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.

Emily Carrier

Documents & Publications

Title	Date
Privately Insured People’s Use of Emergency Departments: Perception of Urgency is Reality for Patients HSC Research Brief No. 31 Many privately insured people with an urgent medical problem go to hospital emergency departments (EDs) even though they could be treated safely and at lower cost elsewhere. Understanding why insured patients decide to seek care in EDs rather than other settings can help purchasers and payers safely guide patients to…	December 30, 2013
Hospital Quality Reporting: Separating the Signal from the Noise NIHCR Policy Analysis No. 11 Gaps in hospital safety and quality have prompted public and private payers to push for greater accountability through clinical quality measurement and reporting initiatives, which have grown rapidly in the past two decades. With U.S. health care costs high and rising, purchasers increasingly are seeking to identify high-value hospitals that…	April 24, 2013
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
Hospital Geographic Expansion: The New Medical Arms Race? Health Affairs, Vol. 31, No. 4 The emphasis that hospitals place on cutting-edge technology and niche specialty services to attract physicians and patients has set the stage for health care’s most recent competitive trend: an increased level of targeted, geographic service expansion to “capture” well-insured patients. Researchers conducted interviews in twelve U.S. communities in 2010 and…	April 9, 2012
Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients Community Report No. 12 Indianapolis’ major hospital systems continue to encroach on each other’s traditional territories, engaging in a battle of bricks and mortar in suburban areas to compete for well-insured patients, according to a new Community Report released today by the Center for Studying Health System Change (HSC). The study was funded jointly…	December 30, 2011
Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage NIHCR Policy Analysis No. 7 While there is little debate about a growing primary care workforce shortage in the United States, precise estimates of current and projected need vary. A secondary problem contributing to addressing capacity shortfalls is that the distribution of primary care practitioners often is mismatched with patient needs. For example, patients in…	December 10, 2011
Economic Downturn Strains Miami Health Care System Community Report No. 11 In September 2010, a team of researchers from the Center for Studying Health System Change (HSC), as part of the Community Tracking Study (CTS), visited Miami to study how health care is organized, financed and delivered in that community. Researchers interviewed more than 45 health care leaders, including representatives of…	September 29, 2011
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…	September 20, 2011
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…	May 19, 2011
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…	February 24, 2011
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…	January 24, 2011
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…	October 24, 2010
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…	September 29, 2010