Insurance Reform: Research

Restricted Provider Choice in the ACA Marketplace

Aug. 8, 2018

On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”

Preferred Pharmacy Networks and Drug Costs

Ashley Swanson, PhD
Aug. 2, 2018

Amanda Starc, Ashley Swanson

ABSTRACT [FROM JOURNAL] 

Selective contracting is an increasingly popular tool for reducing health care costs, but these savings must be weighed against consumer surplus losses from restricted access. In both public and private prescription drug insurance plans, issuers utilize preferred pharmacy networks to reduce drug prices. We show that, in the Medicare Part D program, drug plans with more restrictive preferred pharmacy networks, and plans with fewer enrollees who are insensitive to preferred pharmacy discounts on copays, pay lower retail drug prices. We then use estimates of...

Reimbursement Rates for Primary Care Services: Evidence of Spillover Effects to Behavioral Health

Jul. 30, 2018

Johanna Catherine Maclean, Chandler McClellan, Michael F. Pesko, Daniel Polsky

Abstract [from journal]

We study spillover effects of the largest ever increase in Medicaid primary care reimbursement rates on behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014 through the Affordable Care Act. We apply differences-in-differences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher...

Learning Your Alzheimer’s Risk: Implications for Long-Term Care Insurance

Jul. 25, 2018

In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance.

Redesigning Provider Payment: Opportunities and Challenges from the Hawaii Experience

Jul. 18, 2018

Kevin G. Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B. Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye...

ABSTRACT [FROM JOURNAL]

Objectives: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

Study Design: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the

...

Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs

Jun. 6, 2018

Abstract [from journal]

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals...

Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation

Jun. 6, 2018

Charlene A. Wong, Sajal Kulhari, Ellen J. McGeoch, Arthur T. Jones, Janet Weiner, Daniel Polsky, ...

Abstract [from journal]

Background: The design of the Affordable Care Act’s (ACA) health insurance marketplaces influences complex health plan choices.

Objective: To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison.

Design: In November–December 2016, we examined the

...

What State Legislators Say About Medicaid, and Why It Matters

May. 29, 2018

Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.

The Future of Medicaid: State Legislator Views on Policy Waivers

Research Brief
May. 23, 2018

A survey of state legislators revealed clear partisan differences in Medicaid reform priorities and policy preferences that states are pursuing in Section 1115 waiver applications. While there was some agreement across parties on broad goals for the Medicaid program, such as reducing health care spending and increasing affordability of health care, there was little consensus on specific policy changes needed to meet these goals.

Trends in hospital-SNF relationships in the care of Medicare beneficiaries

May. 17, 2018

Joshua M. Liao, R. Tamara Konetzka, Rachel M. Werner

Abstract [from journal]

Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and...

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

May. 1, 2018

Abstract [from journal]

Background & Aims: Gastrointestinal bleeding results in significant morbidity, mortality, and healthcare costs in the United States. The Center for Medicare and Medicaid Services' payment reform programs assess quality and value based on rates of hospital readmission for patients with gastrointestinal bleeding, but they identify these patients using Medicare Severity Diagnosis Related Groups (MS-DRGs), which include many types of gastrointestinal bleeding and do not account for the clinical heterogeneity among these patients. We aimed...

Being Uninsured in America

Apr. 26, 2018

For the nearly 30 million people in the United States who have no health insurance, gaining access to care and paying for that care can be a challenge.  A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price.

Most Primary Care Physicians Provide Appointments, But Affordability Remains A Barrier For The Uninsured

Apr. 26, 2018

Brendan Saloner, Katherine Hempstead, Karin Rhodes, Daniel Polsky, Clare Pan, Genevieve M. Kenney

Abstract [from journal]

The US uninsurance rate has nearly been cut in half under the Affordable Care Act, and access to care has improved for the newly insured, but less is known about how the remaining uninsured have fared. In 2012–13 and again in 2016 we conducted an experiment in which trained auditors called primary care offices, including federally qualified health centers, in ten

...

Shift in U.S. Payer Responsibility for the Acute Care of Violent Injuries After the Affordable Care Act: Implications for Prevention

Apr. 11, 2018

Abstract [from journal]

Background: Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in

...

Pages