Findings Brief


Examining the Impact of Part D on Nursing Home Residents

Vol. XIII, No. 4
May 2010

How did nursing home residents fare following implementation of the Medicare Part D program? Becky Briesacher, Ph.D., University of Massachusetts Medical School, and colleagues examined the experience of nursing home residents transitioning to the Medicare Part D prescription benefit and found that nursing home residents have experienced much more modest gains than community-dwelling beneficiaries since implementation of the program.

Major Illness and Financial Disaster: How Close Is the Connection?

Vol. XIII, No. 3
April 2010

Do the uninsured near elderly experience a significant loss in personal wealth when they experience an adverse health event compared to the insured near elderly? David Dranove, Ph.D., professor at Northwestern University, and colleagues compared the financial experience of insured and uninsured individuals who suffer a major illness and found that uninsured, near-elderly individuals who suffer a new, major illness lose between one-third and one-half of their assets to medical expenses.

What Are the Costs to Physicians of Administrative Complexity in Their Interactions with Payers?

Vol. XIII, No. 2
March 2010

What is the cost of physicians' interactions with health plans? Lawrence P. Casalino, M.D., Ph.D., Weill Cornell Medical College and formerly of the University of Chicago, conducted a national survey of physician practices to estimate both the time spent by physicians in interacting with health plans and the cost of the interactions. The researchers found that the total cost of physicians' interactions with health plans is $31.0 billion per year. For more...

Rehospitalization from Skilled Nursing Facilities: Implications for Policy

Vol. XIII, No. 1
February 2010

Evidence shows that most readmissions after an initial hospitalization are unplanned and avoidable, yet reversing the current pattern is challenging. Vincent Mor, Ph.D., Brown University, and colleagues examined the rehospitalization experience of patients discharged to a skilled nursing facility. They found that incentives are not aligned to ensure a smooth transition across care settings or to reduce the likelihood of rehospitalizations.

HCFO Findings Brief: Health Risk Appraisals: How Sharp is This Tool in Shaping Employee Behavior?

December 2009

Do health risk appraisals (HRAs) improve quality and decrease costs? Meredith Rosenthal, Ph.D., and Haiden Huskamp, Ph.D., at Harvard University, examined whether enrollees in employer-sponsored health insurance who voluntarily participated in HRAs differed in regard to demographic characteristics and utilization of health services from those who chose not to participate and those not offered an HRA. The researchers found that though HRAs have been shown to increase use of medical services, they are unlikely the sole solution to engaging consumers in their health.

Financing American Indian Health Care: Impacts and Options for Improving Access and Quality

Key Findings: 
  • Indian Health Service (HIS) per patient funding is less than half of national per capita health spending, and declined further between 2003 and 2006.
  • Under-funding of the IHS system has led to explicit rationing of services to American Indian/Alaska Native patients, with many specialized services provided only for “life or limb threatening” conditions.
  • IHS patients report experiencing access barriers and rate the quality of care process substantially lower than do Medicaid beneficiaries, but most indicate they prefer to use IHS for their health care.
  • Options to increase the funding for American Indian and Alaska Natives health care exist, but would impose higher costs on federal and state budgets and are unlikely to be feasible in the current economic environment. However, IHS might be able to make certain organizational changes that would increase efficiency and its ability to extend existing funding to cover more services.  
October 2009
Kathryn Langwell, et al.

What are the implications of under-funding the Indian Health Service (IHS) for access to care and quality of care provided to American Indians who reside in rural and frontier areas and depend on the IHS for their health care?

How Valid Are the Assumptions Underlying Consumer-Driven Health Plans?

Key Findings: 
  • While consumer-driven health plans (CDHPs) do encourage information seeking behavior, these plans attract individuals who are already activated consumers.
  • The financial incentives inherent in CDHPs cause consumers to decrease utilization of both high and low priority services.
  • Individuals enrolled in high-deductible CDHPs are most likely to discontinue lipid lowering and antihypertensive drugs after enrolling in a CDHP.
  • There is no significant difference in initiation of generic drug use across health plans, with the exception of antidepressants.
May 2009

Getting Tools Used: Lessons Learned from Successful Decision Support Tools Unrelated to Health Care

Key Findings: 
  • The success of decision support tools outside of health care derives from focusing on decisions important to consumers, tailoring content to consumers’ concerns and needs, and sponsorship by an independent, trusted organization with a business model that supports sustained marketing and refinement.
  • Current approaches to decision support tools within health care will benefit from basing future efforts on a clearer understanding of the interests and capacities of target audiences, as well as providing information that aligns with both the timing and range of decisions health care consumers face. In addition, there must be a thoughtful approach to building consumer trust accompanied by a long-term funding commitment or revenue model that will enable decision support tools to become a familiar, expected aspect of health care.
July 2009

The Provision and Reporting of Community Benefits by Hospitals: Lessons from Maryland

Key Findings: 
  • Most Maryland hospitals experienced a difficult learning curve in 2004 when they were required to begin filing annual reports on community benefit expenditures, but hospital leaders now generally see the reporting requirements to have been beneficial for hospitals.
  • Charity care and health professional education each account for about one-third of community benefit expenditures in Maryland hospitals, and mission-related services around 20 percent.
  • Community benefit accounts for more that 7.2 percent of hospitals’ expenditures on average, with the range from less than two percent to more than 14 percent. Charity care averages 2.1 percent of expenditures, with the range from less than 1 percent to more than 6 percent of expenses.
September 2009

With the advent of new community benefit reporting requirements for nonprofit hospitals nationwide, what lessons can be learned from the experiences of Maryland’s nonprofit hospitals who began reporting community benefit expenditures in 2004? Bradford Gray, Ph.D., and Mark Schlesinger, Ph.D., examined Maryland hospitals’ experiences with this reporting requirement to understand how it worked and to learn what the reports revealed about hospitals’ community benefit expenditures.

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