Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

Assessment Of Receipt Of The First Home Health Care Visit After Hospital Discharge Among Older Adults

Sep. 1, 2020

Jun Li, Mingyu Qi, Rachel M. Werner

Abstract [from journal]

Importance: Home health care is one of the fastest growing postacute services in the US and is increasingly important in the era of coronavirus disease 2019 and payment reform, yet it is unknown whether patients who need home health care are receiving it.

Objective: To examine how often patients referred to home health care at hospital discharge receive it and whether there is evidence of disparities.

Design, setting, and participants: This cross-sectional study used


The Beneficial Effects Of Medicare Advantage Special Needs Plans For Patients With End-Stage Renal Disease

Amole Navathe19-head
Sep. 1, 2020

Brian W. Powers, Jiali Yan, Jingsan Zhu, Kristin A. Linn, Sachin H. Jain, Jennifer Kowalski, Amol S. Navathe

Abstract [from journal]

Patients with end-stage renal disease (ESRD) are a vulnerable population with high rates of morbidity, mortality, and acute care use. Medicare Advantage Special Needs Plans (SNPs) are an alternative financing and delivery model designed to improve care and reduce costs for patients with ESRD, but little is known about their impact. We used detailed clinical, demographic, and claims data to identify fee-for-service Medicare beneficiaries who switched to ESRD SNPs offered by a single health plan (SNP enrollees) and similar


Association Of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, And Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Norma Coe, PhD
Aug. 26, 2020

Sungchul Park, Brent A. Langellier, Robert E. Burke, Jose F. Figueroa, Norma B. Coe

Abstract [from journal]

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the


Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Bruce Kinosian, MD
Aug. 3, 2020

Jennifer M. Reckrey, Mia Yang, Bruce Kinosian, Evan Bollens-Lund, Bruce Leff, Christine Ritchie, Katherine Ornstein

Abstract [from journal]

Millions of older Americans are homebound and may benefit from home-based medical care. We characterized the receipt of this care among community-dwelling, fee-for-service Medicare beneficiaries ages sixty-five and older surveyed in the National Health and Aging Trends Study between 2011 and 2017. Five percent of those surveyed received any home-based medical care between 2011 and 2017 (mean follow-up time per person was 3.4 years), and 75 percent of home-based medical care recipients were homebound. Only 11 percent of the total


Public Insurance Expansions And Mental Health Care Availability

Aug. 1, 2020

Elson Oshman Blunt, Johanna Catherine Maclean, Ioana Popovici, Steven C. Marcus

Abstract [from journal]

Objective: To provide new evidence on the effects of large-scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid.

Data source/study setting: The National Mental Health Services Survey (N-MHSS) 2010-2018.

Study design: A quasi-experimental differences-in-differences design


Overlap Between Medicare's Comprehensive Care For Joint Replacement Program And Accountable Care Organizations

Jul. 22, 2020

Joshua M. Liao, Eric Z. Shan, Yueming Zhao, Yash Shah, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Background: Overlap between Medicare's Comprehensive Care for Joint Replacement (CJR) model and accountable care organizations (ACOs) may result in positive or negative synergies. In this study, we describe the overlap between the programs at the beneficiary and hospital levels.

Methods: We conducted a retrospective study of patient and hospital characteristics using data from 2016 Medicare claims, the US Census Bureau, the American Hospital Association annual survey, Hospital Compare, and the


Clinical Supervision In Community Mental Health: Characterizing Supervision As Usual And Exploring Predictors Of Supervision Content And Process

Rinad Beidas, PhD, U of Penn
Jul. 15, 2020

Simone H. Schriger, Emily M. Becker-Haimes, Laura Skriner, Rinad S. Beidas

Abstract [from journal]

Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community


Economic Implications Of Chinese Diagnosis-Related Group–Based Payment Systems For Critically Ill Patients In ICUs

Jul. 1, 2020

Zhaolin Meng, Yanan Ma, Suhang Song, Ye Li, Dan Wang, Yafei Si, Ruochen Sun, Ruochen Zhang, Hao Xue, Limei Jing, Huazhang Wu

Abstract [from journal]

Objectives: To evaluate the economic implications of payments based on Chinese diagnosis-related groups for critically ill patients in ICUs in terms of total hospital expenditure, out-of-pocket payments, and length of stay.

Design: A pre-post comparison of patient cohorts admitted to ICUs 1 year before and 1 year after Chinese diagnosis-related group reform was undertaken. Demographic characteristics, clinical data, and


What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Payment and Pricing Decisions in Health Care Reform

Issue Brief
Jun. 23, 2020

Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?

Setting Standards for Affordable Health Care

Issue Brief
Jun. 16, 2020

In the run-up to the presidential election, the affordability of health care remains a top concern of the American voting public. But how do we know when health care is affordable? On a policy level, how do we set a standard for affordability that can be implemented in a reformed system? Sometimes policy debates about affordability focus only on whether insurance premiums are affordable, although consumers tend to be concerned about both premiums and out-of-pocket costs. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers, policy experts, and consumer advocates discussed and debated affordability in theory and practice. This issue brief summarizes the panel’s insights.

Association of State Medicaid Expansion With Hospital Community Benefit Spending

May. 29, 2020

Genevieve P. Kanter, Bardia Nabet, Meredith Matone, David M. Rubin

Abstract [from journal]

Importance: Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.

Objective: To examine changes in nonprofit hospital spending on...