Hollingshead, University of California, Berkeley; and Pinar Karaca-Mandic, University of Minnesota, conducted the first evaluation of state rate review authority in the individual market during the years immediately following the ACA’s enactment (2010–2013).

Cost sharing, often seen in the form of copayments, coinsurance, and deductibles, is commonly used to reign in health care spend¬ing. While the intent of cost sharing is to promote greater patient engagement around value-based health care choices, it can lead to patients avoiding necessary medications or services. Value-based insurance design plans (VBID) plans reduce this effect by limiting or eliminating cost sharing for medications and services that offer patients a high value return on their health.

Palliative care is typically associated with services provided to terminally ill cancer patients. Increasingly, however, palliative care is considered a treatment option for other life-limiting illnesses and for easing chronic pain.

The Choosing Wisely initiative encourages physicians, patients, and other health care stakeholders to engage in conversations about medical tests and procedures that may be unnecessary and, in some instances, cause harm. Drawing on HCFO-funded work, Carrie H. Colla and colleagues examined the prevalence, geographic variation, and Medicare spending associated with selected tests identified as low-value by specialty societies participating in the initiative.
 

Several factors influence a patient’s choice of health care providers, including cost and quality. Increasingly, health plans, employers, and other payers are creating tiered provider networks to help guide patients’ decisions about care providers.

Healthcare payment reform is becoming one of the most important issues debated by healthcare policymakers, payers, providers, and purchasers. Architects of new payment models point out that the traditional fee-for-service model encourages the use of unnecessary medications and procedures while capitation promotes stinting on care and poses financial challenges to smaller provider groups.

Concern is growing over escalation in the improper and avoidable use of emergency departments (ED) by patients who did not receive appropriate care from their physicians. HCFO grantee John Kralewski and colleagues used a national sample of 212 medical group practices during 2009 to examine practice characteristics influencing the inappropriate use of EDs and ambulatory care sensitive hospital admissions rates by patients.

Among the major provisions of the Patient Protection and Affordable Care Act (ACA) is the tightening of Medicare payment policy. This policy change is expected to reduce Medicare expenditures by $379 billion from 2012 through 2021, according to estimates by the Congressional Budget Office. However, the implications for provider behavior and the care received by patients are unclear...