Grantee Publication

Does Location Determine Medical Practice Patterns?

A large body of research suggests that geographic variation accounts for the differences in Medicare spending. In this editorial, Reschovsky reviews findings from his HCFO-funded study and other work to demonstrate that while there are clear variations in clinical practice across geographic areas, the degree of variation and the importance of geography have been overstated.

Virtual Mentor: American Medical Association Journal of Ethics
Vol. 16 No. 2
February 2014
Reschovsky, J.

Research from the Dartmouth Atlas finds that that after adjusting for area differences in Medicare payment levels and patient health, very wide geographical disparities in costs remain. In this editorial, James Reschovsky, Ph.D. reviews findings from his HCFO-funded study and other work, which has shown that that after controlling for variations in Medicare payment and case-mix, population health accounts for at least 75 to 85 percent of the remaining variation in Medicare spending.

Limiting Low-Value Care by “Choosing Wisely”

The ABIM Foundation’s Choosing Wisely campaign launched in 2011, and it spurred conversations between physicians and patients about the appropriateness of select tests and treatments, providing an opportunity to reduce low-value care. Drawing on HCFO-funded work, this commentary explores the practical utility of the Choosing Wisely recommendations in identifying and reducing waste in the U.S. health care system. 

Virtual Mentor: American Medical Association Journal of Ethics
Vol. 16 No. 2
February 2014
Schpero, W.L.

The Dartmouth Atlas of Health Care has long documented widespread variations in use of effective care. Needed attention is now being paid to use of ineffective—or low-value—care, a form of overtreatment. In 2009, the American Board of Internal Medicine (ABIM) Foundation gave a grant to the National Physicians Alliance to develop lists to help primary physicians “be good stewards of resources.” In March 2011, the ABIM Foundation announced their Choosing Wisely campaign.

Five Features Of Value-Based Insurance Design Plans Were Associated With Higher Rates Of Medication Adherence

Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. In this study, HCFO grantees evaluated seventy-six plans introduced by a large pharmacy benefit manager and highlight plan features associated with greater medication adherence.

Health Affairs
Vol. 33 No. 3
February 2014
Choudhry, N.K., Fischer, M.A., Smith, B.F., et al.

Value-based insurance design (VBID) plans selectively lower cost sharing to increase medication adherence. Existing plans have been structured in a variety of ways, and these variations could influence the effectiveness of VBID plans. The researchers evaluated seventy-six plans introduced by a large pharmacy benefit manager during 2007–10.

Value-Based Insurance Design Program in North Carolina Increased Medication Adherence But Was Not Cost Neutral

Value-based insurance design (VBID) has shown promise for improving medication adherence by lowering or eliminating patients’ payments for some medications. In this study, HCFO grantees use the Blue Cross Blue Shield of North Carolina’s VBID program to examine if eliminating copayments for generic medications and reducing copays for brand-name medications will increase medication adherence.

Health Affairs
Vol. 33 No. 2
February 2014
Maciejewski, M.L., Wansink, D., Lindquist, J.H., Parker, J.C., Farley, J.F.

Value-based insurance design (VBID) has shown promise for improving medication adherence by lowering or eliminating patients’ payments for some medications. Yet the business case for VBID remains unclear. VBID is based on the premise that higher medication and administrative expenses incurred by insurers will be offset by lower nonmedication expenditures that result from better disease control. This article examines Blue Cross Blue Shield of North Carolina’s VBID program, which began in 2008.

Choosing Wisely — The Politics and Economics of Labeling Low-Value Services

With its Choosing Wisely campaign, the American Board of Internal Medicine (ABIM) Foundation boldly invited professional societies to own their role as “stewards of finite health care resources.” In this perspective, HCFO grantees review the aims of the Choosing Wisely campaign and describe the challenges of identifying low-value services with the potential for significant cost-savings.

The New England Journal of Medicine
January 2014
Morden, N.E., Colla, C.H., Sequist, T.D., Rosenthal, M.B.,

With its Choosing Wisely campaign, the American Board of Internal Medicine (ABIM) Foundation boldly invited professional societies to own their role as “stewards of finite health care resources.” Beginning in 2009, the National Physicians Alliance, funded by the ABIM Foundation, guided volunteers from three primary care specialties through the development of “Top Five” lists — specialty-specific enumerations of five achievable practice changes to improve patient health through better treatment choices, reduced risks and, where possible, reduced costs.

Should healthy Medicare beneficiaries postpone enrollment in Medicare Part D?

This study compares estimated lifetime out-of-pocket prescription drug expenditures on outpatient prescription drugs, premiums and late enrollment penalties for healthy 65-year-old Medicare beneficiaries if they (a) purchase Part D as soon as they are eligible versus (b) waiting until they contract a drug-intensive condition.

Health Economics
Vol. 18, No. 8
October 2008
Atherly, A. and Dowd, B.

We compare estimated lifetime out-of-pocket prescription drug expenditures on outpatient prescription drugs, premiums and late enrollment penalties for healthy 65-year-old Medicare beneficiaries if they (a) purchase Part D as soon as they are eligible versus (b) waiting until they contract a drug-intensive condition. Using data from the Medicare Current Beneficiary Survey, a representative sample of the Medicare population, we estimate the annual probability that a healthy 65-year-old will transition to a drug-intensive health state or death.

Variation in Diabetes Care Quality Among Medicare Advantage Plans: Understanding the Role of Case Mix

This study investigates whether variation in Medicare Advantage plan performance on comprehensive diabetes care is explained by the case mix of plans.

American Journal of Medical Quality
Vol. 27, No. 5
September/October 2012
Abraham, J.M., Marmor, S., Knutson, D. et al.

This study investigates whether variation in Medicare Advantage plan performance on comprehensive diabetes care is explained by the case mix of plans. Using data on 513 Medicare Advantage plan-year observations for 2007 and 2008, the authors estimate multivariate regressions for 3 diabetes care quality measures: (1) hemoglobin screening, (2) low-density lipoprotein screening, and (3) retinal eye exam.

Who Really Pays for Medicaid: Intended and Unintended Consequences of the Matching Grant

The goal of the Medicaid intergovernmental matching grant is to stimulate state spending while achieving some level of beneficiary and taxpayer equity. This study estimates federal and state Medicaid tax burdens per family and discusses intended and unintended consequences of the matching grant.

Public Finance Review
Vol. 42, No. 1
January 2014
Adams, E.K., Ketsche, P.G., and Minyard, K.J.

The goal of the Medicaid intergovernmental matching grant is to stimulate state spending while achieving some level of beneficiary and taxpayer equity. This study uses the Current Population Survey data on 174,031 families to estimate federal and state Medicaid tax burdens per family, net of tax exporting. Of the total U.S. $305 billion spent on Medicaid in 2004, U.S. $29.9 billion is redistributed through the grant’s Federal Medical Assistance Percentage, as residents of low-income states export federal tax burdens to higher-income states. Another U.S.

Paying physician group practices for quality: A statewide quasi-experiment

This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001–2007.

Healthcare
Vol. 1, No. 3-4
December 2013
Conrad, D.A., Grembowski, D., Perry, L. et al.

This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001–2007. The authors received external funding to provide an objective impact evaluation of the program.

Evaluating Florida's Medicaid Provider Services Network Demonstration

Concerns regarding the quality of care provided to Medicaid enrollees and the program’s financial viability have prompted serious consideration of much greater state flexibility in the structuring of Medicaid and the delivery of health care to Medicaid enrollees. Effective July 1, 2006, Florida embarked on a 5-year research and demonstration project that significantly changed its Medicaid program. One element of the Florida reform initiative was the inclusion of provider service networks (PSNs).

Health Services Research
Vol. 43, No. 1p2
August 2007
Duncan, R.P., Lemak, C.H., Vogel, W.B. et al.

Research Objective. To evaluate the design, development, and implementation of Florida's Medicaid provider service network (PSN) demonstration, and the implications of that demonstration for subsequent Medicaid Reform in Florida. Data Sources, Data Collection. Organizational analyses were based on archival and enrollment data obtained from Florida's Medicaid program and the South Florida Community Care Network, as well as key informant interviews.

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