Findings Brief

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Patient Health Causes Substantial Portion of Geographic Variation in Medicare Costs

Large geographic variations in Medicare costs have long been documented; however, the size and source of this variation has been the subject of dispute. Casemix adjustment, or controlling for area population health, is critical to developing Medicare geographic cost variation estimates, yet there is a lack of consensus on the ideal casemix control method.
 

October 2013
HCFO

Large geographic variations in Medicare costs have long been documented; however, the size and source of this variation has been the subject of dispute.  There are many factors that influence spending per Medicare beneficiary, including, perhaps most importantly, a patient’s health status. Consequently, casemix adjustment, or controlling for area population health, is critical to developing Medicare geographic cost variation estimates.

Protecting Uninsured Patients from High Hospital Charges: Lessons from California

For millions of uninsured Americans, hospital emergency departments (EDs) are one of the few options for medical care, both urgent and non-urgent.  Yet this care may come at a significant price.  Unlike their insured counterparts, uninsured and other “self-pay” patients receive hospital bills based on “billed charges.”

September 2013
HCFO

For millions of uninsured Americans, hospital emergency departments (EDs) are one of the few options for medical care, both urgent and non-urgent.  Yet this care may come at a significant price.  Unlike their insured counterparts, uninsured and other “self-pay” patients receive hospital bills based on “billed charges.”  These charges have risen rapidly over time and now bear little relationship to the actual market prices paid by insured patients.  For the uninsured, high billed charges may translate into a potentially overwhelming financial burde

Florida Hospitals' Volume Response to Medicare's Outpatient Prospective Payment System

The Medicare Outpatient Prospective Payment System (OPPS) was established by the Balanced Budget Act of 1997 as an attempt to simplify and reduce Medicare payments for hospital outpatient services by creating a new fee schedule. HCFO researchers studied the effects of the OPPS on how much outpatient care is provided by Florida hospitals and who pays for it.

Vol. XVI, No. 3
May 2013
HCFO

The Medicare Outpatient Prospective Payment System (OPPS) was established by the Balanced Budget Act of 1997 and went into effect on August 1, 2000. The OPPS was an attempt to simplify and reduce Medicare payments for hospital outpatient services by creating a new fee schedule. In a Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program-funded study, Daifeng He, Ph.D., and Jennifer Mellor, Ph.D., studied the effects of the OPPS on how much outpatient care is provided by Florida hospitals and who pays for it.

Consolidation in Health Plan and Hospital Markets: Implications for Hospital Prices

Over the past two decades, a wave of hospital mergers and acquisitions has resulted in many highly concentrated hospital markets across the United States.  This phenomenon has raised concerns that consolidated hospitals are using their increased bargaining power to secure higher prices from health plans, thereby adding to the nation’s already unmanageable health care costs.

April 2013
HCFO

Over the past two decades, a wave of hospital mergers and acquisitions has resulted in many highly concentrated hospital markets across the United States.  This phenomenon has raised concerns that consolidated hospitals are using their increased bargaining power to secure higher prices from health plans, thereby adding to the nation’s already unmanageable health care costs.  For their part, hospitals and other health care providers point out that consolidation among health plans has also occurred in recent years.  Hospitals warn that health plans’ power to drive d

Value-Based Insurance Design Yields Near- and Long-Term Improvements in Medication Adherence

Medication adherence is critical to the management of chronic conditions. Yet, many patients forgo medication when confronted with unmanageable or rising medication costs, a phenomenon termed cost-related nonadherence.

March 2013
HCFO

Medication adherence is critical to the management of chronic conditions. Yet, many patients forgo medication when confronted with unmanageable or rising medication costs, a phenomenon termed cost-related nonadherence. Value-based insurance design (VBID) is a benefit design strategy that aims to align patient cost sharing with the value of a particular clinical service, often by eliminating or reducing copayments for effective treatments.

HCFO Findings Brief: Program Features and Targeting Are the Keys to Successful Medicare Care Coordination Interventions

Policymakers seeking to slow the growth in Medicare spending are increasingly exploring care coordination interventions involving beneficiaries with multiple chronic conditions.  In a HCFO-funded study, researchers took a closer look at the programs in the Medicare Coordinated Care Demonstration in order to assess which interventions worked and for whom.

December 2012
HCFO

Policymakers seeking to slow the growth in Medicare spending are increasingly exploring care coordination interventions involving beneficiaries with multiple chronic conditions.  In a HCFO-funded study, Randall Brown, Ph.D., Deborah Peikes, Ph.D., and colleagues at Mathematica Policy Research took a closer look at the programs in the Medicare Coordinated Care Demonstration in order to assess which interventions worked and for whom.  The researchers found that while the 11 programs they examined did not reduce hospitalizations among enrollees overall, four of the programs were succ

Encouraging Generic Use Can Yield Significant Savings

Rising prescription drug costs continue to be an issue of importance to patients, health insurers, and the federal government. One popular cost containment solution is encouraging the use of generic drugs over brand-name drugs.

November 2012
HCFO

Rising prescription drug costs continue to be an issue of importance to patients, health insurers, and the federal government. One popular cost containment solution is encouraging the use of generic drugs over brand-name drugs. In general, utilization of generic medication is increasing in the United States. In addition to being lower cost, generic drug utilization is associated with increased medication adherence, which can lead to fewer hospitalizations and emergency department visits.

In Health Care Spending, Americans Who Make the Least Contribute the Greatest Share of Income

Health care costs consume a growing percent of the U.S. gross domestic product, and economic literature has demonstrated that ultimately individuals pay these costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a HCFO-funded study, researchers explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

October 2012
HCFO

Health care costs consume a growing percent of the U.S. gross domestic product, and economic literature has demonstrated that ultimately individuals pay these costs, either through taxes, reduced wages, or direct out-of-pocket and premium payments. In a HCFO-funded study, Patricia Ketsche, Ph.D., Kathleen Adams, Ph.D., and colleagues explored the distribution of the individual family’s financial burden from the combination of public and private health care spending.

Impact of Prior Authorization on Medication Adherence and Health Service Use by Patients with Bipolar Illness in Medicaid

Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy.

September 2012
HCFO

Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy.  Prior authorization is most effective in drug classes with high substitutability. However, for certain conditions, like mental health disorders, drugs are not always readily substitutable. In a HCFO-funded study, Christine Y. Lu, Ph.D., Stephen B.

HCFO Findings Brief: Reducing Prenatal Smoking: The Role of State Policies

July 2012
HCFO

Despite the evidence linking smoking with poor birth outcomes and long term negative health effects for both mothers and children, pregnant women continue to smoke.  One goal of the federally-supported Healthy People 2020 is to reduce the prevalence of cigarette smoking during pregnancy to 1 percent. While most states have instituted more restrictive smoking policies during the past several years, the challenge for policymakers is to identify the right mix of strategies to achieve significant and lasting results. In an HCFO-funded study, E.

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