Grantee Publication

Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropriate testing among Medicare fee-for-service beneficiaries are unknown. In this HCFO-funded study, the researchers examined baseline laboratory testing rates to identify predictors of suboptimal testing and to assess the prevalence of abnormal creatinine and potassium among beneficiaries initiating ACE inhibitors or ARBs.

Commercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously — via videoconference, telephone, or webchat — to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed. Drawing on HCFO-funded work, R. Adams Dudley, University of California, San Francisco, and colleagues assessed the variation in the quality of urgent health care among virtual visit companies.

Many organizations are developing health care price information tools for consumers. However, consumers may avoid low-price care if they perceive price to be associated with quality. In a HCFO-funded study, Carolin Hagelskamp and David Schleifer of Public Agenda conducted a nationally representative survey to examine whether consumers perceive that price and quality are associated and whether the way in which questions are framed affects consumers’ responses.

Calls for transparency in health care prices are increasing, in an effort to encourage and enable patients to make value-based decisions. Yet there is very little evidence of whether and how patients use health care price transparency tools. In a HCFO-funded study, Anna Sinaiko, Harvard T.H. Chan School of Public Health, and colleagues evaluated the experiences of an insured population of nonelderly adults with Aetna’s Member Payment Estimator, a web-based tool that provides real-time, personalized, episode-level price estimates.

Policymakers and health insurers generally view retail clinics as a delivery model that may reduce health care spending by substituting for more costly visits to physician offices or emergency departments (EDs). However, given their lower price and convenience, retail clinics may also lead to new utilization of health care services by patients who otherwise would not seek care, thus increasing spending. In a study funded by the Robert Wood Johnson Foundation Changes in Health Care Financing and Organization (HCFO) initiative, 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 they subsequently reduced health care spending.

Nonprofit and for-profit hospitals respond differently to reductions in Medicare payments; thus, studies of the impact of legislated Medicare payment cuts on care of the uninsured should account for differences in hospital ownership in communities. In her HCFO-funded study, Jennifer Mellor, Ph.D., College of William and Mary, examined the amount of hospital outpatient care provided to the uninsured and its association with Medicare payment rate cuts following the implementation of Medicare's Outpatient Prospective Payment System.

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. In her HCFO-funded study, Valerie Lewis, Ph.D., and researchers created composite measures of preventive care quality to examine associations of ACO characteristics with performance.

Drawing on HCFO-funded work, this issue brief shares key findings regarding public health insurance eligibility and premiums for children and families. HCFO grantees E. Kathleen Adams, Emory University, and Patricia Ketsche, George State University, conducted a comprehensive analysis of the effect of state expansions targeting parents and children from 1999 to 2012, along with the effect that accompanying premiums and subsidies had on family coverage decisions.

Practicing telemedicine is fundamentally different from conducting a face-to-face encounter. In addition to physical separation and its implications for examination, telemedicine automatically brings into the relationship a third partner—the organization providing the technology and setting the parameters of the e-visit. Drawing on HCFO-funded work, this Viewpoint discusses some of the promises of and pitfalls presented by telemedicine and their implications for medical education.

This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service (FFS) enrollees.