Insurance Reform: Research

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

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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

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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

...

Prior Authorization Requirements for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Across US Private and Public Payers

Research Brief
Mar. 28, 2018

A comprehensive review of prior authorization (PA) requirements for a new class of expensive cholesterol-lowering drugs known as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors has found unusually complex and burdensome demands across public and private insurance plans in the United States. These findings raise concerns that current policies may create undue barriers to care even in medically appropriate patients, particularly since requirements were just as stringent for patients with a genetic condition that creates more clear-cut eligibility for PCSK9 inhibitor treatment.

Do Changes in Post-Acute Care Use at Hospitals Participating in an Accountable Care Organization Spillover to All Medicare Beneficiaries?

Mar. 22, 2018

Amol S. Navathe, Alexander M. Bain, Rachel M. Werner

Abtract [from journal]

Background
While early evidence suggests that Medicare accountable care organizations (ACOs) may reduce post-acute care (PAC) utilization for attributed beneficiaries, whether these effects spill over to all beneficiaries admitted to hospitals participating in ACOs stray is unknown.

Objective
The objective of this study was to evaluate whether changes in PAC use and Medicare spending spill over to all beneficiaries admitted to hospitals participating in the Medicare

...

State-Based Marketplaces Outperform Federally-Facilitated Marketplaces

Issue Brief
Mar. 21, 2018

In response to regulatory changes at the federal level, states that run their own marketplaces have taken steps to stabilize their individual markets. In this comparison of state-based and federally-facilitated marketplaces from 2016-2018, we find that SBMs had slower premium increases (43% vs. 75%), and fewer carrier exits, than FFMs. The total population participating in FFMs declined by 10%, while the enrolled population in SBMs remained largely stable, increasing by 2%. We find that the performance of the ACA marketplaces varies by state and appears to cluster around marketplace types.

State Adoption of Incentives to Promote Evidence-Based Practices in Behavioral Health Systems

Mar. 14, 2018

Rebecca E. Stewart, Steven C. Marcus, Trevor R. Hadley, Brian M. Hepburn, ...

Abstract [from journal]

ObjectiveDespite the critical role behavioral health care payers can play in creating an incentive to use evidence-based practices (EBPs), little research has examined which incentives are used in public mental health systems, the largest providers of mental health care in the United States.

MethodsThe authors surveyed state mental health directors from 44 states about whether they used any...

Characteristics of Hospitals Earning Savings in the First Year of Mandatory Bundled Payment for Hip and Knee Surgery

Mar. 8, 2018

Amol S. NavatheJoshua M. Liao, Yash Shah, Zoe Lyon, Paula ...

In JAMA, Amol Navathe and LDI colleagues Joshua Liao, Paula Chatterjee, Dan Polsky, and Ezekiel Emanuel examine hospital savings and quality results for the first year of the Comprehensive Care for Joint Replacement (CJR) bundled payment program. Since April 2016, Medicare has bundled payments for hip and knee replacements at 799 hospitals through CJR. The program incentivizes quality and cost containment by providing retrospective bonus payments that increase as hospitals exceed their cost and quality benchmarks, or imposing penalties if hospitals fall short. While the CJR...

The Effect of Integration of Hospitals and Post-Acute Care Providers on Medicare Payment and Patient Outcomes

Research Brief
Mar. 6, 2018

Vertical integration between hospitals and skilled nursing facilities (SNFs) increases Medicare payments for the first 60 days of care by $2,424 (17%), compared to hospital-SNF pairs that are not vertically integrated. These integrated hospital–SNF pairs also experience a decline in 30-day rates of rehospitalization or death of 5 percentage points on a base rate of 31.3%. Vertical integration between hospitals and home health agencies (HHAs) has little effect on Medicare payments and patient outcomes, nor does informal integration in either setting.

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