Policy Research & Analysis

Title	Date
Upcoding in Medicare Advantage Among Dual Medicare-Medicaid Enrollees Medicare Advantage (MA) plans report relatively more diagnoses per enrollee compared with those for similar fee-for-service enrollees, resulting in greater capitation payments. This practice, known as “upcoding,” results in excess government spending. Dual Medicare-Medicaid enrollees have increasingly enrolled in MA plans, some of which are targeted to duals. That duals…	February 5, 2026
Improving Access to Primary Care for Underserved Populations: A Review of Findings from Five Case Studies and Recommendations Strong, accessible primary care improves population health outcomes. It preventsillness and death, and is associated with a reduction in health disparities. TheUnited States falls short on many indicators that demonstrate the strength of anation’s primary care system, and underserved populations in the country experiencesignificant barriers to accessing primary care. In…	January 9, 2025
Household Health Care Payments Under Rate Setting, Spending Growth Target, and Single-Payer Policies Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households. The objective of this study is to estimate the distribution of household health care payments across income under health care reform policies. Cross-sectional study with microsimulation used nationally representative data of the…	January 9, 2025
Patterns and Drivers of Medicare Advantage Enrollment Growth, 2017–2023 In 2024, over half of Medicare enrollees received coverage through MedicareAdvantage (MA) plans (Freed et al 2024a). MA has grown rapidly in the past decade,from about a third of Medicare enrollment in 2015 to over half in 2024. The growth ofMA has important implications for the financial sustainability of the…	January 9, 2025
Assessing the Feasibility and Likelihood of Policy Options to Lower Specialty Drug Costs Specialty drugs are high-cost medications often used to treat complex chronic conditions. Even with insurance coverage, patients may face very high out-of-pocket costs, which in turn may restrict access. While the Inflation Reduction Act of 2022 included policies designed to reduce specialty drug costs, relatively few policies have been enacted…	January 8, 2025
The Effects of Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending A Medicare buy-in program would allow qualifying individuals currently ineligible for Medicare to purchase a Medicare-like health insurance plan. The buy-in would be administered as a distinct program but could take advantage of Medicare's premium structure, benefit design, or provider payment rates (NASI 2020). After comprehensive health reform failed to…	January 5, 2021
Sine Qua Non: A Healthy Nation Requires Real Budget Constraints in All Government Health Programs Every government health program should operate under the same budget constraint that applies to other government programs. Failure to do so represents bad budgeting and economic, social, and health policy; redistributes income in perverse ways; and makes health care allocation extremely inefficient. No excuses for this failure to act—largely centered…	November 4, 2020
Strategies to Advance Insulin Affordability in the United States How did insulin become unaffordable for millions of Americans and what can policymakers do about it? Altarum's new report, Strategies to Advance Insulin Affordability in the United States, answers this question and provides a detailed set of policy proposals to make insulins affordable to patients and payers through federal regulation, market…	September 17, 2020
Private Health Plans Pay Hospitals Much Higher Prices in Indiana than in Michigan: Explanations and Implications Premiums for employer-sponsored health insurance have been growing at a rate well above growth in wages or overall inflation. Excess premium growth, in turn, suppresses wage growth and creates financial hardship for the middle class while, at the same time, reducing government tax revenues and employment. Spending on hospital care…	May 12, 2020
Impacts of Prior Authorization on Health Care Costs and Quality This brief summarizes the use of prior authorization policies for coverage of health care goods and services and reviews the evidence on cost and quality impacts of these policies. Click here to download this report.	November 29, 2019
Assessing Responses to Increased Provider Consolidation in Six Markets: Final Report Few communities in the United States have been exempt from the recent wave of consolidation among health care providers, whether it is hospital-to-hospital mergers and acquisitions (horizontal consolidation) or hospital acquisitions of physician groups and other ambulatory service providers (vertical consolidation). Increased provider concentration has been demonstrated to lead to…	October 28, 2019
Did Medicare Advantage Payment Cuts Affect Beneficiaries Access and Affordability? DISCUSSION The ACA’s cuts to MA payments were expected to reduce the attractiveness of MA to both plans and beneficiaries, primarily through reductions in rebates, thereby decreasing enrollment in the MA plan program.7-9 Instead, MA enrollment steadily increased as the ACA was implemented. Prior research indicates that MA plans…	September 5, 2019
Why Did Medicare Advantage Enrollment Grow as Payment Pressure Increased? Medicare Advantage (MA), also known as Medicare Part C, gives Medicare beneficiaries an option to receive their Parts A and B benefits through private health insurance plans as an alternative to traditional Medicare. MA has been attractive to many Medicare beneficiaries in part because of several enhancements plans typically make…	April 15, 2019
Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities Background. The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate…	February 20, 2019
Assessing Responses to Increased Provider Consolidation in Three Markets: Detroit, Syracuse and Northern Virginia Rising health care prices have increased concerns about hospital and health system consolidation among policymakers, regulators, employers, and other purchasers of health coverage. Although merging hospitals and health systems claim they can achieve greater efficiencies through their consolidation, the economic literature almost universally finds that hospitals that merge have prices…	November 29, 2018
Why Do Medicare Advantage Plans Have Narrow Networks? In contrast to commercial markets, narrow networks in Medicare Advantage (MA) markets are not motivated by unit-price discounts for insurers in exchange for higher patient volume for health systems. Through 15 interviews with MA experts, MA insurers, and health systems, we confirmed that the Medicare fee schedule is the basis…	November 25, 2018
Case Study Analysis: The Detroit Health Care Market Rising health care prices have increased concerns about hospital and health system consolidation among policymakers, regulators, employers, and other purchasers of health coverage. Although merging hospitals and health systems claim they can achieve greater efficiencies through their consolidation, the economic literature almost universally finds that hospitals that merge have prices…	November 15, 2018
Case Study Analysis: The Syracuse Health Care Market Rising health care prices have increased concerns about hospital and health system consolidation among policymakers, regulators, employers, and other purchasers of health coverage. Although merging hospitals and health systems claim they can achieve greater efficiencies through their consolidation, the economic literature almost universally finds that hospitals that merge have prices…	November 14, 2018
Case Study Analysis: The Northern Virginia Health Care Market Rising health care prices have increased concerns about hospital and health system consolidation among policymakers, regulators, employers, and other purchasers of health coverage. Although merging hospitals and health systems claim they can achieve greater efficiencies through their consolidation, the economic literature almost universally finds that hospitals that merge have prices…	October 15, 2018
Insuring Good Health: A Health Insurance Literacy and Navigation Project Since the Affordable Care Act (ACA) was passed in 2010, the U.S. uninsured rate has dropped significantly. Considerable resources have been devoted to outreach and enrollment of the uninsured. A new occupational group, generically called ‘enrollment assisters’ (also known as patient navigators, certified application counselors), was created by the ACA…	October 1, 2018
Comparison of Inpatient Utilization for Traditional Medicaid and Healthy Michigan Recipients in Detroit With the launch of the Healthy Michigan expansion of Medicaid eligibility in April 2014, enrollment in Medicaid in the three-county Detroit area increased quickly. By June 2016, area enrollment in Healthy Michigan reached 279,000, most of them single adult males, and most enrolled in a managed care plan. Healthy Michigan…	January 15, 2018
Emergency Medical Services in Detroit: Progress and Potential Introduction In 2013, the city of Detroit had fewer than 10 working ambulances. A 911 caller with a medical emergency was likely to wait 20 minutes or more for help to arrive, and there was no consistent assessment of data. Emergency medical services (EMS) response and firefighting were completely separate…	May 31, 2017
Health Insurance Challenges in the Post-Affordable Care Act (ACA) Era: a Qualitative Study of the Perspective of Low-Income People of Color in Metropolitan Detroit Abstract Low-income people of color are at risk of remaining uninsured due to a variety of factors. This study examined Affordable Care Act (ACA)-related and other health insurance enrollment experiences, observations, navigation needs, and experiences maintaining health insurance coverage among low-income communities of color in an economically disadvantaged community (Metropolitan…	February 1, 2017
Capital Investment by Detroit-Area Providers Michigan regulates the supply of medical facilities and services through the Certificate of Need (CON) process. Among the activities subject to CON review are construction of new medical facilities, starting certain new services, acquisition of major pieces of equipment, and transfers of ownership. Michigan’s original CON law was enacted in…	December 31, 2016
Changes in Payer Mix and Net Income for Detroit-Area Hospitals The Affordable Care Act expanded health insurance coverage in three significant ways: by increasing eligibility for Medicaid, mandating that individuals have insurance coverage, and providing subsidies to make insurance more affordable. In Michigan, data from the most recent Current Population Survey shows that the percentage of the population without insurance…	December 31, 2016
Financial Impact of Medicaid Expansion for Health Plans Michigan accepted the opportunity to expand Medicaid eligibility under the Affordable Care Act, and the Healthy Michigan program began enrolling recipients in April 2014. Enrollment quickly grew to 600,000 persons with household incomes up to 138% of the Federal Poverty Level. The expansion population generally comprised single adults without children.…	December 31, 2016
Provider Payment Trends and Strategies in the Detroit Area A key element of the Affordable Care Act has been promoting changes in the way Medicare, Medicaid, and private insurers pay hospitals, physicians, and others for the health care services they provide. When the era of managed care began more than 30 years ago, health insurers moved away from the…	December 31, 2016
The Promise and Challenge of Implementing a Community Health Worker Strategy to Reduce Infant Mortality The authors would like to thank: current and past program leadership and support staff; the outstanding team of Community Health Workers who serve as Community Neighborhood Navigators; and the WIN Network program participants who freely and enthusiastically shared their experiences. Detroit has a serious infant mortality problem. Infants die there…	October 25, 2016
Effects of the Affordable Care Act on Health Insurance Coverage in Southeast Michigan Introduction Since the launch of the Affordable Care Act’s (ACA) coverage expansion in 2014, millions of previously uninsured Americans have enrolled in health insurance.[1] The ACA coverage expansion has two primary components: expansion of Medicaid eligibility to low-income adults and financial assistance to help individuals purchase private coverage through the…	July 27, 2016
Effects of the Affordable Care Act on the Health Care Safety Net in Detroit Introduction Since its passage in 2010, the Affordable Care Act (ACA) has introduced a series of health care financing and delivery reforms to expand coverage, invest in health care infrastructure, and implement changes to improve quality and costs. In 2014, the ACA’s coverage expansion began in Michigan through the launches…	July 27, 2016
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 the Cadillac tax, according to…	October 8, 2015
Limiting Tax Breaks for Employer-Sponsored Health Insurance: Cadillac Tax vs. Capping the Tax Exclusion NIHCR Research Brief No. 20 Among the most expensive "but nearly invisible" federal expenditures is the roughly $250 billion1 annual tax break for employer-sponsored health insurance. Under current law, the value of both employer and most employee contributions for health insurance are excluded from employee federal income tax and employer and employee payroll taxes. While…	October 8, 2015
Health Reform 2.0: Alternate State Waiver Paths Under the Affordable Care Act NIHCR Research Brief No. 19 State leaders interested in reforming their health care systems face a dilemma. Every state’s health care system is utterly dependent on funding flows from federal health programs and subsidies in the federal tax system, but federal programs, in some cases, run counter to state political cultures and priorities. Section 1332…	September 24, 2015
Interspecialty Communication Supported by Health Information Technology Associated with Lower Hospitalization Rates for Ambulatory Care-Sensitive Conditions Journal of the American Board of Family Medicine Background: Practice tools, such as health information technology (HIT), can potentially support care processes, such as communication between health care providers, and influence care for so-called ambulatory care-sensitive conditions (ACSCs). Good outpatient care can potentially prevent the need for hospitalization of patients with ACSCs. To date, associations between primary care…	May 15, 2015
Many Families May Face Sharply Higher Costs If Public Health Insurance For Their Children Is Rolled Back Abstract Millions of US children could lose access to public health care coverage if Congress does not renew federal funding for the Children’s Health Insurance Program (CHIP), which is set to expire September 30, 2015—the end of the federal fiscal year. Additional cuts in public coverage for children in families…	April 1, 2015
Bridging the Disconnect Between Patient Wishes and Care at the End of Life NIHCR Policy Analysis No. 12 Most Americans want to die at home, but most die in hospitals or other facilities. Most people care more about quality of life than prolonging life as long as possible, but many receive invasive, life-sustaining treatments that diminish quality of life. Often, the disconnect between patient wishes and actual care…	March 19, 2015
King v. Burwell, CHIP, and Medicaid: What Lies Ahead for Children’s Health Coverage? In Brief The coming months will be important in determining the framework for children’s health insurance coverage. The future availability of tax credits for marketplace coverage under the Affordable Care Act (ACA) in the 34 states that do not have a state-based marketplace (SBM) is in the hands of the…	March 1, 2015
Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle NIHCR Research Brief No. 18 As purchasers seek strategies to reduce high health care provider prices, interest in reference pricing—or capping payment for a particular medical service—has grown significantly. However, potential savings to health plans and purchasers from reference pricing for medical services are modest, according to a new analysis by researchers at the former…	October 9, 2014
Using Electronic Health Records to Support Hospital Medication Reconciliation While electronic health records (EHRs) can help standardize medication reconciliation for hospitalized patients, data quality, technical problems and workflow issues continue to pose challenges, according to a new qualitative study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR). Designed to reduce errors, medication reconciliation is a systematic…	July 29, 2014
Hospital Experiences Using Electronic Health Records to Support Medication Reconciliation NIHCR Research Brief No. 17 Hospitals face increasing pressure to implement medication reconciliation—a systematic way to ensure accurate patient medication lists at admission, during a hospitalization and at discharge—to reduce errors and improve patient outcomes. Electronic health records (EHRs) can help standardize medication reconciliation, but data quality and technical and workflow issues continue to pose…	July 29, 2014
Hospital Outpatient Prices Much Higher than Community Settings for Same 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 Health Care Reform (NIHCR). The average hospital outpatient…	June 26, 2014
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 for identical services provided in a physician’s office or other community-based setting, according to a study by researchers at the former Center for Studying Health System Change (HSC). Using private insurance claims data…	June 26, 2014
Patient Engagement During Medical Visits and Smoking Cessation Counseling JAMA Internal Medicine Importance: Increased patient engagement with health and health care is considered crucial to increasing the quality of health care and patient self-management of health. Objective: To examine whether patients with high levels of engagement during medical encounters are more likely to receive advice and counseling about smoking compared with less…	June 9, 2014
When Medicare Squeezes Payments, Hospital Use Declines for Nonelderly, Too 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 in the journal Health Services Research.The 2010…	May 21, 2014
Cutting Medicare Hospital Prices Leads to a Spillover Reduction in Hospital Discharges for the Nonelderly Health Services Research Objective. To measure spillover effects of Medicare inpatient hospital prices on the nonelderly (under age 65). Primary Data Sources. Healthcare Cost and Utilization Project State Inpatient Databases (10 states, 1995-2009) and Medicare Hospital Cost Reports. Study Design. Outcomes include nonelderly discharges, length of stay and case mix, staffed hospital bed-days,…	May 21, 2014
Putting the Union Label on Health Benefits: Collective Bargaining and Cost-Saving Strategies NIHCR Research Brief No. 15 Historically, collective bargaining has led to comprehensive health benefits with a broad choice of providers, modest enrollee premium contributions and limited patient cost sharing at the point of service. With rising health care costs crowding out wage increases, some labor unions are pursuing measures to slow health care spending growth…	May 7, 2014
Accountable Care Organizations 2.0: Linking Beneficiaries JAMA Internal Medicine There is broad consensus among physicians, hospital and health insurance leaders, and policy makers to reform payment to health care providers so as to reduce the role of fee for service, which encourages high volume, and instead to use systems that reward better patient outcomes, such as bundled payments for…	April 22, 2014
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 example, a knee or hip replacement—the price of the initial inpatient stay explains almost all of the wide variation from hospital to hospital in spending on so-called episodes of care, according to a study by researchers at the former Center for Studying…	February 27, 2014
High-Price Hospitals Bigger but Not Necessarily Better Health Affairs, Web First While higher-price hospitals tend to be bigger, have larger market shares and offer expensive specialized services, they don’t necessarily provide better quality of care than lower-price hospitals, according to a study from the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR) published today as a Web First by Health…	January 29, 2014
Understanding Differences Between High- and Low-Price Hospitals: Implications for Efforts to Rein In Costs Health Affairs, Web First Private insurers pay widely varying prices for inpatient care across hospitals. Previous research indicates that certain hospitals use market clout to obtain higher payment rates, but there have been few in-depth examinations of the relationship between hospital characteristics and pricing power. This study used private insurance claims data to identify…	January 29, 2014
Patients’ Sense of Urgency—Not Convenience—Contributes to Much ED Use HSC Research Brief No. 31 Contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), the people most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National…	December 30, 2013
Privately Insured People’s Use of Emergency Departments: Perception of Urgency is Reality for Patients HSC Research Brief No. 31 Many privately insured people with an urgent medical problem go to hospital emergency departments (EDs) even though they could be treated safely and at lower cost elsewhere. Understanding why insured patients decide to seek care in EDs rather than other settings can help purchasers and payers safely guide patients to…	December 30, 2013
Steering Patients to Lower-Price Hospitals Prompts Others to Lower Prices 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 Health System Change (HSC) for the nonpartisan, nonprofit…	December 4, 2013
The Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer HSC Research Brief No. 30 In the context of high health care costs and wide variation in hospital prices, purchasers are seeking ways to encourage consumers to make more price-conscious choices of providers. The California Public Employees’ Retirement System (CalPERS) in 2011 adopted a strategy—known as reference pricing—to guide enrollees to hospitals that provide hip…	December 4, 2013
How Do Hospitals Cope with Sustained Slow Growth in Medicare Prices? Health Services Research, Early View Objective. To estimate the effects of changes in Medicare inpatient hospital prices on hospitals’ overall revenues, operating expenses, profits, assets, and staffing. Primary Data Source. Medicare hospital cost reports (1996–2009). Study Design. For each hospital, we quantify the year-to-year price impacts from changes in the Medicare payment formula.We use cumulative simulated price impacts as…	October 3, 2013
High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power HSC Research Brief No. 27 Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients are much higher than Medicare payment rates and vary widely across and within markets, according to a study by the Center for Studying Health System Change (HSC) based on claims data for about 590,000 active and retired nonelderly…	September 4, 2013
The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? HSC Research Brief No. 26 As the U.S. health care system grapples with strained hospital emergency department (ED) capacity in some areas, primary care clinician shortages and rising health care costs, urgent care centers have emerged as an alternative care setting that may help improve access and contain costs. Growing to 9,000 locations in recent…	July 11, 2013
Contrary to Conventional Cost-Shifting Wisdom, Lower Medicare Hospital Payment Rates Lead to Lower Rates for Private Payers 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) published in…	May 6, 2013
Scaling Up Payment Reform Pilots Key to Health Care Cost Containment 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 Studying Health System…	May 6, 2013
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 Many policy makers believe that when Medicare constrains its payment rates for hospital inpatient care, private insurers end up paying higher rates as a result. I tested this “cost-shifting” theory using a unique new data set that combines MarketScan private claims data with Medicare hospital cost reports. Contrary to the…	May 6, 2013
Achieving Health Care Cost Containment Through Provider Payment Reform that Engages Patients and Providers Health Affairs, Vol. 32, No. 5 The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of…	May 6, 2013
Hospital Quality Reporting: Separating the Signal from the Noise NIHCR Policy Analysis No. 11 Gaps in hospital safety and quality have prompted public and private payers to push for greater accountability through clinical quality measurement and reporting initiatives, which have grown rapidly in the past two decades. With U.S. health care costs high and rising, purchasers increasingly are seeking to identify high-value hospitals that…	April 24, 2013
Primary Care Workforce Shortages: Nurse Practitioner Scope-of-Practice Laws and Payment Policies NIHCR Research Brief No. 13 Amid concerns about primary care provider shortages, especially in light of health reform coverage expansions in 2014, some believe that revising state laws governing nurse practitioners’ (NP) scope of practice is a way to increase primary care capacity. State laws vary widely in the level of physician oversight required for…	February 27, 2013
Few Americans Switch Employer Health Plans for Better Quality, Lower Costs NIHCR Research Brief No. 12 Less than 2.5 percent of nonelderly Americans in 2010 with employer coverage—about the same proportion as in 2003—initiated a change in health plans to reduce their health insurance costs or get a better quality plan, according to a new national study by the Center for Studying Health System Change (HSC)…	January 31, 2013
Few Americans Switch Employer Health Plans for Better Quality, Lower Costs NIHCR Research Brief No. 12 About one in eight (12.8%) nonelderly Americans with employer coverage switched health plans in 2010—down from one in six (17.2%) in 2003, according to a new national study by the Center for Studying Health System Change (HSC). As was true in 2003, about 5 percent of people with employer coverage…	January 31, 2013
Employer-Sponsored Insurance and Health Reform: Doing the Math NIHCR Research Brief No. 11 Amid concerns that health reform might hasten the ongoing decline of employer health coverage, the calculus of offering coverage will continue to make economic sense for businesses employing most workers (81%) now offered insurance, according to a new national study for the nonpartisan, nonprofit National Institute for Health Care Reform…	December 19, 2012
Employer-Sponsored Insurance and Health Reform: Doing the Math NIHCR Research Brief No. 11 Almost 60 percent of Americans younger than 65 obtain health insurance through an employer, but the proportion is steadily declining, largely because of rising health care costs. The decline in employer coverage has disproportionately affected low-wage workers and those in small firms. Amid concerns that national health reform will hasten…	December 19, 2012
Easier Access to After-Hours Care Linked to Less Emergency Department Use Health Affairs, Web First Patients with problems reaching their primary care practice after hours are more likely to report ending up in the emergency department and going without needed medical care, according to a study by the Center for Studying Health System Change (HSC) published today as a Web First by Health Affairs. Funded…	December 12, 2012
After-Hours Access to Primary Care Practices Linked with Lower Emergency Department Use and Less Unmet Medical Need Health Affairs, Web First One goal of the Affordable Care Act is to improve patients’ access to primary care and the coordination of that care. An important ingredient in achieving that goal is ensuring that patients have access to their primary care practice outside of regular business hours. This analysis of the 2010 Health…	December 12, 2012
Local Public Hospitals: Changing with the Times HSC Research Brief No. 25 Over the last 15 years, public hospitals have pursued multiple strategies to help maintain financial viability without abandoning their mission to care for low-income people, according to findings from the Center for Studying Health System Change’s (HSC) site visits to 12 nationally representative metropolitan communities. Local public hospitals serve as…	November 29, 2012
U.S. Families’ Use of Workplace Health Clinics, 2007-2010 NIHCR Research Brief No. 10 Despite heightened employer interest in workplace clinics as a cost-containment tool, only 4 percent of American families in 2010 reported visiting a workplace clinic in the previous year—the same proportion as in 2007, according to a national study by the Center for Studying Health System Change (HSC). The severe 2007-09…	October 24, 2012
High-Intensity Primary Care: Lessons for Physician and Patient Engagement NIHCR Research Brief No. 9 WASHINGTON, DC—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, accordingto a new qualitative study by the Center for Studying Health System Change (HSC) for the…	October 4, 2012
High-Intensity Primary Care: Lessons for Physician and Patient Engagement NIHCR Research Brief No. 9 To prevent costly emergency department visits and hospitalizations, a handful of care-delivery models offer high-intensity primary care to a subset of patients with complex or multiple chronic conditions, such as diabetes, congestive heart failure, obesity and depression. Early assessments of high-intensity primary care programs show promise, but these programs’ success…	October 4, 2012
Adapting Tools from Other Nations to Slow U.S. Prescription Drug Spending NIHCR Policy Analysis No. 10 Outpatient prescription drugs account for about 10 percent—$259 billion in 2010—of total U.S. health spending. Expiring patents on many of the most commonly prescribed drugs have helped slow the rate of spending growth in recent years, but drug spending is likely to accelerate again as new drugs come to market.…	August 30, 2012
Health Care Safety Net Coordination Grows in Some Communities Health Affairs, Vol. 31, No. 8 Safety net clinics, hospitals and other providers that care for uninsured and low-income people increasingly are seeking ways to coordinate services to increase access, improve quality and reduce costs, according to a study by the Center for Studying Health System Change (HSC) published in the August edition of Health Affairs.…	August 6, 2012
Safety-Net Providers in Some U.S. Communities Have Increasingly Embraced Coordinated Care Models Health Affairs, Vol. 31, No. 8 Safety net organizations, which provide health services to uninsured and low-income people, increasingly are looking for ways to coordinate services among providers to improve access to and quality of care and to reduce costs. This analysis, a part of the Community Tracking Study, examined trends in safety net coordination activities…	August 6, 2012
Small Employers and Self-Insured Health Benefits: Too Small to Succeed? HSC Issue Brief No. 138 Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees’ medical care through self-insurance. Because self-insurance arrangements may offer advantages—such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design—they are…	July 19, 2012
Addressing Hospital Pricing Leverage through Regulation: State Rate Setting NIHCR Policy Analysis No. 9 Although U.S. health care spending growth has slowed in recent years, health spending continues to outpace growth of the overall economy and workers’ wages. There are clear signs that rising prices paid to medical providers—especially for hospital care—play a significant role in rising premiums for privately insured people. Over the…	May 8, 2012
Health Plan-Provider Price Negotiations: Passing the Buck to Employers Health Affairs, Vol. 31, No. 5 Given the negotiating clout of so-called must-have hospitals and physician groups, even dominant health plans are wary of disrupting the status quo by trying to constrain prices, perhaps because insurers can simply pass along higher costs to employers and their workers, according to a study by the Center for Studying…	May 7, 2012
The Growing Power of Some Providers to Win Steep Payment Increases from Insurers Suggests Policy Remedies May be Neededuggests Policy Remedies May be Needed Health Affairs, Vol. 31, No. 5 In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large…	May 7, 2012
Limited Options to Managed 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). Unlike conventional prescription drugs, where spending trends have moderated because of…	April 26, 2012
Limited Options to Manage Specialty Drug Spending HSC Research Brief No. 22 Spending on specialty drugs typically high-cost biologic medications to treat complex medical conditions is growing at a high rate and represents an increasing share of U.S. pharmaceutical spending and overall health spending. Absence of generic substitutes, or even brand-name therapeutic equivalents in many cases, gives drug manufacturers near-monopoly pricing power…	April 16, 2012
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 study by the Center for Studying Health System Change (HSC) published…	April 9, 2012
Hospital Geographic Expansion: The New Medical Arms Race? Health Affairs, Vol. 31, No. 4 The emphasis that hospitals place on cutting-edge technology and niche specialty services to attract physicians and patients has set the stage for health care’s most recent competitive trend: an increased level of targeted, geographic service expansion to “capture” well-insured patients. Researchers conducted interviews in twelve U.S. communities in 2010 and…	April 9, 2012
Great Recession Accelerated Long-Term Decline of Employer Health Coverage NIHCR Research Brief No. 8 Between 2007 and 2010, the share of U.S. children and working-age adults with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform…	March 15, 2012
Great Recession Accelerated Long-Term Decline of Employer Health Coverage NIHCR Research Brief No. 8 Between 2007 and 2010, the share of children and working-age adults in the United States with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by the Center for Studying Health System Change (HSC). The key factor driving the sharp…	March 15, 2012
State Benefit Mandates and National Health Reform NIHCR Policy Analysis No. 8 From requirements that insurers cover prescription drugs to services of chiropractors, state health benefit mandates have a long and controversial history. Critics contend mandates drive up health insurance costs, while advocates assert they ensure access to important care. The 2010 national health reform law requires states to pay for mandated…	February 29, 2012
Health Status and Hospital Prices Key to Regional Variation in Private Spending NIHCR Research Brief No. 7 Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices—especially for hospital care—also play a key role, according to a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health…	February 15, 2012
Health Status and Hospital Prices Key to Regional Variation in Private Health Care Spending NIHCR Research Brief No. 7 Differences in health status explain much of the regional variation in spending for privately insured people, but differences in provider prices—especially for hospital care—also play a key role, according to a study by the Center for Studying Health System Change (HSC) based on claims data for active and retired nonelderly…	February 15, 2012
Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients Community Report No. 12 Indianapolis’ major hospital systems continue to encroach on each other’s traditional territories, engaging in a battle of bricks and mortar in suburban areas to compete for well-insured patients, according to a new Community Report released today by the Center for Studying Health System Change (HSC). The study was funded jointly…	December 30, 2011
Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage NIHCR Policy Analysis No. 7 While there is little debate about a growing primary care workforce shortage in the United States, precise estimates of current and projected need vary. A secondary problem contributing to addressing capacity shortfalls is that the distribution of primary care practitioners often is mismatched with patient needs. For example, patients in…	December 10, 2011
A Third of Adults Discharged from a Hospital Don’t See a Doctor Within 30 Days NIHCR Research Brief No. 6 One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).…	December 8, 2011
Physician Visits After Hospital Discharge: Implications for Reducing Readmissions NIHCR Research Brief No. 6 Public and private payers view reducing avoidable hospital readmissions as a way to improve quality and reduce unnecessary costs. While policy makers have targeted readmissions stemming from poor quality of care during an initial hospital stay, readmissions also can occur when patients don’t receive appropriate follow-up care or ongoing outpatient…	December 8, 2011
Federally Qualified Health Centers Poised for Significant Role in Reform HSC Research Brief No. 21 Tracing their roots to the civil rights movement and the 1960s’ War on Poverty, federally qualified health centers (FQHCs) have grown from fringe providers to mainstays of many local health care system safety nets, according to a study released today by the Center for Studying Health System Change (HSC). With…	November 11, 2011
A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under Reform HSC Research Brief No. 21 Community health centers have evolved from fringe providers to mainstays of many local health care systems. Those designated as federally qualified health centers (FQHCs), in particular, have largely established themselves as key providers of comprehensive, efficient, high-quality primary care services to low-income people, especially Medicaid and uninsured patients. The Center…	November 10, 2011
Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs NIHCR Policy Analysis No. 6 Under national health reform, new federal rules will govern the nongroup and small-group health insurance markets, including a requirement for state-based health insurance exchanges, or marketplaces, to be operational by Jan. 1, 2014. Between now and then, both the federal government and states must make key decisions about the design…	November 9, 2011
Reforming Provider Payment—The Price Side of the Equation New England Journal of Medicine, Vol. 365, No. 14 WASHINGTON , DC—Unless public and private health care payers send consistent signals to providers through payment reform about controlling both the price and quantity of care, they risk working at cross purposes, according to a perspective by Paul B. Ginsburg, president of the Center for Studying Health System Change (HSC),…	October 6, 2011
Reforming Provider Payment—The Price Side of the Equation New England Journal of Medicine, Vol. 365, No. 14 It's pretty basic economics: spending equals price times quantity. For some time, public health care payers, such as Medicare and Medicaid, have focused much of their cost-containment effort on constraining the prices they pay for health care services, which they set administratively. The Affordable Care Act includes additional constraints on…	October 6, 2011
Economic Downturn Strains Miami Health Care System Community Report No. 11 WASHINGTON , DC—Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a new Community Report released today by the Center for Studying Health System Change (HSC).While hospital competition…	September 29, 2011
Economic Downturn Strains Miami Health Care System Community Report No. 11 In September 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Miami to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including representatives of…	September 29, 2011

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Policy Research & Analysis