Research Roundup - October 2016


California Governor Signs Bill to Disaggregate Asian-American Health Data

By Chris Fuchs | NBC News | Sept. 27, 2016

A new California law requires the state Department of Public Health to break down demographic data it collects by ethnicity or ancestry for Native Hawaiian, Asian, and Pacific-Islander groups reports NBC. The bill will better expose disparities in healthcare and will enable researchers, policymakers and advocates to better identify, track and address health disparities that affect specific ethnic groups.


Despite Being Shamed for Overcharging Patients, Hospitals Raised Their Prices, Again

By Lena H. Sun | Washington Post | Oct. 20, 2016

In a study released earlier this year, researchers looked at charges at 20 Florida hospitals during the three months before the negative publicity and again during the same three month period the following year. There was no evidence that negative publicity resulted in any reduction in charges. Instead, the charges were significantly higher following the publicity. In addition, the 20 hospitals studied were less likely than other Florida hospitals to achieve three or more stars in the quality metrics system used by CMS.


New Program Helps Cut Costs in Crisp County

By Emileigh Forrester | WALB News 10 | Oct. 20, 2016

A Rural Hospital Stabilization Grant from the state of Georgia has funded a Mobile Integrated Healthcare Program at Crisp Regional Hospital that has reduced readmissions within 30 days of discharge from 35 to just 4, according to WALB News 10. The results stem from targeting “frequent flyers” -- people who frequently call 911 for non-emergencies -- and by providing unsolicited EMT visits to ensure these patients are taking care of themselves, such as taking their medication properly. The grant is set to expire in December 2016, but the hospital plans to continue the program.


Addressing “Super-Utilizers” with Better Access to Housing

By Ray Cavanaugh | Chicago Tribune | Sept. 2, 2016

The University of Illinois Hospital & Health Sciences System in Chicago is testing a possible solution to “super utilizers” of healthcare  According to the Chicago Tribune. The pilot program puts chronically homeless emergency department users in subsidized housing and to provide them with case managers to help handle a range of needs.  Being a “super-utilizer” isn’t a requirement for the program but participants must be chronically homeless and have severe medical needs.  


Governor Proposes a Rebate to Cushion Insurance Rate Hikes

The new plan, proposed by Governor Mark Dayton, would reduce health insurance premiums by 25 percent for Minnesotans who don’t qualify for subsidies, according to CBS Minnesota. The plan is being introduced after plans were approved for rate increases of 55 percent for 2017.


All-Payer Model Passes in Vermont

By Jess Aloe | Burlington Free Press | Oct. 26, 2016

Vermont’s Green Mountain Care Board approved an all-payer waiver, according to the Burlington Free Press. Under an all-payer model, providers are paid set amounts for care, rather than being paid per test, service or procedure.Proponents believe the initiative will more effectively manage chronic diseases and save VT $10 billion over the next 10 years .


New Virginia Law Requires Payment Estimate for Any Elective Procedure, Test, or Service, When Requested

American Association of Healthcare Administrative Management | July 1, 2016

Hospitals must provide a payment estimate for scheduled elective procedures, tests, or services to patients who request it at least three days in advance of a schedule service, according to the Virginia Chapter of the American Association of Healthcare Administrative Management. The law, which went into effect July 1, 2016,  aims to improve price transparency of medical services. The new law shouldn’t be too burdensome for providers, given that patients must request the information, according to an article in the Journal of Health Care Finance.


Washington Secures Federal Support to Transform Health System, Improve Behavioral Healthcare and Control Costs

Governor’s Office | Oct. 3, 2016

The state of Washington will partner with CMS on a five-year Medicaid demonstration waiver to continue implementing the Healthier Washington plan through regional Accountable Communities of Health. The project is part of Washington’s effort to focus on prevention and proactive management of physical and mental health issues and control costs. The waiver will provide $1.1 billion in funding for these reform strategies and $375 million for services, including supportive housing and supported employment services for Medicaid enrollees.

Different Regions, Different Care: A Report on Procedure Rate Variation in Washington State

Washington Health Alliance | August 2016

The Washington Health Alliance released a report that reveals that a patient’s location can influence the treatment or services he or she receives. The report covers the entire state of Washington and includes results for 22 tests and treatments in five categories (ear/throat, ortho-/neurosurgery, diagnostic tests, obstetrics/gynecology, and special topics). The report also divides results by age range and gender, which can reveal additional variation.

Recent Reports

Employer Health Insurance Costs Growing More Slowly at the Employee’s Expense

Shelby Livingston | Modern Healthcare | Oct. 26, 2016

Employer benefit costs are growing more slowly, likely a result of employees shifting to high deductible health plans, according to Modern Healthcare. Costs to employers increased 2.4 percent in 2016, compared to 3.8 percent in 2015.

Progress in the Adoption of Alternative Payment Models Promoting Quality and Value

Health Care Payment Learning & Action Network | Oct. 25, 2016

About 23 percent of healthcare dollars spent in 2015 were associated with non-fee-for-service arrangements and another 15 percent were for  fee-for-service arrangements that measure quality and value, according to a report by the Health Care Payment Learning & Action Network. Adoption of non-fee-for-service arrangements is anticipated to grow in coming years.

Drug Coupons: Helping a Few at the Expense of Everyone

By Margot Sanger-Katz | New York Times | Oct. 12, 2016

Research suggests that pharmaceutical coupons increase total healthcare spending by encouraging patients to choose more expensive drugs when there are lower-priced substitutes available, according to an article in The New York Times. One study examining 23 pharmaceutical products found that coupons resulted in $700 million to $2.7 billion in additional spending over five years. Those high costs boomerang back to patients in the form of higher insurance premiums. 

Pharmaceutical Industry-Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

By R. Adams Dudley and Philip R. Lee | JAMA Internal Medicine | Aug. 1, 2016

Pharmaceutical marketing gifts from manufacturers to physicians was associated with an increased rate of prescribing branded drugs, according to this article in JAMA Internal Medicine. Similar results were found in an analysis of Massachusetts physicians published a few months earlier in June.

Healthcare Quality: HHS Should Better Align Health Quality Measures

By U.S. Government Accountability Office | Oct. 13, 2016

Only a small proportion of measures are commonly used by public and private payers, according to a recent report published by the GAO. The misalignment is the result of dispersed decision making, variation in reporting systems and a lack in the development of meaningful measures. The misalignment of measures results in administrative burden to providers and can result in quality information that is not comparable.

WHO Recommends Sin Taxes to Combat Obesity

By Sabrina Tavernise | New York Times | Oct. 11, 2016

A report recently released from the World Health Organization (WHO) found that sin taxes can promote healthier lifestyles, according to The New York Times. The report found that reducing the price of fresh fruits 10-30 percent can increase consumption, while increasing the cost of unhealthy products can reduce consumption. These strategies could be key in combating obesity, diabetes and tooth decay.

Narrow Physician Networks Offer Some Premium Relief Compared to Larger Networks

By Daniel Polsky, et al.  | Leonard Davis Institute of Health Economics | Oct. 4, 2016

Restrictive provider networks offer premium relief to consumers; however, there is no significant difference in premium savings when comparing highly restrictive networks and moderately restrictive networks, according to the Leonard Davis Institute of Health Economics. Extremely narrow networks, with fewer than 10 percent of physicians in a service area, reduced premiums by 6.7 percent, or about $212-$339 per year, compared to larger network with 40-60 percent of area physician. The authors note that successful narrow networks must be transparent, adequate and provide cost-savings to consumers. 

Consumer Engagement in Medicaid Accountable Care Organizations: A Review of Practices in Six States

By Kris Wiitala, Margaret Ann Metzger and Ann Hwang | Community Catalyst | September 2016

While six states include some structure for consumer engagement at the state and ACO levels, the format and effectiveness of these structures varies widely, according to a Community Catalyst Center for Consumer Engagement in Health Innovation report. The report reviewed the consumer engagement structures of Medicaid ACOs in six states -- Colorado, Maine, Minnesota, New Jersey, Oregon and Vermont -- and specifically focused on consumer participation at the state policy-making level related to design, implementation, and oversight of each state's ACO program.

Low-Value Healthcare Services in a Commercially Insured Population

By Rachel O. Reid, Brendan Rabideau and Neeraj Sood. | JAMA Internal Medicine | October 2016

A sample of nearly 1.5 million commercially insured patients revealed that 7.8 percent had received one of 28 low-value services, according to a new report from RAND.  The total cost of these services - such as receiving an MRI for uncomplicated headache -- was $32.8 million in 2013.  Previous estimates have only looked at the prevalence of low-value care in the Medicare population.

Guided Care Shows Promising Approach in Caring for Complex Patients

By Martha Hostetter, et al. | The Commonwealth Fund | Oct. 18, 2016

A report released by The Commonwealth Fund highlights an effective approach to care for high-need patients. “Guided care” allows healthcare providers to coordinate care among patients that have multiple chronic conditions.  According to the report, Lahey Health in Massachusetts was able to achieve a 22 percent reduction in hospital admissions using the guided care approach.  

For more background on drug spending, narrow networks, sin taxes, ACOs and more, please visit


The Solutions to America’s Drug Cost Dilemma

By Harris Meyer | Modern Healthcare | Oct. 1, 2016

Despite growing public outrage over high drug costs, the chances of significant federal action to curb drug costs this year or next are slim, according to Modern Healthcare. Although the majority of Americans believe prescription costs are unreasonable, only one drug manufacturer, Allergan, promised to voluntarily limit price hikes to once a year and to single-digit percentages. Most companies have shifted the blame to insurers’ cost-sharing frameworks and some insurers have moved to value-based reimbursement, despite the absence of broadly accepted metrics that measure value.

Mayo Clinic Wants to Rethink How Hospital Quality is Graded

By John Noseworthy | Modern Healthcare | Oct. 22, 2016

Although the Mayo Clinic was one of the few hospitals to receive a five-star rating from CMS’ Hospital Compare ratings, the health system believes measurement programs need to be improved, according to Modern Healthcare. The health system identifies two key areas needing improvements, including differentiating patient conditions based on complexity and the settings of care.  

Rethinking Automatic Insurance Coverage for Preventive Health Care

By Alison Kodjak | Rhode Island Public Radio | Oct. 10, 2016

Experts warn that linking medical recommendations and insurance coverage leads to financial incentives that can corrupt the process of the U.S. Preventive Services Task Force, according to Rhode Island Public Radio. For example, if pharmaceutical and medical device companies can classify a device as a preventative service, customers would be able to access that device or drug at no cost, which would likely increase utilization. This would, in turn, make price increases essentially invisible to customers.

Refining the Framework for Payment Reform

By Robert Berenson, et al. | Urban Institute | September 2016

The LAN framework for classifying current and potential payment methods provides a great starting point, but ignores some critical operational challenges, according to research featured in the Health Affairs Blog. Existing obstacles, such as risk adjustment and the poor reliability of condition coding, must be addressed before introducing new payment models that may magnify the issues.

Five Lessons From 30 Years of Bundled Payments

By Alan Kaplan, et al. | Health Affairs Blog | Oct. 3, 2016

One of the longest-standing bundled payment programs -- UCLA’s kidney transplant bundle -- exemplifies how bundling can improve care coordination, encourage efficient utilization of services and incentivize quality development, according to a Health Affairs blog post. However, providers must be prepared for the added administrative complexity alternative payment models require.