RAND Health Care has been analyzing major issues related to public and private financing of health care since the program? inception in 1968. An early landmark study in this body of work is the RAND Health Insurance Experiment, still the largest health policy study in U.S. history. RAND work in this research area includes the organization and regulation of health care markets, the effects of population health on public financing, cost-effective allocation of private and public financing, and distributional issues in health and health care associated with health care financing, among others.
This study presents the results of a proof-of-concept modeling effort that utilized individual patient-level data from ten randomized studies and the categorization of these study's participants by chronic pain impact level to estimate the effectiveness and cost-effectiveness of adding recommended nonpharmacologic therapies for CLBP to usual care.
Early indications suggest that value-based incentives are leading to changes; however, incentives remain small, potentially limiting their effectiveness in driving the significant changes needed to derive large improvements in performance.
To help inform accurate valuation of procedures with global periods, Medicare required select practitioners to report on their post-operative visits beginning July 1, 2017. Analysis of 1.4 million procedures with 10- or 90-day global periods, linked to 931,640 post-operative visits, found that the proportion of expected post-operative visits provided was low for all procedures, suggesting the need to revalue procedures with global periods.
Although the federal government is no longer making cost-sharing reduction (CSR) payments to insurers, insurers are still required to provide CSR subsidies to qualifying enrollees. As a result, to fund CSRs, most states and insurers have adopted a practice known as silver loading, in which only the premiums of silver-tiered individual market plans are increased. In this report, the authors address the effects of disallowing this practice.
The Global Payment Program (GPP) seeks to improve health care for California's uninsured by using federal funds to make prospective payments to public health care systems for providing inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program. Through the GPP, public health care systems have put in place a variety of strategies and offered a wider range of services during its first three years.
Technology-enabled collaborative learning and capacity-building models connect generalist providers, often located in remote areas, with specialist teams that help train these providers so that they can deliver care for conditions that generalists might not otherwise feel adequately prepared to handle. This report focuses on the quality of evidence for the effectiveness of such models and describes ways to improve measurement of effectiveness.
California's experience implementing a policy to address surprise medical billing demonstrates that out-of-network payment standards can influence payer-provider bargaining leverage, affecting prices and network breadth.
Prices are the primary reason why the U.S. spends more on health care than any other country.
Earlier research established that the federal government would likely save money if federal cost-sharing-reduction (CSR) payments to insurers under the Affordable Care Act were restored, but total health insurance enrollment would decrease. The authors of this report analyze what would happen if federal lawmakers used the savings from restoring CSR payments to provide additional health insurance subsidies or to finance reinsurance.
This study provides estimates of reported WTP for pain reduction from a large sample of patients using chiropractic care to manage their chronic spinal pain and compares these estimates to what these patients do for care over the next 3 months, to inform coverage policies for ongoing care.
Large price discrepancies exist between what private health plans pay for hospital services and what Medicare pays. RAND Corporation researchers used data from three sources — self-insured employers, state-based all-payer claims databases, and health plans — to assess $13 billion in hospital spending in terms of price levels, variation, and trends from 2015 to 2017 in 25 states. The report lists prices relative to Medicare for specific hospitals.
Primary care spending represents a small percentage -- less than 3% -- of total fee-for-service Medicare spending, though it varies substantially across populations and states.
For many surgeries and other types of procedures, payment from Medicare and most other insurers covers the procedure itself and related services delivered within either ten or 90 days after a surgical procedure during what is called the global period. This report describes the development of a practitioner survey designed to capture the level of post-operative visits that take place during the global period.
Medicare payment for many health care procedures covers not just the procedure itself but also most post-operative care during a fixed "global period." This report describes how CMS could use the new claims-based data on the number of post-operative visits to adjust valuation for procedures with 10- and 90-day global periods. These results may inform further policy development around revaluation for global procedures.
Beneficiaries who are dually enrolled in Medicare and Medicaid are less likely to be enrolled in Medicare Advantage (MA) plans that perform well in the MA Star Rating program than non–dually enrolled beneficiaries. The authors identify the types of services that MA plans implement to meet the needs of dually enrolled and other high-cost, high-need beneficiaries, as well as the types of resources needed to implement these services.
Through the Comprehensive Primary Care (CPC) and Comprehensive Primary Care Plus (CPC+) programs, the Centers for Medicare & Medicaid Services (CMS) has encouraged primary care practices to invest in "comprehensive primary care" capabilities. To help CMS design alternative payment models (APMs) that reimburse primary care practices for these capabilities, the authors developed and piloted a method for estimating related practice expenses.
The economics of integrative oncology are problematic because of the lack of good studies, the lack of historic incentives for efficiency, and the high cost of cancer care and its financial toxicity on patients. However, these problems can be overcome, with help from one good economic evaluation at a time.
Medicare-certified hospitals are required to submit an annual cost report to a Medicare Administrative Contractor. The Centers for Medicare & Medicaid Services (CMS) maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS).The RAND Hospital Data tool is an effort to enhance CMS HCRIS data to make them more useful and accessible to a broad audience, and to provide insights into the hospital industry.
The purpose of this study is to extend the pilot study in a group-randomized controlled trial to test the effectiveness of tailored messaging delivered by Community Health Navigators to guide individuals from especially hard-to-reach, multicultural, and underinsured communities into primary care clinics for referral for CRC screening (Phase I) and to continue navigation after referral to track effects of the intervention on completion of CRC screening (Phase II).
This paper offers a research-grounded perspective on innovative financing mechanisms to facilitate access to expensive yet highly effective breakthrough medical treatments. The authors outline the scope of the problem; describe several policy and market options, including bond financing and linking repayment to real-world value generation; and describe real-world applications.
