Findings Brief : Health Care Financing & Organization

Key findings. (1) Significant variation in quality was found among companies providing virtual visits for management of common acute illnesses. (2) Variation in the performance of the telemedicine companies differed by condition. Specifically, variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis than for streptococcal pharyngitis, low back pain, ankle pain, and recurrent urinary tract infection. (3) Mode of communication (videoconference, telephone, or webchat) had no statistically significant effect on completeness of history and physical examination or adherence to key management decision guidelines...

Key findings. (1) ACOs at provider workforce extremes--few primary care providers or many specialists--performed worse on measures of preventive care quality relative to those with more PCPs and fewer specialists. (2) Upfront investment in ACO formation is associated with higher performance in preventive care quality. (3) ACOs with a higher proportion of minority beneficiaries performed worse on disease prevention measures than did ACOs with a lower proportion of minority beneficiaries. (4) ACOs facing barriers to quality performance may benefit from organizational characteristics such as electronic health record capabilities and hospital inclusion in the ACO...

Key findings. (1) Adjusted premiums in the individual market in states with prior approval authority combined with loss ratio requirements were lower in 2010-2013 than premiums in states with no rate review authority or file-and-use regulations only. (2) Adjusted premiums declined modestly in prior approval states while premiums increased in states with no rate review authority or with file-and-use regulations only. (3) The findings suggest that states with prior approval authority and loss ratio requirements constrained increases in health insurance premiums...

Key findings. Five main features of value-based insurance design plans were found to be associated with higher rates of medication adherence: (1) Plans that provide more generous coverage (2) Plans that target high-risk patients (3) Plans that offer wellness programs (4) Plans that do not offer disease management programs (5) Plans that make the benefit available only for medication order by mail.

(1) After controlling for other factors that could explain patient functioning, the researchers found that each additional palliative care visit during the first month of follow-up increases patient functioning. (2) Patient functioning, as measured at the initial visit, is a far stronger predictor of subsequent functioning than are additional palliative care visits. (3) While palliative care may increase patient functioning, initial patient functioning likely limits what may be achieved in an absolute sense...

(1) Through the Choosing Wisely initiative, medical specialty societies identified non-indicated cardiac testing in low-risk patients and short-interval dual-energy X-ray absorptiometry (DXA) or bone density testing as low-value care. (2) Nationally, 13 percent of low-risk Medicare beneficiaries received non-indicated cardiac tests, and 10 percent of DXAs reimbursed by Medicare were administered at inappropriately short intervals. There is significant geographic variation in the provision of these services...

Patients exhibited strong loyalty to their physicians. There was no impact of tiering on whether patients decided to switch away from a physician who they'd seen previously. (2) Tiering affected the choices of patients who were selecting new physicians. When patients visited a doctor for the first time, they were less likely to choose doctors in the bottom or non-preferred tier. (3) Patients of the lowest-ranked physicians were more likely to switch health plans following the introduction of tiered networks...

(1) Study results indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. (2) Three main factors likely combined to weaken program effects: (1) modest size of the incentive; (2) use of rewards only; (3) targeting incentive payments to the group rather than to individuals. (3) The researchers found that, relative to the scorecard and reporting alone, the addition of the Quality Incentive Payment Structure (QIP) was associated with a reduction in quality, a result contrary to the intent of the payment incentive program...

(1) Practices that are physician-owned and practices that use Electronic Health Records (EHRs) have lower nonemergent emergency department (ED) rates and lower emergent-primary care treatable ED rates. (2) Medical practices with more nurse practitioners or physician assistants per physician have higher emergent-primary care treatable ED and higher ambulatory care sensitive (ACS) rates, but their nonemergent ED rates do not differ statistically from those of other practices. (3) The ability to provide and manage accessible, coordinated care declines as medical practices grow larger and more complex...

Key findings. (1) Between 1995 and 2009, growth in Medicare inpatient prices varied widely across hospital markets. Faster growth typically occurred in less urban areas that had a large market share of for-profit hospitals. (2) By 2008-2009, elderly patients were going to the hospital at the same rate as in the mid-1990s, but their stays were much shorter, and they received much more intensive services. (3) Medicare price cuts, largely attributable to the Balanced Budget Act of 1997, were associated with a decrease in the num­ber of elderly discharges and a decrease in the number of staffed hospital beds, highlighting possible effects of hospital price cuts under health reform...

Key findings. (1) Substantial geographic variation exists in Medicare costs, but to determine the source and extent of this variation requires proper accounting for population health differences. (2) While physician practice patterns likely affect Medicare geographic cost variations, population health explains at least 75 to 85 percent of the variations—more than previously estimated. (3) Policy strategies should consider the magnitude of the impact of beneficiary health status on Medicare costs in order to address geographic variation...

Key findings. (1) In 1997, the amount California hospitals billed uninsured patients was more than twice the amount hospitals received from Medicare for the same services. By 2010, billed charges had grown to be five times what Medicare paid, which trans­lated into a gap of more than $10,000 per day in the hospital. (2) Five years after the passage of the state's Hospital Fair Pricing Act, most California hospitals had financial assistance policies in place to make care more affordable for the state's uninsured population...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Key findings. (1) Value-based insurance design (VBID) improves medication adherence by 1 to 3 percent in the first year after implementation (2) Improvements in adherence were sustained and amplified in the second year post-implementation, ranging from 2 to 5 percent (3) Adherence improvements varied ac­cording to VBID participants' baseline adherence, with greatest improve­ments evident in those with poorer baseline adherence

No abstract text is available yet for this article.

Key findings. (1) Zero copayment for generic drugs is the greatest influencer of generic statin utilization. (2) Both higher copayments for generic drugs and lower copayments for competing brands are associated with a decreased probability of using generic statins. (3) Prior authorization and step therapy requirements for brand-name statins are associated with an increased use of generic drugs. (4) Greater use of generic statins should reduce costs for patients, plans, and Medicare.

Key findings. (1) Health care spending, both public and private, accounted for more than 20 percent of family income for families in the lowest-income quintile, but no more than 16 percent for families in any other income quintile. (2) The Affordable Care Act should reduce, but is unlikely to completely eliminate, some of this inequity through its heavy reliance on federal funding for the Medicaid expansion and income-related subsidies for private insurance.

No abstract text is available yet for this article.

No abstract text is available yet for this article.