HCFO - Grantee Publication

The Impact of Increased Cost-sharing on Utilization of Low Value Services: Evidence from the State of Oregon

cticse — Thu, 15 Dec 2016 19:29:37 +0000

In this HCFO-funded study, the researchers examined the impact of a value-based insurance design (V-BID) program implemented between 2010 and 2013 at a large public employer in the state of Oregon. The program substantially increased cost-sharing, specifically copayments and coinsurance, for several healthcare services believed to be of low value and overused (sleep studies, endoscopies, advanced imaging, and surgeries).

Narrow Provider Networks for Employer Plans

cticse — Thu, 15 Dec 2016 14:31:46 +0000

A frequently noted effect of the insurance market reforms enacted by the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act or ACA) was the emergence of much narrower provider networks than were previously common. These narrow networks are characterized by offering considerably fewer health providers than is typical in the group market, and they are formed primarily based on price discounting. In a HCFO-funded study, Mark A.

A Randomized Trial of Displaying Paid Price Information on Imaging Study and Procedure Ordering Rates

cticse — Fri, 09 Dec 2016 16:27:09 +0000

Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy. The researchers conducted a block randomized controlled trial for one year to examine the effect of displaying paid-price information on test-ordering rates for common imaging studies and procedures within an accountable care organization (ACO).

Determinants of success in Shared Savings Programs: An analysis of ACO and market characteristics

cticse — Fri, 09 Dec 2016 16:07:32 +0000

Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. Using financial performance data from CMS, Medicare claims, and the National Survey of ACOs, the researchers examined ACO and market factors associated with superior financial performance in Medicare ACO programs. They found that in the first year, performance is quite heterogeneous, yet organizational structure does not consistently predict performance.

Association Between Viewing Health Care Price Information and Choice of Health Care Facility

cticse — Tue, 25 Oct 2016 13:35:35 +0000

In the United States, prices for health care services differ dramatically within a single geographic location, often without commensurate differences in quality. Transparency tools that provide price information to help patients identify lower-cost services are a strategy to reduce health care spending.

ACOs Holding Commercial Contracts Are Larger And More Efficient Than Noncommercial ACOs

cticse — Tue, 04 Oct 2016 20:32:38 +0000

Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, the researchers examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). The researchers found that commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores compared to noncommercial ACOs.

How Primary Care Physicians Integrate Price Information into Clinical Decision-Making

cticse — Fri, 02 Sep 2016 18:20:30 +0000

Little is known about how primary care physicians (PCPs) in routine outpatient practice use paid price information (i.e., the amount that insurers finally pay providers) in daily clinical practice. In this HCFO-funded study, the researchers used semi-structured interviews and qualitative analysis to describe the experiences of PCPs who have had paid price information on tests and procedures for at least one year.

Association of Reference Pricing for Diagnostic Laboratory Testing With Changes in Patient Choices, Prices, and Total Spending for Diagnostic Tests

cticse — Tue, 26 Jul 2016 14:00:17 +0000

Prices for laboratory and other clinical services vary widely. Employers and insurers increasingly are adopting “reference pricing” policies to create incentives for patients to select lower-priced facilities. In this HCFO-funded study, the researchers measured the association between implementation of reference pricing and patient choice of laboratory, test prices, patient out-of-pocket spending, and insurer spending.

Variations in Patient Response to Tiered Physician Networks

cticse — Mon, 18 Jul 2016 20:40:58 +0000

Tiered physician networks are a managed care network design used by payers to contain health care costs and improve value in the health care system. Prior studies found that tiered provider networks channel patients to preferred providers in certain contexts. In this HCFO-funded study, the researchers analyzed data from five commercial health plans in Massachusetts to test whether the impact of tiered physician networks varies across different groups of patients.

Use Of Retail Clinics: The Authors Reply

cticse — Fri, 27 May 2016 15:54:59 +0000

This letter is a response to a critique of the researchers' publication, "Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending", published in the March 2016 Health Affairs. The researchers write that they did not find that a small group of "high utilizers" accounted for the majority of the increased visits to retail clinics, likely due to their sampling method. They note that this might change in the future as retail clinics become more popular.