Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Measuring Consumer Valuation of Limited Provider Networks

Jan. 9, 2015

Keith Marzilli Ericson, Amanda Starc

In a National Bureau of Economic Research Working Paper, Amanda Starc and Keith Marzilli Ericson (Boston University) examine how much consumers value network breadth by measuring and comparing insurance plans, and plan choice, on the Massachusetts health insurance exchange. ‘Limited’ or ‘narrow’ network plans are growing in popularity yet there is currently little evidence on consumer valuation of breadth as a plan attribute. Using data from the Massachusetts exchange and the Massachusetts All-Payer Claims Database, Starc and Marzilli quantify the breadth of insurer-hospital...

The Value of Measuring Value

Dec. 20, 2014

(An edited version of this post appeared in Philly.com)

US health care spending has never grown as slowly as it did last year.

Dwight D. Eisenhower was in the Oval Office when the US government began recording health care spending in 1960.  Since that time, growth in health care spending has never been lower than the 3.6% annual rate reported by researchers from the Centers for Medicare and Medicaid Services a few weeks ago in the journal Health Affairs.

Digital Marketing to Physicians: Policy Lags Behind Practice

Nov. 12, 2014

In a Perspective in today’s New England Journal of Medicine, David Grande, LDI's Co-Director of Health Policy, and colleagues write about new digital forms of pharmaceutical and medical device marketing to physicians. The same technologies that can be used to support clinical practice—such as electronic health records, social media, and mobile applications—can also be used to conduct market research and to market directly to physicians. Grande and colleagues write:

The Payer Perspective on Sovaldi

Oct. 2, 2014

Sovaldi, the $84,000 Hepatitis C drug developed by Gilead Sciences, has sparked controversy while marching toward worldwide sales set to exceed $11 billion in 2014. The blockbuster drug’s price is the main sticking point in the debate: critics argue that the cost is unsustainable and will cause payers to restrict treatment for the estimated 3.2 million patients in the United States who live with Hepatitis C, some of whom will develop liver complications.

Hip Fracture Outcomes: Two New Studies

Jun. 25, 2014

Newly-published studies by Senior Fellows Mark Neuman, Jeffrey Silber, Rachel Werner, and colleagues have direct implications for the management of hip fractures, which afflict more than 300,000 older adults each year.

Ensemble of trees approaches to risk adjustment for evaluating a hospital’s performance

Apr. 29, 2014

Yang Liu, Mikhail Traskin, Scott Lorch, Edward George, Dylan Small

In Health Care Management Science, Dylan Small, Scott Lorch and colleagues discuss different mechanisms of risk adjustment used in hospital performance evaluations. Accurate risk adjustment is critical to the reliable assessment and comparison of hospitals. Hospitals are commonly assessed using evaluations that measure their actual outcomes as compared to their risk-adjusted expected outcomes, which take into account factors like patient mix in order to compare hospitals on a level playing field. The authors propose ensemble of trees approaches as superior alternatives to the logistic...