Grantee Publication

Efforts to inject greater price transparency into healthcare continue to gain momentum. While insurers and private companies have tended to lead these efforts, what role can practice and hospital administrators play in increasing price transparency? Public Agenda, with support from the Robert Wood Johnson Foundation, recently conducted a national survey to explore the knowledge, behaviors and attitudes of consumers regarding price information in healthcare.

Physician practices are increasingly integrating with hospitals. For physicians, the expansion of accountable care organization contracts, centered on clinicians taking responsibility for population spending and quality, makes independent practice more challenging. For hospitals and health systems, acquiring practices helps them control referral patterns, coordinate care, and improve their bargaining power with payers.

The Medicare Hospital Readmissions Reduction Program (HRRP), an initiative of the Affordable Care Act, imposes considerable financial penalties on hospitals with excess thirty-day readmissions for patients with selected high-volume conditions. The researchers investigated the intended impact of the program by examining changes in thirty-day readmissions among Medicare patients admitted for three conditions targeted by the program in New York State, compared to Medicare patients with other conditions and with privately insured patients, before and after the program’s introduction.

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums.

Increasingly, policy makers and health services researchers are interested in measuring prices of health care services and understanding how the price of services varies as a function of quality, market structure, managed care penetration, public payer prices, and other factors. Before any conclusions can be reached about determinants of price, price measures must be constructed and their construct validity assessed. This Methods Brief explores different approaches to measuring price, presenting tradeoffs and considerations for various empirical settings.

To make smart choices about their health care, individuals need accurate and timely information about quality and price. States have broad responsibilities for the regulation of health insurance and the provision of medical care and are also major purchasers of health care for their employees. Thus, states have important roles in fostering price transparency. Drawing on RWJF-funded work, this commentary explores how states can reduce gaps in information about health care prices and support conversations between physicians and patients.

In 2012, a total of 32 organizations entered the Pioneer accountable care organization (ACO) program, in which providers can share savings with Medicare if spending falls below a financial benchmark. Performance differences associated with characteristics of Pioneer ACOs have not been well described. Drawing on HCFO-funded work, this article compares per-beneficiary Medicare spending and performance on several quality measures between Pioneer ACOs and local nonparticipating providers before versus after the start of Pioneer ACO contracts in 2012.

As Americans shoulder more health care costs, Public Agenda research suggests that many are hungry for more and better price information. This report finds that a majority of Americans have tried to find information about health care prices before getting care, including 21 percent who have compared prices across multiple providers. This report presents findings from a nationally representative survey of 2,010 U.S. adults (ages 18+), conducted via telephone and online during the summer of 2014. Most of those who have compared prices say they saved money.

Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation’s Choosing Wisely initiative. The researchers used Medicare data from 2006 to 2011, to develop claims-based algorithms and estimate the prevalence of 11 Choosing Wisely low-value services. The researchers used the results of their study to examine the demographic health and health care system correlates of low-value care at a regional level.

Concerns about unsustainable costs in the US Medicare program loom as the number of retirees increase and experience serious and costly illnesses like cancer. Engagement of stakeholders, particularly cancer patients and their families, in prioritizing insured services offers a valuable strategy for informing Medicare coverage policy. Drawing on HCFO-funded work, this article examines how better information about the priorities of patients and family members dealing with cancer can be elicited using participatory decision tool processes.