This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service (FFS) enrollees.
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.
The policy community generally has assumed that Medicare Advantage (MA) plans negotiate hospital payment rates similar to those for commercial insurance products and well above those in traditional Medicare. In a HCFO-funded study, Robert Berenson, M.D., Jonathan Sunshine, Ph.D., Emily Lawton, Urban Institute; and David Helms, Johns Hopkins Bloomberg School of Public Health, interviewed senior hospital and health plan executives to understand the negotiating dynamics between MA plans and hospitals, first to confirm that MA plans do pay hospitals at or near traditional Medicare payment rates and then to explain why.
With the goal of lowering health care costs, many policymakers and health care delivery systems are looking to change the way doctors are paid by focusing on quality of care. One innovative approach has been to shift incentives from a fee-for-service (FFS) payment model to a pay-for-performance (P4P) arrangement, under which doctors are rewarded for improving their quality of care. However, to date the financial incentives may not have triggered practices to change individual physician compensation policies. A recent Washington Post Wonkblog article reports findings from a study by former HCFO grantee Andrew Ryan, Ph.D., University of Michigan, on physician compensation in accountable care organizations (ACOs).