Improving Care Delivery

Title Date
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…

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…

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…

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…

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…

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…

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…

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…

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…

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,…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

Policy Options to Encourage Patient-Physician Shared Decision Making

NIHCR Policy Analysis No. 5

Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s…

Health Care Provider Market Power

Congressional Testimony

Statement of Paul B. Ginsburg, Ph.D. President,Center for Studying Health System Change Research Director, National Institute for Health Care Reform (NIHCR) Before the U.S. House of Representatives Ways and Means Committee, Subcommittee on Health Hearing on "Health Care Industry Consolidation" Chairman Herger, Congressman Stark and members of the Subcommittee, thank…

Physicians Key to Health Maintenance Organization Popularity in Orange County

Community Report No. 10

In June 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Orange County, Calif., to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

Syracuse Health Care Market Works to Right-Size Hospital Capacity

Community Report No. 9

In October 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Syracuse metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Economic Downturn Slows Phoenix’s Once-Booming Health Care Market

Community Report No. 8

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Phoenix metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations

NIHCR Research Brief No. 5

As policy makers try to jumpstart health information technology (HIT) adoption and use in small physician practices, lessons from independent practice associations (IPAs)—networks of small medical practices—can offer guidance about overcoming barriers to HIT adoption and use, according to a new qualitative study by the Center for Studying Health System…

Key Findings from HSC’s 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

HSC Issue Brief No. 135

Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change’s (HSC) 2010 site visits to 12 nationally representative…

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…

Health Care Certificate-of-Need (CON) Laws: Policy or Politics?

NIHCR Research Brief No. 4

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center…

Lansing’s Dominant Hospital, Health Plan Strengthen Market Positions

Community Report No. 7

In August 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Lansing metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Coordination Between Emergency and Primary Care Physicians

NIHCR Research Brief No. 3

While many proposed delivery system reforms encourage primary care physicians to improve care coordination, little attention has been paid to care coordination for patients treated in hospital emergency departments (EDs). As more people become insured under health reform coverage expansions, ED use likely will increase, along with the importance of…

Greenville & Spartanburg: Surging Hospital Employment of Physicians Poses Opportunities and Challenges

Community Report No. 6

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Greenville-Spartanburg metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Lessons from the Field: Making Accountable Care Organizations Real

NIHCR Research Brief No. 2

Policy makers hope that the development of accountable care organizations (ACOs)—organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population—can improve health care quality and efficiency. An examination of existing provider efforts to improve care delivery illustrates that substantial financial and time investments…

Little Rock Health Care Safety Net Stretched by Economic Downturn

Community Report No. 5

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Little Rock metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care…

Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts

Community Report No. 4

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the northern New Jersey metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health…

Seattle Hospital Competition Heats Up, Raising Cost Concerns

Community Report No. 3

In April 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Seattle metropolitan area to study how health care is organized, financed, and delivered in that community. Researchers interviewed more than 50 health care leaders,…

Comparative Effectiveness Research and Medical Innovation

NIHCR Policy Analysis No. 3

Many believe the renewed U.S. public investment in determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research (CER)—will improve patient care by strengthening the evidence base for medical decisions. A major goal of CER is to encourage the use of effective therapies and discourage…

Cleveland Hospital Systems Expand Despite Weak Economy

Community Report No. 2

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Cleveland metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

State Reform Dominates Boston Health Care Market Dynamics

Community Report No. 1

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Boston metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 50 health care leaders, including…

Detroit: Motor City to Medical Mecca?

Detroit Community Report

In February 2010, a team of researchers from the Center for Studying Health System Change (HSC) visited the Detroit metropolitan area on behalf of the National Institute for Health Care Reform to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 55 health…

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

NIHCR Research Brief No. 1

While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees’ health—customized, integrated, comprehensive, diversified programs strongly linked to a firm’s business strategy and strongly championed by senior leadership and managers throughout the company. Employers that lack the ability…

Health Coverage for the High-Risk Uninsured: Policy Options for Design of the Temporary High-Risk Pool

NIHCR Policy Analysis No. 2

Health Coverage for the High-Risk Uninsured:Policy Options for Design of the Temporary High-Risk Pool By Mark Merlis Among the first tasks required by the recently enacted health reform law is creation of a  temporary national high-risk pool program to provide subsidized health coverage to people who are uninsured because of…

Ginsburg Testifies Before Joint Senate and House Committees in Maryland on Hospital Rate Setting

Testimony

Paul B. Ginsburg, Ph.D., HSC President and research director of the National Institute for Health Care Reform, testified before a joint hearing of the Maryland Senate Finance Committee and House Health and Government Operations Committee on hospital rate setting. Access Ginsburg's testimony

Access to Medical Providers

Title Date
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…

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…

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…

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,…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

Physicians Key to Health Maintenance Organization Popularity in Orange County

Community Report No. 10

In June 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Orange County, Calif., to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

Syracuse Health Care Market Works to Right-Size Hospital Capacity

Community Report No. 9

In October 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Syracuse metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Economic Downturn Slows Phoenix’s Once-Booming Health Care Market

Community Report No. 8

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Phoenix metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Health Care Certificate-of-Need (CON) Laws: Policy or Politics?

NIHCR Research Brief No. 4

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center…

Lansing’s Dominant Hospital, Health Plan Strengthen Market Positions

Community Report No. 7

In August 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Lansing metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Greenville & Spartanburg: Surging Hospital Employment of Physicians Poses Opportunities and Challenges

Community Report No. 6

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Greenville-Spartanburg metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Little Rock Health Care Safety Net Stretched by Economic Downturn

Community Report No. 5

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Little Rock metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care…

Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts

Community Report No. 4

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the northern New Jersey metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health…

Seattle Hospital Competition Heats Up, Raising Cost Concerns

Community Report No. 3

In April 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Seattle metropolitan area to study how health care is organized, financed, and delivered in that community. Researchers interviewed more than 50 health care leaders,…

Cleveland Hospital Systems Expand Despite Weak Economy

Community Report No. 2

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Cleveland metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

State Reform Dominates Boston Health Care Market Dynamics

Community Report No. 1

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Boston metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 50 health care leaders, including…

Detroit: Motor City to Medical Mecca?

Detroit Community Report

In February 2010, a team of researchers from the Center for Studying Health System Change (HSC) visited the Detroit metropolitan area on behalf of the National Institute for Health Care Reform to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 55 health…

Health Coverage for the High-Risk Uninsured: Policy Options for Design of the Temporary High-Risk Pool

NIHCR Policy Analysis No. 2

Health Coverage for the High-Risk Uninsured:Policy Options for Design of the Temporary High-Risk Pool By Mark Merlis Among the first tasks required by the recently enacted health reform law is creation of a  temporary national high-risk pool program to provide subsidized health coverage to people who are uninsured because of…

Care Coordination and Management

Title Date
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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

Policy Options to Encourage Patient-Physician Shared Decision Making

NIHCR Policy Analysis No. 5

Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s…

Physicians Key to Health Maintenance Organization Popularity in Orange County

Community Report No. 10

In June 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Orange County, Calif., to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations

NIHCR Research Brief No. 5

As policy makers try to jumpstart health information technology (HIT) adoption and use in small physician practices, lessons from independent practice associations (IPAs)—networks of small medical practices—can offer guidance about overcoming barriers to HIT adoption and use, according to a new qualitative study by the Center for Studying Health System…

Key Findings from HSC’s 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

HSC Issue Brief No. 135

Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change’s (HSC) 2010 site visits to 12 nationally representative…

Coordination Between Emergency and Primary Care Physicians

NIHCR Research Brief No. 3

While many proposed delivery system reforms encourage primary care physicians to improve care coordination, little attention has been paid to care coordination for patients treated in hospital emergency departments (EDs). As more people become insured under health reform coverage expansions, ED use likely will increase, along with the importance of…

Lessons from the Field: Making Accountable Care Organizations Real

NIHCR Research Brief No. 2

Policy makers hope that the development of accountable care organizations (ACOs)—organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population—can improve health care quality and efficiency. An examination of existing provider efforts to improve care delivery illustrates that substantial financial and time investments…

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

NIHCR Research Brief No. 1

While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees’ health—customized, integrated, comprehensive, diversified programs strongly linked to a firm’s business strategy and strongly championed by senior leadership and managers throughout the company. Employers that lack the ability…

Patient Engagement and Shared Decision-making

Title Date
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…

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…

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…

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…

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…

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…

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…

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…

Policy Options to Encourage Patient-Physician Shared Decision Making

NIHCR Policy Analysis No. 5

Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s…

Lessons from the Field: Making Accountable Care Organizations Real

NIHCR Research Brief No. 2

Policy makers hope that the development of accountable care organizations (ACOs)—organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population—can improve health care quality and efficiency. An examination of existing provider efforts to improve care delivery illustrates that substantial financial and time investments…

Comparative Effectiveness Research and Medical Innovation

NIHCR Policy Analysis No. 3

Many believe the renewed U.S. public investment in determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research (CER)—will improve patient care by strengthening the evidence base for medical decisions. A major goal of CER is to encourage the use of effective therapies and discourage…

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

NIHCR Research Brief No. 1

While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees’ health—customized, integrated, comprehensive, diversified programs strongly linked to a firm’s business strategy and strongly championed by senior leadership and managers throughout the company. Employers that lack the ability…

Prevention and Improving Health

Title Date
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…

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…

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…

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…

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…

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…

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,…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

Policy Options to Encourage Patient-Physician Shared Decision Making

NIHCR Policy Analysis No. 5

Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s…

Health Care Provider Market Power

Congressional Testimony

Statement of Paul B. Ginsburg, Ph.D. President,Center for Studying Health System Change Research Director, National Institute for Health Care Reform (NIHCR) Before the U.S. House of Representatives Ways and Means Committee, Subcommittee on Health Hearing on "Health Care Industry Consolidation" Chairman Herger, Congressman Stark and members of the Subcommittee, thank…

Physicians Key to Health Maintenance Organization Popularity in Orange County

Community Report No. 10

In June 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Orange County, Calif., to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

Syracuse Health Care Market Works to Right-Size Hospital Capacity

Community Report No. 9

In October 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Syracuse metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Economic Downturn Slows Phoenix’s Once-Booming Health Care Market

Community Report No. 8

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Phoenix metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations

NIHCR Research Brief No. 5

As policy makers try to jumpstart health information technology (HIT) adoption and use in small physician practices, lessons from independent practice associations (IPAs)—networks of small medical practices—can offer guidance about overcoming barriers to HIT adoption and use, according to a new qualitative study by the Center for Studying Health System…

Key Findings from HSC’s 2010 Site Visits: Health Care Markets Weather Economic Downturn, Brace for Health Reform

HSC Issue Brief No. 135

Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from the Center for Studying Health System Change’s (HSC) 2010 site visits to 12 nationally representative…

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…

Health Care Certificate-of-Need (CON) Laws: Policy or Politics?

NIHCR Research Brief No. 4

Originally intended to ensure access to care, maintain or improve quality, and control capital expenditures on health care services and facilities, the certificate-of-need (CON) process has evolved into an arena where providers often battle for service-line dominance and market share, according to a new qualitative research study from the Center…

Lansing’s Dominant Hospital, Health Plan Strengthen Market Positions

Community Report No. 7

In August 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Lansing metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care leaders,…

Greenville & Spartanburg: Surging Hospital Employment of Physicians Poses Opportunities and Challenges

Community Report No. 6

In July 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Greenville-Spartanburg metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders,…

Coordination Between Emergency and Primary Care Physicians

NIHCR Research Brief No. 3

While many proposed delivery system reforms encourage primary care physicians to improve care coordination, little attention has been paid to care coordination for patients treated in hospital emergency departments (EDs). As more people become insured under health reform coverage expansions, ED use likely will increase, along with the importance of…

Lessons from the Field: Making Accountable Care Organizations Real

NIHCR Research Brief No. 2

Policy makers hope that the development of accountable care organizations (ACOs)—organized groups of physicians, hospitals or other providers jointly accountable for caring for a defined patient population—can improve health care quality and efficiency. An examination of existing provider efforts to improve care delivery illustrates that substantial financial and time investments…

Little Rock Health Care Safety Net Stretched by Economic Downturn

Community Report No. 5

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Little Rock metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health care…

Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts

Community Report No. 4

In May 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the northern New Jersey metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 40 health…

Seattle Hospital Competition Heats Up, Raising Cost Concerns

Community Report No. 3

In April 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited the Seattle metropolitan area to study how health care is organized, financed, and delivered in that community. Researchers interviewed more than 50 health care leaders,…

Comparative Effectiveness Research and Medical Innovation

NIHCR Policy Analysis No. 3

Many believe the renewed U.S. public investment in determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research (CER)—will improve patient care by strengthening the evidence base for medical decisions. A major goal of CER is to encourage the use of effective therapies and discourage…

Cleveland Hospital Systems Expand Despite Weak Economy

Community Report No. 2

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Cleveland metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including…

State Reform Dominates Boston Health Care Market Dynamics

Community Report No. 1

In March 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study, visited the Boston metropolitan area to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 50 health care leaders, including…

Detroit: Motor City to Medical Mecca?

Detroit Community Report

In February 2010, a team of researchers from the Center for Studying Health System Change (HSC) visited the Detroit metropolitan area on behalf of the National Institute for Health Care Reform to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 55 health…

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

NIHCR Research Brief No. 1

While employer wellness programs have spread rapidly in recent years, few employers implement programs likely to make a meaningful difference in employees’ health—customized, integrated, comprehensive, diversified programs strongly linked to a firm’s business strategy and strongly championed by senior leadership and managers throughout the company. Employers that lack the ability…

Ginsburg Testifies Before Joint Senate and House Committees in Maryland on Hospital Rate Setting

Testimony

Paul B. Ginsburg, Ph.D., HSC President and research director of the National Institute for Health Care Reform, testified before a joint hearing of the Maryland Senate Finance Committee and House Health and Government Operations Committee on hospital rate setting. Access Ginsburg's testimony