- Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance. January 2016
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.
In the past few years, private exchanges offering employer-sponsored health coverage—available from competing insurers—have emerged among both large and small employers. Despite the marked potential of private exchanges, their growth has been slower than expected, raising public policy and regulatory questions. This study evaluated the potential benefits and drawbacks of private multi-carrier exchanges.
- Private Health Insurance Exchanges for Employers: Issues for Regulators and Public Policy October 2015
Mark A. Hall, a professor of law and public health in the Division of Public Health Sciences at Wake Forest University Medical School, is conducting a qualitative analysis on public policy issues related to private exchanges in order to inform state and federal officials and other policy actors about the current state and potential future of private health insurance exchanges, including possible measures to improve their benefit or mitigate negative effects.
- Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices October 2015
Financial integration between physicians and hospitals may help health care provider organizations meet the challenges of new payment models but also may enhance the bargaining power of provider organizations, leading to higher prices and spending in commercial health care markets. Using regression analysis, the researchers estimated the relationship between changes in physician-hospital integration in 240 metropolitan statistical areas (MSAs) and concurrent changes in spending.
Competition in the health insurance industry serves to protect consumers by providing access to affordable care. As Aetna looks to acquire Humana, and Anthem pursues Cigna, the proposed health insurance mergers have raised concerns over whether consolidation will reduce competition. A recent article in the New York Times highlights both sides of the debate.
- Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act September 2015
The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. The researchers identified changes in states’ rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA’s enactment, and linked these changes to the Centers for Medicare and Medicaid Services’ (CMS) criteria for an effective rate review program.
Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available. In order to describe both the linkage of laboratory results data to Medicare claims and the completeness of these results data, the researchers obtained information about laboratory orders and results for all Medicare fee-for-service beneficiaries in 10 eastern states in 2011.
- Control Outcomes and Exposures for Improving Internal Validity of Nonrandomized Studies October 2015
Control outcomes and exposures can improve internal validity of nonrandomized studies by assessing residual bias in effect estimates. The researchers reviewed examples of control outcomes and exposures from prior studies in Google Scholar and Medline.