Research Briefs

Title Date
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…

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…

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.…

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…

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…

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…

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

Health insurance benefit structures, particularly cost-sharing amounts, can either encourage or discourage patients from seeking care. The goal is to strike the right balance so out-of-pocket costs don’t discourage people from getting needed care but do prompt them to consider costs before seeking discretionary care. In 2011, contracts between the…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…

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…