Journal Articles
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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… |
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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… |
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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… |
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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… |
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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… |
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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,… |
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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… |
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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… |
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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… |
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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… |
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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… |
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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… |
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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… |
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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… |
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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… |
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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… |
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Spending to Save—ACOs and the Medicare Shared Savings Program
New England Journal of Medicine, Vol. 364, No. 22 While criticism that the government set the bar too high for accountable care organizations (ACOs) has been fast and furious, the proposed rule for the Shared Savings Program is a wake-up call that Medicare is serious about achieving better care for individuals, better health for populations and lower growth in… |