HCFO Year in Preview and Review

Recently, we’ve witnessed exciting changes as the Robert Wood Johnson Foundation works to build a national Culture of Health enabling all in our diverse society to lead healthy lives, now and for generations to come. Those changes have required some necessary priority shifts – the development of new programs and the sunset of others. During the past year and in the coming months, we will continue to wind down the Changes in Health Care Financing and Organization (HCFO) program with its close scheduled for September 2016. This effort has provided us the opportunity to reflect on the enormous contributions of HCFO-funded research for the field.

Previewing the Year Ahead

During the upcoming year, staff will focus its efforts on dissemination and convening in support of active grants and recently closed grants [1]. Our goal is to facilitate the use of research findings to help inform the work of policymakers and health care leaders. We will also look for ways to showcase the impact of HCFO-funded work on policy and practice. For those studies with findings that could help inform current areas of interest within federal agencies, AcademyHealth staff will identify opportunities to schedule briefings with policymakers at their offices to allow HCFO researchers to present findings from recently completed studies. These face-to-face meetings are an effective means of sharing research findings with policy audiences, as well as helping grantees broaden their connections with research end-users.

Reviewing the Year Past

Connecting Researchers and Policymakers

HCFO staff are supporting six grantees (Chien [2], Cuellar [3], Hagelskamp/Schleifer [4], Sinaiko [5], McWilliams/Chernew [6], Swift/Gabel [7]) who are conducting studies awarded through a special solicitation, Understanding the Use and Impact of Price Data in Health Care. A primary goal of this project is to ensure that study findings reach decision makers, and over the past year we facilitated multiple opportunities to bring visibility to these ongoing studies. We coordinated a virtual briefing with staff at CMS as well as staff at HHS in the Office of the Secretary that took place in May 2015. In addition, the grantees have briefed staff at the FTC.

Similarly, in the wake of increased action around potential insurer consolidation, HCFO grantees Brad Herring and Erin Trish briefed staff at the FTC, DOJ and ASPE on findings from a study [8] they conducted exploring the impact of hospital-market concentration on price competition in insurance markets. These briefings are designed to report evidence to help inform deliberations without taking a policy position.

Webinars

We believe strongly in our commitment to supporting the field, including professional development offerings for new and established researchers. Our webinars are designed to disseminate the work of HCFO-funded researchers and help inform current policy questions. Last month, HCFO researchers presented their findings on states’ rate review authority:

• “Is Rate Review the Answer to Lower Health Insurance Premiums?”
  Richard Scheffler, Brent Fulton, Ann Hollingshead, University of California, Berkeley; and Pinar Karaca-Mandic, University of Minnesota, discussed their HCFO-funded evaluation of state rate review authority in the individual market during the years immediately after the enactment of the ACA, 2010-13. The researchers focused on whether rate regulation, coupled with loss ratio requirements, moderates health insurance premium increases. Discussants Sabrina Corlette from the Center on Health Insurance Reforms (CHIR) at Georgetown University's Health Policy Institute and Kevin Beagan from the Health Care Access Bureau in Massachusetts' Division of Insurance reflected on the policy implications of the study. More about the researchers' study appears in this HCFO Findings Brief [9]. The webinar recording can also be accessed online [10].
• “Implications of Narrow Networks and the Tradeoff between Price and Choice”
  This webinar addressed the potential policy responses to the growth of narrow network plans and identified where more evidence is needed, to inform researchers and decision makers. Michael Chernew from Harvard Medical School presented the underlying evidence and motivations behind network design strategies, Lynn Quincy from the Consumers Union explored the implications of these network design strategies for consumers, and Sabrina Corlette from Georgetown University discussed recent state experience and action in response to narrow networks. The webinar was sponsored by HCFO and a Research Insights conference grant from the U.S. Agency for Healthcare Research and Quality. The webinar recording can be accessed online [11].

An upcoming webinar [12] (January 26, 2016, 2:00 – 3:15 p.m. ET) explores the current state of private exchanges:

• “Emerging Private Health Insurance Exchanges: How Should Regulators and Public Policy Respond?”
  During this webinar, Mark Hall from Wake Forest University will present findings from his HCFO-funded work exploring the current state and potential future of private exchanges. He will discuss whether regulatory intervention is called for at this juncture in the evolution of these exchanges, either to spur their development or guard against potential concerns. The full results of the study are available in the report “Private Health Insurance Exchanges for Employers: Issues for Regulators and Public Policy [13].” An overview and summary of the key findings are available in the related HCFO Study Snapshot [14]. Following Professor Hall’s presentation, discussant Alan Cohen, Chief Strategy Officer and Co-Founder of Liazon, an exchange technology provider, will offer his insights on the implications of the study findings for employers.

HCFO Study Snapshots

In an effort to make findings from HCFO-funded projects more accessible to our policy audience, we launched the “Study Snapshot” publication series. These one-page documents capture the key findings from a study and describe the most important complexities of the research and implications for policy.  We released five Snapshots in 2015:

• Tiered Physician Networks: A Tool to Promote Value [15], March 2015
• “What’s Your Price?” Many Americans Seek Health Care Prices, Fewer Compare across Providers [16], May 2015
• Reducing Medicare Readmissions in New York Hospitals [17], July 2015
• Hospital Pricing Under Medicare Advantage and Traditional Medicare [18], September 2015
• Issues in Private Health Insurance Exchanges for Employers [14], November 2015

HCFO Findings Briefs

In addition to the Snapshots, HCFO staff publishes Findings Briefs, which are designed to reach a broad range of audiences. In this publication, staff summarize the work of a grantee and discuss important policy implications of the study findings. In 2015, we produced the following three briefs:

• The Impact of the Early Introduction of Palliative Care on Patient Functioning [19], February 2015
• Achieving Medication Adherence through Value-Based Insurance Design [20], May 2015
• The Association of State Rate Review Authority with Health Insurance Premiums [9], October 2015

Grantee Publications

The high quality of HCFO grantees’ work is most clearly demonstrated in their peer-reviewed publications. In 2015, grantees published 15 articles in a variety of journals. Grantees also authored reports, blog posts and other publications in an effort to further disseminate their work.

• Neprash, H.T, et al., Measuring Prices in Health Care Markets Using Commercial Claims Data [21], Health Services Research, March 2015

• Sinaiko, A.D., et al., The Role of States in Improving Price Transparency in Health Care [22], JAMA Internal Medicine, March 2015

• Report: How Much Will it Cost? How Americans Use Prices in Health Care [23], David Schleifer, Carolin Hagelskamp and Chloe Rinehart, March 2015

• McWilliams, J.M., et al., Performance Differences in Year 1 of Pioneer Accountable Care Organizations [24], NEJM, April 2015

• Carey, K and Lin, M., Readmissions to New York Hospitals Fell for Three Target Conditions from 2008 to 2012, Consistent with Medicare Goals [25], Health Affairs, June 2015

• Trish, E.E., and Herring, B.H.,  How do Health Insurance Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums? [26], Journal of Health Economics, July 2015

• Song, Z., et al., Medicare Fee Cuts and Cardiologist-Hospital Integration [27], JAMA Internal Medicine, July 2015

• AJMC Blog: Face-to-Face Price Transparency [28], Andrea Ducas and David Schleifer, July 2015

• Ketsche, P., et al., The Distribution of the Burden of US Health Care Financing [29], International Journal of Financial Research, May 2015

• Kralewski, J., et al., The Relationships of Physician Practice Characteristics to Quality of Care and Costs [30], Health Services Research, June 2015

• Karaca-Mandic, P., et al., States with Stronger Rate Review Authority Experienced Lower Premiums in the Individual Market in 2010-13 [31], Health Affairs, August 2015

• Berenson, R.A., et al., Why Medicare Advantage Plans Pay Hospitals Traditional Medicare Prices [32], Health Affairs, August 2015

• Dusetzina, S.B., et al., Control Outcomes and Exposures for Improving Internal Validity of Nonrandomized Studies [33], Health Services Research, October 2015

• Report: Private Health Insurance Exchanges for Employers: Issues for Regulators and Public Policy [13], Mark A. Hall, J.D., October 2015

• Hammill, B.G., et al., Linkage of Laboratory Results to Medicare Fee-for-Service Claims [34], Medical Care, September 2015

• Fulton, B.D., et al., Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives from the Affordable Care Act [35], Inquiry, September 2015

• Neprash, H.T., et al., Association of Financial Integration Between Physicians and Hospitals with Commercial Health Care Prices [36], JAMA Internal Medicine, October 2015

• DeJong, C., Lucey, C.R., Dudley, R.A., Incorporating a New Technology While Doing No Harm, Virtually [37], JAMA, December 2015

• Issue Brief: Families Matter: Insuring Both Parents and Their Children [38], E. Kathleen Adams and Patricia Ketsche, January 2016

A Successful 25+ Years

The Foundation should be enormously proud of its investment in HCFO. The program’s success can be measured in many important ways: the studies advanced knowledge, informed policy and made an impact on the field. HCFO also served as a launching pad in the careers of many young researchers. The consistently high quality of the program inured to the benefit of the Foundation, enhancing RWJF’s reputation as an honest broker of evidence. In the final months of the program, HCFO staff look forward to documenting the tremendous impact and legacy of the HCFO program on health policy and health services research.