- Assessing the Influence of Medical Group Practice Characteristics on Reducing Inappropriate Emergency Department and Avoidable Hospitalization Rates August 2014
Concern is growing over escalation in the improper and avoidable use of emergency departments by patients who did not receive appropriate care from their physicians. It is important to understand the costs of preventing these incidents at the medical group practice level.
- Physicians’ and Hospitals’ Varied Responses to Changes in Medicare Payment: Findings from HCFO Research August 2014
Efforts to address the nation's deficit and escalating health care costs require timely and policy-relevant research on the impact of changes to Medicare payment. Though not intended as a comprehensive list of all relevant HCFO-funded work, this synthesis provides a helpful guide for identifying policy-relevant research on the topic.
In 2011, the American Board of Internal Medicine Foundation created the Choosing Wisely initiative, which encourages physicians to be responsible stewards of finite healthcare resources. Using Medicare administrative data from 2006 to 2011, the researchers estimated the proportion of low-risk Medicare beneficiaries receiving non-invasive cardiac screening tests as well as the regional variation in and spending associated with these tests.
With the proliferation of narrow network plans on the new exchanges and more broadly in Medicare Advantage and commercial plans, consumers are being steered to health care coverage that offers lower prices, through reduced premiums, but limited choice. Anecdotal evidence to date suggests that the exchange networks are narrower than consumers anticipated, which may leave them vulnerable to the financial burden of out-of-network care for services not adequately covered within network...
The researchers evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experiences during its initial implementation period (July 2011-March 2012). The researchers concluded that the timing of financial incentives in HVBP was not associated with improved quality of care.
As insurers and large employers grapple with how to reign in health care costs, a growing number are turning to reference pricing, a benefit design that limits the amount an insurer will pay for certain health care services. As reported by the Associated Press, the Obama administration recently indicated that the use of reference pricing by large group and self-funded group plans does not violate the Affordable Care Act’s cap on patients’ annual out-of-pocket costs. A current HCFO-funded study is examing the impact of one company's reference pricing program on consumer choice and provider pricing for laboratory and diagnostic imaging services...
During the late 1990s and early 2000s, pay-for-performance (P4P) programs grew in popularity. Given P4P’s increasing popularity, it is important to understand whether P4P is actually associated with improving quality.
- The Doctor Will “See” You Now: States and Researchers Explore the Quality and Value of Telemedicine May 2014
Telemedicine, which involves providing health care services through a variety of electronic mediums including the internet, presents an opportunity to address barriers patients may face in accessing health care. At least fourteen states, including Florida, are considering legislation to increase the use of telemedicine through broader insurance coverage.
- Stability of children’s insurance coverage and implications for access to care: Evidence from the Survey of Income and Program Participation February 2014
Even as the number of children with health insurance has increased, coverage transitions—movement into and out of coverage and between public and private insurance— have become more common. Drawing on HCFO-funded work, this article examines whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, the researchers estimate the relationship between insurance and the probability that a child has at least one physician visit per year.
The Accountable Care Organization (ACO) concept proposed by the Affordable Care Act legislation is based on models developed by Integrated Delivery Systems (IDS). It is widely believed that these organizations reduce costs and improve quality of care through better integration and coordination of services. Although some studies have suggested improved quality of care, the cost savings attributed to these care systems is still uncertain. Drawing on HCFO-funded work, this article attempts to shed light on this issue by analyzing the costs and quality of care in integrated versus non-integrated physician practices.