HCFO Year in Review
Supporting Innovative Studies
Informing Policy and Practice
The end of the year offers an ideal opportunity to take stock. Did the investments we made in 2011 through the Robert Wood Johnson Foundation’s HCFO program have an impact? Did our work matter? Did we do our part to improve health and health care in this country?
The answer is yes. Our investments do make an impact, our work – your work – matters and each of us is doing what we can to provide the evidence policymakers need to improve health and health care in this country.
HCFO’s impact is evident across a variety of dimensions. One is its longevity as a unique funding vehicle for researchers who seek to conduct studies on the financing and organization of care. Another is the resource HCFO provides for investigator initiated research. External evaluators of the program report that “HCFO is a popular program that would leave a large gap or void in the field of health policy research if it were not available.” The grants we fund are critical to our effort to inform policy and practice. Another dimension of our impact is our ability to bring the research and policy communities together through various convening activities. This bridging function provides a unique and valuable service, educating researchers about policy needs and policymakers about the most current and relevant evidence. Finally, we move that evidence forward through a variety of dissemination strategies, ensuring that evidence is communicated broadly to the decision-makers who need it and the research community who will build upon it.
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Supporting Innovative Studies
A distinctive feature of HCFO is its emphasis on investigator-initiated studies. The four studies we funded this year span a breadth of issues on the health care landscape: costs control, the implication of different organizational and payment strategies on quality and value, and the potential to extract lessons from state based policies.
With the movement toward greater consolidation in the health care industry, questions have surfaced about the potential negative consequences of this trend. In response to a clear need for current information on health care market contraction, HCFO has funded Brad Herring, Ph.D., Johns Hopkins University, to examine the impact of hospital-market concentration on price competition in insurance markets.
There has also been growing interest in the role of end of life care in one’s disease trajectory and its attendant costs and benefits. To help inform policy discussions, HCFO funded Don Taylor, Ph.D., Duke University, to conduct a study identifying the use, cost and quality tradeoff in the Medicare hospice benefit.
Even as new cost control strategies are developed, current strategies can help inform decision- making. Jennifer Mellor, Ph.D., College of William and Mary, is currently working on a study examining the impact of the outpatient prospective payment system on hospitals’ Medicare volume and out-patient care.
Similarly, as federal decision makers work to implement reforms at a national level, they often look to states’ previous experiences for lessons. In a new HCFO grant, Glenn Melnick, Ph.D., Public Health Institute, looks to California’s experience as he examines the impact of fair-pricing regulations and government subsidies on the costs of hospital services for the uninsured.
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Informing Policy and Practice
A unique feature of the HCFO program is its ability to quickly respond to the information needs of policymakers and practitioners. This year, HCFO hosted a meeting of expert researchers, policymakers, insurers, actuaries, and analysts to discuss insurance pricing in the individual and small group markets. The meeting was particularly timely in light of various health reform provisions and the development of related insurance regulations. The group explored how rate review, medical loss ratio requirements, risk adjustment, risk corridors and other factors were likely to shape premiums and market dynamics.1
Critical to informing policy is the underlying information used to respond to research gaps. This year, HCFO launched the first in a series of webinars designed to help inform the research community about the benefits and challenges of using various data sets. In September, HCFO hosted a webinar focused on best practices for obtaining and using Medicare data. Two experienced HCFO researchers, Jack Hoadley of Georgetown University and Jim Reschovsky of the Center for Studying Health System Change, shared their accumulated wisdom in securing and working with Medicare data. Barbara Frank from the Research Data Assistance Center (ResDAC) at the University of Minnesota provided additional resources, tips, and guidance drawn from her organization’s role as a CMS contractor assisting researchers. The webinar drew more than 400 participants.2 Events such as these broaden our reach to new and diverse audiences who may be less familiar with the HCFO program.
One of HCFO’s most notable activities is its grantee briefings, which are designed to promote timely communication of research to policymakers. Policymakers are invited to attend a briefing of a grantee’s pre-publication findings. This “early look” at evidence that can help to inform their decision-making. The briefings often serve as a networking opportunity and a starting point for future connections between the policymakers and researchers, who may serve as an expert resource.
In 2011, five HCFO grantees presented their findings to invited audiences of policymakers, researchers, and other participants. These briefings are uniformly praised as highly useful events, both from the perspective of the grantee who is able to refine analyses based on feedback from the discussion, as well as from the perspective of those in attendance. The grantees who presented findings this year were:
- Jeffrey McCullough, Ph.D., The Effect of Health IT on Quality, March 11, 2011
- Matthew Maciejewski, Ph.D., The Patient and System Benefits of Value-Based Insurance Design, May 16, 2011
- Ateev Mehrotra, M.D., The Impact of Retail Clinics on Overall Utilization of Care, November 17, 2011
- Jack Hoadley, Ph.D., Impact of State Policies Supporting Medicare Part D for the Dually Eligible and Cindy Park Thomas, Ph.D., Impact of State Policies Supporting Medicare Part D for the Dually Eligible, December 8, 2011
HCFO grantees were highly successful last year in publishing their work; 27 publications appeared in peer-reviewed journals, including Health Affairs, the Journal of the American Medical Association, and the New England Journal of Medicine, as well as grey literature commonly used by policymakers.
- Ashwood, J.S. et al. “Trends in Retail Clinic Use Among the Commercially Insured,” American Journal of Managed Care, Vol. 17, No. 11, November 2011, pp. e443-e448.
- Jacobson, M. et al. “Geographic Variation in Physician’s Responses to a Reimbursement Change,” NEJM, Vol. 365, No. 2, December 1, 2011, pp. 2049-2052
- Hsia, R. and Shen, Y. “Rising Closures of Hospital Trauma Centers Disproportionately Burden Vulnerable Populations,” Health Affairs, Vol. 30, No. 10, October 2011, pp. 1912-1920
- Zuckerman, S. et al. “Undocumented Immigrants, Left Out of Health Reform, Likely to Continue to Grow As Share of the Uninsured,” Health Affairs, Vol. 30, No. 10, October 2011, pp. 1997-2004.
- Ketsche, P., Adams, K.E., et al. “Lower-Income Families Pay a Higher Share of Income Toward National Health Care Spending Than Higher-Income Families Do,” Health Affairs, Vol. 30, No. 9, September 2011, pp. 1637-1646
- Melnick, G., Shen, Y., et al. “The Increased Concentration of Health Plan Markets Can Benefit Consumers Through Lower Hospital Prices,” Health Affairs, Vol. 30, No. 9, September 2011, pp. 1728-1733
- Prentice, J.C. et al. “Primary Care and Health Outcomes Among Older Patients with Diabetes,” Health Services Research, August 2011, published online.
- Morra, D. et al. "US Physician Practices Versus Canadians: Spending Nearly Four Times as Much Money Interacting with Payers,” Health Affairs, Vol. 30, No. 8, August 2011, pp. 1443-1450
- Mays, G.P. and S.A. Smith. “Evidence Links Increase in Public Health Spending to Declines in Preventable Deaths,” Health Affairs, July 2011 Web First.
- Gilmer, T.P. and Kronick, R.G. “Differences in the Volume of Service and In Prices Drive Big Variations in Medicaid Spending Among U.S. States and Regions,” Health Affairs, Vol. 30, No. 7, July 2011, pp. 1316-1324
- Wallace, N.T. et al. “The Individual and Program Impacts of Eliminating Medicaid Dental Benefits in the Oregon Health Plan,” American Journal of Public Health, June 16, 2011, Published Online, pp. e1-e7
- Pizer, D. and J. Prentice. “Time is Money: Outpatient Waiting Times and Health Insurance Choices of Elderly Veterans in the United States,” Journal of Health Economics, May 2011, published online.
- Shen, Y. and R. Hsia. “Association Between Ambulance Diversion and Survival Among Patients with Acute Myocardial Infarction,” JAMA, Vol. 305, No. 23, June 12, 2011, pp. 2440-2447.
- Hadley, J. et al. “Medical Spending and the Health of the Elderly,” Health Services Research, May 24, 2011, published online.
- Stuart, B. et al. “Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes?” Health Services Research, Vol. 46, No. 4, July 2011, pp. 1180-1199.
- Hsia, R.Y., Kellerman, A.L. and Shen, Y. “Factors Associated with Closures of Emergency Departments in the United States,” JAMA, Vol. 305, No. 19, May 18, 2011, pp. 1978-1985
- Baum, N.M. et al. “Resource Allocation in Public Health Practice: A National Survey of Local Public Health Officials,” Journal of Public Health Management and Practice, Vol. 17, No. 3, April 2011, pp. 265-274.
- Frakt, A.B. “How Much Do Hospitals Cost Shift? A Review of the Evidence,” Milbank Quarterly, Vol. 89, No. 1, April 2011.
- Abraham, J.M. and P. Karaca-Mandic. “Regulating the Medical Loss Ratio: Implications for the Individual Market,” American Journal of Managed Care, Vol. 17, No. 3, March 2011, pp. 211-218.
- Varda, D. “Data-Driven Management Strategies in Public Health Collaboratives,” Journal of Public Health Management and Practice, Vol. 17, No, 2, March/April 2011, pp. 122-132.
- Reschovsky, J.D., et al. “Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries,” Health Services Research, Vol. 46, No. 4, July 2011, pp. 997-1021.
- Schur, C.L., et al. “Local Public Health Capacities to Address the Needs of Culturally and Linguistically Diverse Populations,” Journal of Public Health Management and Practice, Vol. 17, No, 2, March/April 2011, pp. 177-186.
- Galbraith, A.A., et al. “Nearly Half of Families in High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden,” Health Affairs, Vol. 30, No.2, February 2011, pp. 322-331.
- Lu, C.Y., et al. “Association Between Prior Authorization for Medications and Health Service Use by Medicaid Patients with Bipolar Disorder,” Psychiatric Services, Vol, 62, No. 2, February 2011, pp. 186-193.
- Kralewski, J.E., et al. “Differences in the Cost of Health Care Provided by Group Practices in Minnesota,” Minnesota Medicine, February 2011.
- Hsia, R. and Shen, Y. “Possible Geographic Barrier to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communities,” Archives of Surgery, Vol. 146, No. 1, January 2011, pp.46-52.
- Mor, V. and Besdine, R.W. “Policy Options to Improve Discharge Planning and Reduce Rehospitalization,” JAMA, Vol. 305, No. 3, January 19, 2011, pp. 302-303.
To ensure that the work of our grantees reaches a broad range of audiences, staff members prepare briefs summarizing the key findings from HCFO-supported studies. In 2011, the following briefs and reports were published on the HCFO website:
- Families with Chronic Conditions in High-Deductible Health Plans Facing Substantial Financial Burden, Vol. XIV, No. 1, March 2011
- Regulating the Medical Loss Ratio: Implications for the Individual Market, Vol. XIV, No. 2, April 2011
- A Review of the Evidence on Cost-Shifting, Vol. XIV, No. 3, May 2011
- Does Medication Adherence Lower Medicare Spending Among Beneficiaries with Diabetes, Vol. XIV, No. 4, July 2011
- Consequences of SCHIP Expansions for Household Wellbeing, Vol. XIV, No. 5, August 2011
- The Individual and Program Impacts of Eliminating Medicaid Dental Benefits in the Oregon Health Plan, Vol. XIV, No. 6, September 2011
- Association between Ambulance Diversion and Survival Among Patients with Acute Myocardial Infarction, Vol., XIV, No. 7, October 2011
- Compared to Canadians, U.S. Physicians Spend Nearly Four Times as Much Money Interacting with Payers, Vol. XIV, No. 8, November 2011.
Grantees work and areas of expertise were also featured in monthly “hot topics” (http://www.hcfo.org/publications/hot-topics) and “grantee spotlights” (http://www.hcfo.org/spotlights) published on the HCFO website.
Grantees as a Resource for Decision Makers
In addition to publishing their findings, HCFO grantees serve as resources transmitting information directly to policymakers and other stakeholders by participating in interviews and in-person and phone communications, conducting commissioned work, providing testimony, synthesizing a body of work, serving on expert panels, and engaging in other activities that create a bridge between research and policy. HCFO grantees have made informal presentations to policymakers at the Office of the Assistant Secretary for Planning and Evaluation and the Centers for Medicare and Medicaid Services, and Congressional support agencies like MedPAC, the United States Government Accountability Office, the Congressional Research Service, and the Congressional Budget Office.
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Mindful of our mission to be relevant to policy, HCFO had ample opportunity and success moving knowledge to action in 2011. Through the grants we funded, the meetings we conducted, and the publications we supported, HCFO demonstrated its value to policymakers and to the health services research field at large.
At this critical juncture in the health care environment, solutions are needed to resolve the multitude of challenges associated with cost, access and quality. Looking ahead to 2012, HCFO will explore new ways to identify the needs of the policy community and support timely, relevant research to inform decisionmaking. We continue to encourage new investigators who seek to build on an existing body of work or develop an innovative line of research to consider HCFO as a funding source. We will do our part to develop new pathways for translating research for policymakers, including social networking tools.
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1. Shore, K. “Considerations Related to Pricing Individual and Small Group Health Insurance Under Health Reform,” HCFO Issue Brief, July 2011 http://www.hcfo.org/files/hcfo/HCFO%20Policy%20Brief%20July%202011.pdf
2. A recording of the webinar is available at http://www.academyhealth.org/Training/ResourceDetail.cfm?ItemNumber=7764