The National Institute for Health Care Reform (NIHCR) contracted with the Center for Studying Health System Change (HSC) between 2009 and 2013 to conduct health policy research and analyses to improve the organization, financing and delivery of health care in the United States. HSC ceased operations on Dec. 31, 2013, after merging with Mathematica Policy Research, which assumed the HSC contract to complete NIHCR projects. Beginning in 2014, NIHCR has contracted with Altarum Institute’s Center for Sustainable Health Spending and others, with a focus on research to improve health in Detroit.

Amanda E. Lechner

Documents & Publications

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…	March 19, 2015
Putting the Union Label on Health Benefits: Collective Bargaining and Cost-Saving Strategies NIHCR Research Brief No. 15 Historically, collective bargaining has led to comprehensive health benefits with a broad choice of providers, modest enrollee premium contributions and limited patient cost sharing at the point of service. With rising health care costs crowding out wage increases, some labor unions are pursuing measures to slow health care spending growth…	May 7, 2014
The Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer HSC Research Brief No. 30 In the context of high health care costs and wide variation in hospital prices, purchasers are seeking ways to encourage consumers to make more price-conscious choices of providers. The California Public Employees’ Retirement System (CalPERS) in 2011 adopted a strategy—known as reference pricing—to guide enrollees to hospitals that provide hip…	December 4, 2013
The Surge in Urgent Care Centers: Emergency Department Alternative or Costly Convenience? HSC Research Brief No. 26 As the U.S. health care system grapples with strained hospital emergency department (ED) capacity in some areas, primary care clinician shortages and rising health care costs, urgent care centers have emerged as an alternative care setting that may help improve access and contain costs. Growing to 9,000 locations in recent…	July 11, 2013
High-Intensity Primary Care: Lessons for Physician and Patient Engagement NIHCR Research Brief No. 9 To prevent costly emergency department visits and hospitalizations, a handful of care-delivery models offer high-intensity primary care to a subset of patients with complex or multiple chronic conditions, such as diabetes, congestive heart failure, obesity and depression. Early assessments of high-intensity primary care programs show promise, but these programs’ success…	October 4, 2012
State Benefit Mandates and National Health Reform NIHCR Policy Analysis No. 8 From requirements that insurers cover prescription drugs to services of chiropractors, state health benefit mandates have a long and controversial history. Critics contend mandates drive up health insurance costs, while advocates assert they ensure access to important care. The 2010 national health reform law requires states to pay for mandated…	February 29, 2012