Center for Studying Health System Change

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Addressing Hospital Pricing Leverage through Regulation: State Rate Setting

Amid growing evidence that rising prices—especially for hospital care—play a key role in rising premiums for privately insured people, policy makers may want to revisit a tool—rate setting—used decades ago by a number of states to constrain hospital costs, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Health Plan-Provider Price Negotiations: Passing the Buck to Employers

Given the negotiating clout of so-called must-have hospitals and physician groups, even dominant health plans are wary of disrupting the status quo by trying to constrain prices, perhaps because insurers can simply pass along higher costs to employers and their workers, according to a study by the Center for Studying Health System Change (HSC) published in the May edition of Health Affairs.

Home Health and Durable Medical Equipment Major Drivers of Medicare Spending Variation

Most analyses of geographic variation in Medicare spending have focused on total spending, but a new Health Affairs study by researchers at HSC and Mathematica Policy Research looks at differences in spending across categories of medical services, such as diagnostic tests and durable equipment, finding considerable variation across 60 communities. Even among communities with high or low total health care use, the study found very different combinations of services were used to produce medical care.

Limited Options to Manage Specialty Drug Spending

Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change (HSC).

Hospital Geographic Expansion: The New Medical Arms Race?

Hospitals’ longstanding competitive focus on cutting-edge technology, niche specialty services and amenities to attract physicians and patients has set the stage for the next chapter in hospital competition—targeted geographic expansion into new markets with well-insured people, according to a study by HSC published in the April edition of Health Affairs.

Can Promoting Primary Care Help Bend the Cost Curve?

The national health care reform law includes a temporary five-year, 10-percent increase in what Medicare pays for primary care services provided by primary care clinicians. In a new Commonwealth Fund issue brief, researchers at the Center for Studying Health System Change (HSC) and Mathematica Policy Research model what would likely happen if the payment increase were permanent. The study concludes that increased spending on primary services would be more than offset by lower Medicare spending for other services—primarily hospitalizations, outpatient services and post-acute care—with the net result a drop in longer-term Medicare spending of nearly 2 percent.

Great Recession Accelerated Long-Term Decline of Employer Health Coverage

Between 2007 and 2010, the share of U.S. children and working-age adults with employer-sponsored health insurance dropped 10 percentage points from 63.6 percent to 53.5 percent, according to a new national study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Slower Growth in Medicare Spending—Is This the New Normal?

While the economic downturn and other temporary factors likely have a role in slowing Medicare spending growth, past cost-control efforts and the looming specter of broader provider payment reform may signal a longer-term slowdown in Medicare spending growth, according to a perspective by researchers at the Center for Studying Health System Change (HSC), published online today in the New England Journal of Medicine.

State Benefit Mandates and National Health Reform

While the national health reform law requires states to pay for health benefit mandates that exceed a minimum package of covered services, states’ financial liability for mandates is likely to be relatively small, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Health Status and Hospital Prices Key to Regional Variation in Private Spending

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, accordingto a new study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Increasing Physician Fees Expands Access to Care, While Coverage Expansion Effects Mixed

Increasing physician fees clearly increased children's access to physician services, while coverage expansions under the Children's Health Insurance Program had more modest effects on children's access to care, according to a study by HSC published online in the journal Health Services Research.

Indianapolis Hospital Systems Compete for Well-Insured, Suburban Patients

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 HSC.

1 in 5 Americans in Families with Problems Paying Medical Bills in 2010

More than one in five Americans were in families with problems paying medical bills in 2010—about the same proportion as in 2007, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation (RWJF).

Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage

While there’s little debate about a growing primary care workforce shortage in the United States, it’s less clear whether existing workforce policies—such as educational loan forgiveness or scholarships and higher payment rates—can boost the supply of practitioners quickly enough, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Prescription Drug Access Problems Remain Level Between 2007 and 2010

Despite the weak economy and more people lacking health insurance, the proportion of Americans reporting problems affording prescription drugs remained level between 2007 and 2010, with more than one in eight going without a prescribed drug in 2010, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation.

A Third of Adults Discharged from a Hospital Don't See a Doctor Within 30 Days

One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Surprising Decline in Consumers Seeking Health Information

After a striking rise in the last decade, the proportion of American adults seeking information about a personal health concern from a source other than their doctor dropped to 50 percent in 2010, down from 56 percent in 2007, according to a national study released today by HSC and funded by the Robert Wood Johnson Foundation (RWJF).

Transmitting and Processing Electronic Prescriptions: Physician Practices and Pharmacies

This study focuses on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies. It explores facilitators of and barriers to the electronic transmission of new prescriptions and renewals and pharmacy e-prescription processing.

Federally Qualified Health Centers Poised for Significant Role in Reform

Tracing their roots to the civil rights movement and the 1960s’ War on Poverty, federally qualified health centers (FQHCs) have grown from fringe providers to mainstays of many local health care system safety nets, according to a study released today by HSC.

Promoting Healthy Competition in Health Insurance Exchanges: Options and Trade-offs

While federal and state policy makers face many complex decisions about the design and operation of new state-based health insurance exchanges, the overarching goal of the exchanges is straightforward—promoting healthy competition among insurers to provide better health care at lower total cost, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Employer-Sponsored Health Insurance: Down but Not Out

Rising costs and the lingering fallout from the great recession are altering the calculus of employer approaches to offering health benefits, according to a study released today by HSC.

Health Care's Role in Deficit Reduction—Guiding Principles

Cutting federal health care spending over the next 10 years will be particularly challenging for the congressional super committee charged with proposing $1.2 trillion in additional deficit reduction by Thanksgiving, according to a perspective by researchers at HSC published online today in the New England Journal of Medicine.

HSC's 16th Annual Wall Street Comes to Washington Conference on Oct. 12

HSC's 16th Annual Wall Street Comes to Washington conference was held on Wednesday, Oct. 12, 2011, in Washington, D.C. A transcript of the conference is now available.

Low Patient Activation and Hispanic Immigrants' Access Barriers

Increasing Hispanic immigrants’ ability to take a more active role in managing their health and health care may be as important as expanding health coverage in reducing access disparities, according to a study by the Center for Studying Health System Change (HSC) published in the October edition of Health Affairs.

Reforming Provider Payment—The Price Side of the Equation

Unless public and private health care payers send consistent signals to providers through payment reform about controlling both the price and quantity of care, they risk working at cross purposes, according to a perspective by Paul B. Ginsburg, president of the Center for Studying Health System Change (HSC), published online today in the New England Journal of Medicine.

Economic Downturn Strains Miami Health Care System

Despite the economic downturn’s severe fallout on Miami’s tourism, real estate and construction sectors, some hospitals are expanding beyond their traditional geographic markets to compete for privately insured patients, according to a new Community Report released today by HSC.

Adding Patients to the Decision Equation

While evidence suggests that patients’ medical decisions in the United States, even momentous ones, are seldom well informed, greater use of shared decision making between clinicians and patients might help bridge the gap between the care patients want and the care they actually receive, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Ginsburg Testifies at Ways & Means Health Panel on Provider Market Power

While consolidation contributes to dominant hospitals’ upper hand in negotiating higher payment rates from private insurers, other factors, including consumer perceptions of quality and desire for broad provider choice, provision of highly specialized services, and geographic niches, contribute to providers’ market power, economist Paul B. Ginsburg, Ph.D., president of HSC, told Congress today.

Mixed Signals: Americans’ Problems Getting Medical Care Decline Modestly Between 2007 and 2010

Likely reflecting the severe economic downturn and subsequent decline in demand for health care, the proportion of Americans who reported going without or delaying needed care declined modestly between 2007 and 2010, according to a national study released today by the HSC and funded by the Robert Wood Johnson Foundation.

Ginsburg Named Among Top 100 Most Influential in Health Care

For the eighth time, HSC President Paul B. Ginsburg was named to Modern Healthcare's 100 Most Influential in Health Care list. To view the complete list click here.

Hospitals Rush to Employ Physicians to Shore Up Referrals, Admissions

While not new, the pace of hospital employment of physicians has quickened in many communities, driven largely by hospitals’ quest to increase market share and revenue, according to a study released today by HSC.

Why Jumpstarting Local Economies through Health Care Expansions Hampers Federal Deficit Reduction

Understanding why health care spending growth is a problem from a national perspective, while simultaneously an attractive way to promote economic growth from a local perspective, is key to identifying ways to finance health care that better align local interests with those of the nation, according to a commentary published today by HSC.

Physicians Key to Health Maintenance Organization Popularity in Orange County

The extent of health plan delegation of financial risk and utilization management to physicians caring for health maintenance organization (HMO) enrollees makes Orange County stand out from many health care markets, according to a new Community Report released today by HSC.

Syracuse Health Care Market Works to Right-Size Hospital Capacity

Largely stable over the last three years, the Syracuse health care market continues to grapple with the challenge of finding the right level and mix of hospital capacity, according to a new Community Report released today by HSC.

Economic Downturn Slows Phoenix’s Once-Booming Health Care Market

After more than a decade of rapid population growth and a thriving economy, Phoenix’s once-booming health care market has adopted a more cautious outlook amid the lingering effects of the great recession, according to a new Community Report released today by HSC.

Developments Affecting Health Care Spending and What Can Be Done

HSC President Paul B. Ginsburg, Ph.D., spoke at a U.S. Chamber of Commerce conference titled "Controlling Costs: The Price of Good Health" in Washington, D.C.

Improving Health Care Access for Low-Income People

Communities that formally build collaborative health care safety nets can offer lessons for national health reform by offering roadmaps on how to improve access, reduce the use of unnecessary emergency and inpatient care, and improve people’s health, according to a qualitative study by HSC published in the July edition of Health Affairs.

Health Information Technology and Small Physician Practices

As policy makers try to jumpstart health information technology (HIT) in small physician practices, lessons from independent practice associations—networks of small medical practices—can offer guidance in overcoming barriers to HIT adoption and use, according to a new study by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Health Care Markets Weather Economic Downturn, Brace for Health Reform

Lingering fallout—loss of jobs and employer coverage—from the great recession slowed demand for health care services but did little to slow aggressive competition by dominant hospital systems for well-insured patients, according to key findings from HSC's 2010 site visits to 12 nationally representative metropolitan communities.

Spending to Save—Accountable Care Organizations and the Medicare Shared Savings Program

While criticism that the government set the bar too high for accountable care organizations (ACOs) has been fast and furious, the proposed rule for the Shared Savings Program is a wake-up call that Medicare is serious about achieving better care for individuals, better health for populations and lower growth in expenditures, according to a perspective by HSC President Paul B. Ginsburg, published online today in the New England Journal of Medicine.

Health Care Certificate-of-Need (CON) Laws: Policy or Politics?

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, accordingto a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Care Coordination Among Specialists, Primary Care, Care Management and Patients

Ann S. O'Malley, M.D., M.P.H., HSC senior health researcher, testified before the U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, on research on medical practices' experiences and needs as they use electronic health records as a tool to support the coordination of care for patients.

HSC Researcher Testifies at Senate Hearing on Emergency Department Use

While there is a common perception that emergency department crowding is driven primarily by uninsured people, most of the growth in emergency department volume between 1995 and 2008 was driven by insured people, Peter Cunningham, Ph.D., a senior fellow at HSC, told Congress today.

E-Prescribing and Information to Improve Physician Prescribing Decisions

While many e-prescribing systems have features to provide access to important external patient information—drugs prescribed by physicians in other practices and patient formularies, for example—physician practices face challenges using these tools effectively, according to a study released today by HSC.

Primary Care Physician Willingness and Capacity to Treat More Medicaid Patients

Supporting increased capacity among primary care physicians already treating many Medicaid patients may be the best way to help ensure adequate capacity for people gaining Medicaid coverage under health reform coverage expansions starting in 2014, according to a national study by researchers at HSC and the Kaiser Family Foundation (KFF).

Geographic Variation in Health Care: Changing Policy Directions

While research on geographic variation in health care use and spending has pushed the twin issues of uneven care and costs to the fore, it’s ultimately the broader health care system—not geography—that matters most in improving efficiency and quality, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Achieving Health Information Technology's Potential to Improve Care is Daunting Task

While health information technology (HIT) holds great promise in helping clinicians improve patient care, realizing that potential will require progress on multiple fronts, according to a perspective by Ann S. O’Malley, M.D., M.P.H., a senior researcher at HSC, published today in the New England Journal of Medicine.

Lansing's Dominant Hospital, Health Plan Strengthen Market Positions

In an insular market wary of outsiders, Lansing’s dominant hospital system—Sparrow Health System—and health plan—Blue Cross Blue Shield of Michigan—have reinforced their already-strong market positions, according to a new Community Report released today by HSC.

Primary Care Physician Supply and Health Reform Medicaid Expansions

In much of the country, growth in Medicaid enrollment under health reform will greatly outpace growth in the number of primary care physicians willing to treat new Medicaid patients, according to a national study released today by HSC.

Hospital Employment of Physicians Surges in Greenville-Spartanburg, S.C.

In an area already notable for high rates of physician employment, the two largest hospital systems in Greenville and Spartanburg, S.C., have greatly increased employment of physicians with an eye toward capturing more referrals and admissions, according to a new Community Report released today by HSC.

Coordination Between Emergency and Primary Care Physicians

An examination of emergency and primary care physicians’ ability—and willingness—to communicate found that haphazard communication and poor coordination can undermine effective care, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Follow the Money: Why are High-Cost Medicare Beneficiaries So Costly?

In the quest to unravel the role of supply and demand in health care costs, policy makers may need to reconsider a commonly held premise that the supply of physicians, hospital beds and other health care resources is a major factor driving high Medicare costs, according to a study by HSC published online in the journal Health Services Research.

Little Rock Health Care Safety Net Stretched by Economic Downturn

The economic downturn has been milder in Little Rock than elsewhere, but increased unemployment and an almost 15 percent uninsurance rate have strained the area’s fragmented health care safety net, according to a new Community Report released today by HSC.

Lessons from the Field: Making Accountable Care Organizations Real

An examination of provider efforts to improve patient care illustrates that changing care delivery requires substantial investments—both time and money—even among groups of providers affiliated with one another for many years, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Communication Disconnect Between Primary Care and Specialist Physicians

When it comes to sharing information about patient referrals and consultations, primary care and specialist physicians have decidedly different views about how often their colleagues communicate with them, according to a national study by researchers at HSC in the Jan. 10 Archives of Internal Medicine.

Northern New Jersey Health Care Market Reflects Urban-Suburban Contrasts

Northern New Jersey is a community of contrasts with affluent suburbs and financially strong health care providers juxtaposed against the fragile health care safety net of impoverished inner-city Newark, according to a new Community Report released today by HSC.

Physician Ownership of Medical Equipment Highlights Self-Referral Issue

Amid cost and quality concerns about overuse of advanced imaging on patients, one in six physicians in 2008 reported their practice owned or leased advanced imaging equipment, according to a national study released today by the HSC.

If You Build Health Insurance Exchanges, Will the Healthy Come?

Almost one-third of uninsured people eligible to receive subsidies to buy insurance through state-based exchanges have had no recent problems with their health, access to medical care or paying medical bills, according to a national study released today by HSC.

NEJM Health Policy Report Examines Medicare Physician Payment Policies

Repeated down-to-the-wire congressional interventions to avert double-digit Medicare physician payment rate cuts have hit closest to home for practicing physicians, but other policies to improve the accuracy of physician payment and reform provider payment more broadly may prove as important in the long run, according to a health policy report by Paul B. Ginsburg, Ph.D., published online today by the New England Journal of Medicine.

Seattle Hospital Competition Heats Up, Raising Cost Concerns

Known as a market where hospital systems focus on particular niches rather than head-to-head competition, Seattle now faces growing competition as hospital systems vie for market share in the city and seek new affiliations and growth in affluent suburbs, according to a new Community Report by HSC.

Wide Variation in Private Insurer Payment Rates Evidence of Hospital Market Power

Wide variation in private insurer payment rates to hospitals across and within local markets suggests that some hospitals have significant market power to negotiate higher-than-competitive prices, according to a study released today by HSC commissioned by Catalyst for Payment Reform.

Physician E-mail with Patients Uncommon

Despite indications that many patients want to communicate with their physicians via e-mail, physicians’ use of e-mail with patients is the exception rather than the rule, according to a new national study released today by HSC.

Comparative Effectiveness Research and Medical Innovation

Determining what treatments work best for which patients in real-world settings—known as comparative effectiveness research—can help foster beneficial medical innovation, according to a new Policy Analysis from the nonprofit, nonpartisan National Institute for Health Care Reform (NIHCR).

Transcript of HSC's 15th Annual Wall Street Comes to Washington Conference Now Available

HSC's 15th Annual Wall Street Comes to Washington conference was held on Tuesday, Sept. 28, 2010, in Washington, D.C. A transcript of the conference is now available.

Cleveland Hospital Systems Expand Despite Weak Economy

Attracting well-insured suburban patients, expanding profitable specialty-service lines and winning physician loyalty are the main fields of competition between the two dominant Cleveland health systems, leading to ever-more consolidation of the hospital and physician sectors, according to a new Community Report released today by HSC.

Physician Reimbursement and Participation in Medicaid

Peter J. Cunningham, Ph.D., HSC senior fellow and director of quantitative research, testified before the Medicaid and CHIP Payment and Access Commission (MACPAC) on physician reimbursement and participation in Medicaid.

CBO Principal Analyst Joins HSC as Senior Researcher

Chapin D. White, Ph.D., formerly a principal analyst at the Congressional Budget Office (CBO), has joined the Center for Studying Health System Change (HSC) as a senior health researcher.

Affordability of Medical Care a Moving Target for Families

While more Americans under 65 with employer health coverage faced problems paying medical bills between 2003 and 2007, increased out-of-pocket spending on health services played only a small part in the rising financial stress for families, according to an HSC study published online in the journal Medical Care Research and Review.

Damage Caps No Cure for Physician Fear of Malpractice Suits

Even in states with economic damage caps in malpractice suits, physicians remain highly concerned about being sued, suggesting that many popular tort reform proposals may do little to deter the practice of defensive medicine that contributes to unnecessary health spending, according to a study by researchers at HSC in the September Health Affairs.

State Health Reform Dominates Boston Health Care Market

Massachusetts’ 2006 landmark health reform law has reverberated throughout the Boston health care market as providers, insurers, employers and consumers adjust and adapt to a post-reform world of nearly universal health insurance coverage, according to a new Community Report released today by HSC.

Detroit: Motor City to Medical Mecca?

Despite a weak economic outlook, Detroit area hospital systems plan to spend more than $1.3 billion in the coming years on capital improvements, leading some to hope that medical care can help revitalize the area’s economy, according to a new Community Report released today by HSC and the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Employer Wellness Initiatives Grow Rapidly, but Effectiveness Varies Widely

While employer wellness programs have spread rapidly in recent years, few firms implement comprehensive programs likely to make a meaningful difference in employees’ health, according to a new study conducted by HSC for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).

Even When Physicians Adopt E-Prescribing, Use of Advanced Features Lags

Even when physicians have access to e-prescribing, many do not routinely use the technology, particularly the more advanced features the federal government is promoting with financial incentives, according to a new national study released today by HSC.

Politics and Policy of Comparative Effectiveness

Interest in evaluating which health care interventions work best under what circumstances has surged in recent years as policy makers seek tools to moderate the cost of public entitlement programs and to facilitate affordable coverage expansions. This Mathematica Issue Brief, coauthored by HSC Vice President Elizabeth Docteur, looks at the comparative effectiveness research initiative passed as part of health care reform and the policy challenges relevant to the successful implementation of comparative effectiveness research.

Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World?

Wellness and prevention strategies are fast becoming a standard feature of employer-based health benefits in hopes of countering rapidly rising health care costs that drive higher insurance premiums. Panelists at an HSC conference titled Innovations in Preventing and Managing Chronic Conditions: What's Working in the Real World? explored how effective employer-sponsored wellness and prevention initiatives focus on health improvement as a business strategy that foster work and community environments that help people lower risk factors. An HSC Issue Brief describing the conference proceedings is now available.

Policy Options for Design of the Temporary High-Risk Health Coverage Pool

While 5.6-million to 7-million Americans may qualify for health coverage through the new temporary national high-risk pool program, the $5 billion allocated until 2014 will cover only a small fraction of those in need, according to a new Policy Analysis from the National Institute for Health Care Reform (NIHCR). Policy makers will face hard choices to stretch the funding to cover uninsured people with pre-existing medical conditions, and the analysis reviews key issues that must be resolved as the high-risk program is implemented.

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