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.
In November 2013, the HCFO initiative convened health care practitioners, administrators, health services researchers, and policy experts from private sector and government agencies to discuss the implementation status of Medicare’s Hospital Readmissions Reduction Program (HRRP). The HRRP has focused hospitals’ attention on improving efficiency and quality, yet refinements to the program are needed to address implementation challenges.
In a tiered network, health insurers sort providers into tiers based on cost and quality performance, and patients have a financial incentive (they pay lower cost-sharing) to see a provider in a higher performing tier. Cost-efficiency is typically gauged using episode-level costs and utilization, while quality is judged through claims-based process measures, external certification, and, in some cases, use of health information technology. Drawing on HCFO-funded work, this article assesses whether patient choice of physician or health plan was affected by physician tier-rankings.
An article in MedPage Today describes potential changes to the Affordable Care Act's (ACA) medical loss ratio (MLR) requirement in light of the administrative and technical challenges insurers faced during the implementation of health insurance marketplaces. HCFO-funded work has examined the relationship between MLRs and the stability, or destabilization, of insurance markets as well as the potential impact of the ACA MLR requirement on insurers and enrollees in the individual market in each state.
Although health care is one of the largest industries in the United States, 73% of US residents who are ill have difficulty obtaining nonemergency care on nights, weekends, and holidays. Commercial e-visit websites—companies without bricks-and-mortar clinics that use the internet to connect patients to clinicians whom they never meet in person—may address the need for accessible, convenient care. Drawing on HCFO-funded work, this viewpoint explores the potential benefits and challenges of using e-visit websites and possible ways in which the websites, policymakers, and clinicians can respond to these challenges.
Patients suffering from chronic medical conditions and chronic pain are increasingly turning to palliative care as a way to relieve their symptoms and manage their care. In a recent New York Times article, columnist Jane E. Brody explains the benefits of using palliative care to treat chronic pain and the challenges that our medical system faces in making this type of care more widely utilized.