Payment Policy and Benefit Design

Title Date

Balancing Access and Costs: Health Benefit Structures for Privately Insured People

NIHCR Research Brief No. 21

Along with increased spending on physician services, expanded coverage of outpatient physician visits contributed to higher spending on advanced imaging, diagnostic tests, minor procedures and prescription drugs, according to a new study from the nonprofit, nonpartisan National Institute for Health Care ...

Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax Exclusion

NIHCR Research Brief No. 20

The so-called Cadillac tax on high-cost health benefits is only slightly less progressive than capping the tax exclusion on the $250-billion annual tax break for employer health coverage because employers are likely to try and avoid paying either tax by restructuring health benefits, especially under ...

Health Reform 2.0: Alternate State Waiver Paths Under the Affordable Care Act

NIHCR Research Brief No. 19

With current financing of U.S. health care highly dependent on federal health spending and tax subsidies for private insurance, state leaders seeking to take health reform to the next level face the quandary of losing federal funding flows if they act unilaterally to control health care spending, according ...

Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle

NIHCR Research Brief No. 18

Despite heightened interest in reference pricing--or capping payment for a particular medical service--potential savings to health plans and purchasers are modest, according to a new study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Location, Location, Location: Hospital Outpatient Prices Much Higher than Community Settings for Identical Services

NIHCR Research Brief No. 16

Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price or more for identical services provided in a physician’s office or other community-based setting, according to a study from the nonpartisan, nonprofit National Institute for ...

Cutting Medicare Hospital Prices Leads to a Spillover Reduction in Hospital Discharges for the Nonelderly

Health Services Research

When Medicare keeps a tight rein on inpatient hospital payments, hospitals scale back overall capacity, resulting in less hospital use by nonelderly patients—not just elderly patients, according to a study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR) published online ...

Putting the Union Label on Health Benefits: Collective Bargaining and Cost-Saving Strategies

NIHCR Research Brief No. 15

With rising health care costs crowding out wage increases, some labor unions are pursuing cost-saving strategies that shield workers from higher out-of-pocket costs, according to a new qualitative study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Accountable Care Organizations 2.0: Linking Beneficiaries

JAMA Internal Medicine

The failure to formally link Medicare beneficiaries to accountable care organizations threatens to undermine efforts to improve care and control costs, according to an invited commentary by economist Paul B. Ginsburg, Ph.D., published online April 21 in JAMA Internal Medicine .

Inpatient Hospital Prices Drive Spending Variation for Episodes of Care for Privately Insured Patients

NIHCR Research Brief No. 14

When including all care related to a hospitalization--for a knee or hip replacement, for example--the price of the initial inpatient stay explains almost all of the wide spending variation from hospital to hospital on so-called episodes of care, according to a study from the nonpartisan, nonprofit National ...

The Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer

HSC Research Brief No. 30

Along with steering patients to lower-price hospitals, a California Public Employees Retirement System (CalPERS) reference pricing initiative influenced market dynamics by motivating other hospitals to reduce prices for hip and knee replacements, according to a qualitative study by the Center for Studying ...

How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices?

Health Services Research, Early View

On average, hospitals do not appear to make up for Medicare cuts by “cost shifting,” but by adjusting their operating expenses over the long run. The Medicare price cuts in the Affordable Care Act will “bend the curve,” that is, significantly slow the growth in hospitals’ total revenues and ...

The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience?

HSC Research Brief No. 26

Consumer demand for more convenient and timely access to care for illnesses and injuries is a major driver of the rapid growth of urgent care centers across the country, according to a new qualitative study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National ...

Contrary to Cost-Shifting Theory, Lower Medicare Hospital Payment Rates for Inpatient Care Lead to Lower Private Payment Rates

Health Affairs, Vol. 32, No. 5

Contrary to the notion that hospitals charge private payers higher payment rates to offset lower Medicare rates, it turns out the opposite is true—lower Medicare payment rates lead to lower private rates for inpatient care, according to a study by the Center for Studying Health System Change (HSC) ...

Achieving Health Care Cost Containment Through Provider Payment Reform that Engages Patients and Providers

Health Affairs, Vol. 32, No. 5

Scaling up health care payment reform to control costs and improve quality will require both sticks to prod providers from the sidelines and carrots to guide patients to more-efficient, higher-quality doctors and hospitals, according to an article by Paul B. Ginsburg, Ph.D., president of the Center for ...

Hospital Quality Reporting: Separating the Signal from the Noise

NIHCR Policy Analysis No. 11

Amid the proliferation of quality measures, reporting requirements and transparency efforts, purchasers often find it difficult to separate the signal from the noise when determining what hospital quality measures are important, how to interpret and use quality information in a meaningful way, and how ...

High-Intensity Primary Care: Lessons for Physician and Patient Engagement

NIHCR Research Brief No. 9

If fledgling efforts to improve quality and lower costs by focusing extra primary care attention on patients with complex conditions are to succeed, ensuring physicians and patients are on board will be key, according to a new qualitative study by the Center for Studying Health System Change (HSC) for ...

Small Employers and Self-Insured Health Benefits: Too Small to Succeed?

HSC Issue Brief No. 138

While large firms often assume financial risk for enrollees’ medical care through self-insurance, small firms’ growing interest in the practice may pose challenges for policy makers, according to a new qualitative study by the Center for Studying Health System Change (HSC).

Limited Options to Manage Specialty Drug Spending

HSC Research Brief No. 22

Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change (HSC). The study was funded ...

Hospital Geographic Expansion: The New Medical Arms Race?

Health Affairs, Vol. 31, No. 4

Hospitals’ longstanding competitive focus on cutting-edge technology, niche specialty services and amenities to attract physicians and patients has set the stage for the next chapter in hospital competition—targeted geographic expansion into new markets with well-insured people, according to a ...

State Benefit Mandates and National Health Reform

NIHCR Policy Analysis No. 8

While the national health reform law requires states to pay for health benefit mandates that exceed a minimum package of covered services, states' financial liability for mandates is likely to be relatively small, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for ...
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The National Institute for Health Care Reform (NIHCR) contracted with the Center for Studying Health System Change (HSC) between 2009 and 2013 to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States. HSC ceased operations on Dec. 31, 2013, after merging with Mathematica Policy Research, which assumed the HSC contract to complete NIHCR projects.