Health Care Payment Approaches

commentary

Rethinking the Impact of Audio-Only Visits on Health Equity

New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. It may be time to consider limiting audio-only visits in the pursuit of health equity.

Lori Uscher-Pines, Lucy B. Schulson

commentary

Twelve-Month Continuous Eligibility for Medicaid Adults Can Stabilize Coverage with a Modest Cost Increase

Churning—frequent moving in and out of Medicaid due to income fluctuation—increases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Federal and state policymakers might consider continuous eligibility to help stabilize Medicaid enrollment.

Harry H. Liu, Leighton Ku

commentary

What Are the Practical Considerations for Outcome-Based Payment in the NHS?

Uncertainty can surround the effectiveness or cost-effectiveness of a new medicine, making it difficult to agree on a medicine's price. One solution to avoid unduly delaying or restricting patients' access is to link the medicine's price to the outcomes it produces in a patient. Despite some barriers, outcome-based payment could offer a “win” for patients, the NHS, and industry.

Amanda Cole, Jon Sussex

commentary

Fintech's Role in Reducing Disparities and Financial Barriers to Health Care Access

Given the growing pressures on health care systems globally and the need for innovative approaches to financing health care, the time may be ripe to develop a robust evidence base and share learning on fintech-enabled approaches that could support universal health coverage agendas and healthier and more stable societies.

Sam Alom, Sonja Marjanovic @SonjaCambs

blog

Vaccine Hesitancy, Sexual Misconduct in the U.S. Military, the Iran Nuclear Deal: RAND Weekly Recap

This weekly recap focuses on Black Americans' vaccine hesitancy, sexual harassment and sexual assault in the U.S. military, rejoining the Iran nuclear deal, and more.

commentary

ACA Subsidies for Higher-Income Families Are Key to Enrolling More Americans

The House Ways and Means Committee has proposed several insurance reforms in its emergency COVID-19 relief package, including increasing subsidizes and extending subsidies to people with higher incomes. The proposed combined approach is a far more efficient means of covering uninsured Americans than enhancing subsidies only for those who are currently eligible.

Christine Eibner @Chrissyeibner

commentary

Why States' 'Netflix Model' Prescription Drug Arrangements Are No Silver Bullet

Despite the buzz and catchy notion that subscription models are “Netflix for drugs,” it's hard to come up with a theoretical case that supports subscription models over traditional price negotiation between payers and manufacturers over a per-dose or per-unit price.

Harry H. Liu, Andrew W. Mulcahy @AndrewWMulcahy

blog

COVID-19, Out-of-Network Hospital Payments, Russia's Economy: RAND Weekly Recap

This weekly recap focuses on COVID-19, limiting out-of-network hospital payments, Russia's sluggish economy, and more.

blog

Taliban, Health Care, Russia: RAND Weekly Recap

This weekly recap focuses on U.S.-Taliban peace talks, what single-payer health care really means, comparing threats from Russia and China, and more.

blog

The Most Popular RAND Research of 2018

RAND serves as an objective source of facts that help inform the world's most pressing policy debates. When decisions are based on the best evidence, that's when public policy can have a positive impact on people's lives. We're highlighting the 10 research projects that RAND.org readers found most engaging this year.

commentary

Medicare for All: Sounds Good, but What Does It Mean?

Traditional Medicare is popular and therefore can lend a good brand name to coverage expansion proposals, but its limits can be significant for some patients. Those proposing and evaluating “Medicare for All” proposals should consider whether and how these limits are addressed.

David Anderson, Jodi L. Liu @jodilliu, et al.

commentary

Misconceptions About 'Medicare for All'

Medicare for All is a talking point for both major U.S. political parties. Would it be free? Would people have to switch doctors? Would waits be long? Misconceptions abound about single-payer proposals and their likely effects. Here are the facts.

Jodi L. Liu @jodilliu, Christine Eibner @Chrissyeibner

commentary

Potential Benefits for Most New Yorkers but No Free Lunch: Tough Decisions for Single-Payer Health Care in New York

A single-payer plan in New York would shift health care spending to the state instead of private insurers. As with any far-reaching legislation, there are trade-offs. It's important that policymakers consider the impact of the single-payer plan in totality.

Jodi L. Liu @jodilliu

commentary

Savings from a Single-Payer Health System Would Not Be Automatic

Polls have shown increasing public support for a single-payer system in the United States. Yet there is no agreement on how to set up and pay for a single-payer system or even how much it would cost.

Jodi L. Liu @jodilliu

commentary

Improving MACRA's Chances of Success

Starting in 2019, the Medicare Access and CHIP Reauthorization Act will integrate and potentially simplify performance measurement by combining many measures and programs. Research provides insight into how to avoid pitfalls in MACRA's rollout.

Adam J. Rose, Peter S. Hussey, et al.

commentary

Paying for Telemedicine

Telehealth, delivering health services and information via technology, holds great promise. But more information is needed to determine what works and what doesn't.

Shira H. Fischer @ShiraFischer

blog

Five Years of the Affordable Care Act

The Affordable Care Act has officially been part of the U.S. health care landscape for five years. We reflect on the twists and turns that followed its passage and the RAND research that informed debates along the way, and look ahead to the future of the ACA.

commentary

The Great Patient Experience Survey Myth

Patient experience with care is an essential element in any assessment of health care quality. Surveys give patients a voice and provide fair and relevant indicators that complement other metrics of health care quality to inform patients' choices and providers' decisions about how to improve care.

Rebecca Anhang Price, Marc N. Elliott

commentary

The Winding Path to Effective Bundled Payment

It's not unusual for a demonstration to fall short of its original objectives. Learning from such cases is part of the innovation process. This is especially worthwhile for bundled payment, which has many potential benefits for patients, providers, and payers.

M. Susan Ridgely, Peter S. Hussey

q&a

ACOs: Making Organizations 'Accountable' for Care

The Affordable Care Act focuses primarily on extending coverage to uninsured Americans, but it is also intended to help curb cost growth. M. Susan Ridgely explains one of the key tools for doing that—the “accountable care organization,” an alternative delivery model intended to lower costs while also improving quality of care.

blog

A Cure for Overtreatment: RAND Guidelines for Appropriate Care

Reducing inappropriate and wasteful tests, treatments and procedures has the potential to save billions annually and simultaneously improve the quality and safety of American medicine.

Arthur L. Kellermann

commentary

Physician Compensation, Cost, and Quality

Pay for performance, transparency, and other innovative ways of compensating physicians will work only if, at the same time, the system for providing care is changed to one that has clear objectives and provides specific tools to help physicians achieve those objectives, writes Robert H. Brook.

Robert H. Brook

commentary

Quality, Transparency, and the US Government

If the government is demanding transparency of physicians and hospitals, the very least the physicians and hospitals should do is demand transparency of the government, writes Robert Brook.

Robert H. Brook