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.

Applying Private Plan Rules for Prior Authorization to Traditional Medicare

Jun. 1, 2021

There is broad agreement that there is plenty of wasteful and low-value care in our health care system. But there’s less agreement about how to identify it and even less agreement about what to do about it. Health insurers have taken different approaches to this problem. Some insurers have adopted prior authorization, a managed care tool that requires physicians to obtain insurer approval before performing particular services.

Meeting the Moment at Penn LDI’s Health Reform Conference

May. 25, 2021

"There are decades when nothing happens, and there are weeks when decades happen...that describes what's happening right now,” said Sen. Tom Daschle, at Penn LDI’s recent conference on health care reform. An unusual mix of optimism and pragmatism pervaded the conference sessions, as participants acknowledged the serious ideological divides that threaten any large-scale reforms.

The Future of Value-Based Payment: A Road Map to 2030

Feb. 18, 2021

The 2020s require a new strategy that moves from a short-term focus on testing new payment models to a long-term focus on expanding models that are most likely to generate substantial savings and improve quality. This white paper outlines a new direction for the federal government—primarily through the Centers for Medicare and Medicaid Services (CMS)—to chart over the next decade aimed at completing the transition to a health care system that pays for value and reduced health disparities, rather than high volumes of services.

The Future of Value-Based Payment

Feb. 18, 2021

A decade of innovation and experimentation has failed to transform the health care system to one that pays for value rather than volume. It is now time to reconsider how value-based payment models can generate substantial savings and improve quality and health equity. Experts from the University of Pennsylvania, with input from a national panel of experts, reviewed the effectiveness of past payment reforms implemented by the Centers for Medicare and Medicaid Services (CMS) and made recommendations about how to accelerate and complete the nation’s transformation to value-based payment. This brief summarizes recommendations that provide a path toward widespread adoption and success of alternative payment models, producing better health outcomes for all Americans, reducing wasteful spending, improving health equity, and more effectively stewarding taxpayer funds to support other national priorities.

Regulating Prescription Drug Prices

Feb. 2, 2021

In the perennial debate over drug pricing, U.S. policymakers have proposed lowering domestic prices by tying them in some way to international prices. But policymakers seem less interested in understanding or adapting the regulatory frameworks that produce these lower prices in other countries.

The Effects of the Affordable Care Act on Access and Outcomes of Colon Surgery

Jan. 19, 2021

Ezra S. Brooks, Jason Tong, Catherine W. Mavroudis, Christopher Wirtalla, Giorgos C. Karakousis, Nicole M. Saur, Cary B. Aarons, Najjia N. Mahmoud, Rachel R. Kelz

Abstract [from journal]

Background: Insurance status has been strongly associated with both access to and outcomes of colon resection (CRS). Under the Affordable Care Act (ACA), individual states opted to participate in Medicaid expansion (ME) and adopt essential health benefits (EHB).

Methods: We performed a quasi-experimental difference-in-differences (DID) analysis of 2012-2017 state-level inpatient claims with risk adjustment. We examined frequency of emergent presentation and in-hospital death. Subset analyses


Spillover Effects of Medicare’s Voluntary Bundled Payments for Joint Replacement Surgery to Patients Insured by Commercial Health Plans

Dec. 22, 2020

Amol S. Navathe, Joshua M. Liao, Kristin A. Linn, Yi Zhang, Akriti Mishra, Robin Wang, Claire T. Dinh, Jingsan Zhu, Deborah S. Cousins, Jacob Lindner, Ezekiel J. Emanuel

Abstract [from journal]

Background: Under the Bundled Payments for Care Improvement (BPCI) program, bundled paymtents for lower-extremity joint replacement (LEJR) are associated with 2% to 4% cost savings with stable quality among Medicare fee-for-service beneficiaries. However, BPCI may prompt practice changes that benefit all patients, not just fee-for-service beneficiaries.

Objective: To examine the association between hospital participation in BPCI and LEJR outcomes for patients with commercial insurance or


Engaging Consumers in Medicaid Program Design: Strategies from the States

Dec. 15, 2020

Jane M. Zhu, Ruth Rowland, Rose Gunn, Sarah E. Gollust, David T. Grande

Abstract [from journal]

Context: Consumer engagement early in the process of health care policymaking may improve the effectiveness of program planning and implementation, promote patient-centric care, enhance beneficiary protections, and offer opportunities to improve service delivery. As Medicaid programs grow in scale and complexity, greater consumer input may guide successful program design, but little is known about the extent to which state agencies are currently engaging consumers in the design and implementation of programs and policies, and how

Impact of Medicaid Expansion on Liver-Related Mortality

Dec. 3, 2020

Smriti Rajita Kumar, Sameed Ahmed M. Khatana, David Goldberg

Abstract [from journal]

Background & aims: The Affordable Care Act provided the opportunity for states to expand Medicaid for low-income individuals. Not all states adopted Medicaid expansion, and the timing of adoption among expansion states varied. Prior studies have shown that Medicaid expansion improved mortality rates for several chronic conditions. Although there are data on the association between Medicaid expansion on insurance type among patients waitlisted for a liver transplant, there are no data on its impact on liver


ACA Dependent Coverage & Young Adults with Cancer

Dec. 2, 2020

As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.