LDI Briefs

Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk

Research Brief
Jan. 20, 2016

In this study, LDI Senior Fellow Jeffrey Silber and colleagues at the Children’s Hospital of Philadelphia and the University of Pennsylvania look at how better nurse working environments influence the “value” of care, which is defined as the quality of care relative to the cost of providing it. Past studies of nurse work environments have looked at their impact on either quality or cost, but not on both. This study asks whether selecting hospitals based solely on excellent nursing environments identifies a set of hospitals that display better outcomes and value, a question most relevant to a patient seeking advice on where to go for care.

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

Research Brief
Jan. 15, 2016

To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion. 

ACA-Mandated Elimination of Cost Sharing for Preventive Screening Has Had Limited Early Impact

Research Brief
Dec. 21, 2015

To reduce financial barriers to receiving recommended preventive care, the Affordable Care Act (ACA) eliminated patient cost sharing for many preventive services. This provision, rolled out between September 2010 and January 2011, applies to all private insurance plans and exempts ‘grandfathered plans’. In this study, LDI Senior Fellow Shivan Mehta and colleagues investigated whether this ACA provision has its intended effect on colonoscopy and mammography rates. 

How Nursing Affects Medicare’s Outcome-based Hospital Payments

Data Brief
Nov. 12, 2015

Improving value is one of the central aims of recent and ongoing health care reform. In our last LDI/INQRI Brief, we reviewed the evidence of the role of nurses in increasing the value of health care. In this companion brief, we dig deeper into the three reimbursement strategies that Medicare uses to align hospital financial incentives with quality of care, and we calculate the potential effects of nursing-sensitive quality indicators on hospital payments.

Increasing the Value of Health Care: The Role of Nurses

Issue Brief
Oct. 15, 2015

Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value. 

State Variation in Narrow Networks on the ACA Marketplaces

Data Brief
Aug. 24, 2015

In June, we presented national data from one of the first attempts to measure the size of provider networks in plans sold on the health
insurance marketplaces. We used simple “T-shirt” sizes to categorize networks in a way that could help consumers quickly grasp the
choices they were making. In this Data Brief, we present network sizes summarized up to the level of the state and the rating area.
This analysis should help regulators and consumers assess and understand the trade-off between premiums and network size as we
enter the next open enrollment period.

The Skinny on Narrow Networks in Health Insurance Marketplace Plans

Data Brief
Jun. 23, 2015

The Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. 

The Financial Condition and Performance of CO-OP Plans

Data Brief
Feb. 10, 2015

The liquidation of CoOportunity Health, one of 23 non-profit health insurers created by the Affordable Care Act (ACA) has heightened concerns about the financial condition of the other CO-OP plans. This brief summarizes key data from CO-OPs’ third quarter 2014 National Association of Insurance Commissioners financial reports to state insurance regulators. We review CO-OP funding, enrollment, underwriting results, and rates. The data indicate that CO-OPs varied widely in terms of enrollment, pricing, and underwriting results. Many CO-OPs, including those with relatively high 2014 premium rates, had very little enrollment; others gained substantial enrollment, generally in conjunction with relatively low rates.

Window Shopping on Healthcare.gov and the State-Based Marketplaces: More Consumer Support Needed

Data Brief
Dec. 17, 2014

This data brief examines the window-shopping experience that consumers encountered on each health insurance marketplace website during the first two weeks of the Affordable Care Act's second open enrollment period. The marketplaces have made some progress toward adopting the recommended "Top 5 Rules for Decision Support." Shoppers found plenty of sorting and filtering options, but insufficient information about providers and little true decision support. 

Primary Care Shortages: More Than a Head Count

Issue Brief
Nov. 21, 2014

The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. 

Essential Health Benefits: 50-State Variations on a Theme

Data Brief
Oct. 22, 2014

All qualified health plans under the Affordable Care Act must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. Each state is allowed to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits (such as treatments for autism, infertility, or temporomandibular joint disorders). 

How Did Rural Residents Fare on the Health Insurance Marketplaces?

Data Brief
Aug. 29, 2014

How are rural areas faring with the Affordable Care Act? Has the law fostered competition among plans or have one or two insurers dominated? This Data Brief examines 2014 premiums and finds that residents of rural counties, as a whole, did not face higher premiums than residents of urban counties. However, states with largely rural populations do face fewer choices and higher premiums. These are the states to watch as new issuers enter the marketplaces and 2015 premiums are filed.

Health Insurance Rates and Rate Review

Data Brief
Jun. 27, 2014

Health insurers participating in the new Marketplaces are filing rates for 2015 during the next few months. A few states have already released data on proposed rates. There is substantial economic, policy, and political interest in the magnitude of proposed rate changes. This brief provides background for understanding the economic drivers of proposed rates, state and federal rate review authority, the effects of rate changes on Marketplace enrollees and federal spending on premium credits, and the economic and political dynamics of the rate review and approval process.

Final Enrollment Rates Show Federally Run Marketplaces Make Up Lost Ground at End of Enrollment

Data Brief
May. 29, 2014

This new data brief updates our interim March 2014 findings with enrollment rates at the close of the Affordable Care Act's first open enrollment period. It focuses on enrollment rates by state and type of marketplace, and assesses changes in enrollment rates in the final six weeks. 

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