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Publications from RAND Health Care Researchers

Options for Reinvesting Savings from Restored Federal Cost-Sharing Reduction Payments: Examining the Effects of Two Policy Alternatives on Spending and Enrollment in the Individual Health Insurance Market 2019

Sarah A. Nowak, Jodi L. Liu, Preethi Rao
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.
RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel April 30, 2019 Meeting 2019

Cheryl L. Damberg, Maria DeYoreo
On April 30, 2019, the RAND Corporation convened a Technical Expert Panel (TEP) web meeting to gather input on analyses that could be conducted to further enhance the Medicare Advantage (MA) and Part D Contract Star Ratings program.
Displaying Behavioral Health Measurement-Based Care Data: Identifying Key Features from Clinician and Patient Perspectives 2019

Kimberly A. Hepner, Carrie M. Farmer, Stephanie Brooks Holliday, Sarika Bharil, Rachel E. Kimerling, Pearl McGee-Vincent, Shannon E. McCaslin, Craig Rosen
Measurement-based care (MBC) in behavioral health is intended to improve the effectiveness of care through routine monitoring of patient symptoms to inform treatment and engage patients. This report documents the findings from qualitative interviews that assessed clinician and patient perspectives on various options for displaying MBC data.
Influence of Out-of-Network Payment Standards on Insurer-Provider Bargaining: California's Experience 2019

Erin L. Duffy
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.
Evaluation of California's Global Payment Program: Final Report 2019

Justin W. Timbie, Maria DeYoreo, Jodi L. Liu, Denise D. Quigley, Lesley Baseman, Mary Ellen Slaughter, Alina I. Palimaru, Katherine L. Kahn
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.
Reaching Vulnerable Populations in the Disaster-Prone US Gulf Coast: Communicating Across the Crisis Lifecycle 2019

Elizabeth L. Petrun Sayers, Andrew M. Parker, Rajeev Ramchand, Melissa L. Finucane, Vanessa Parks, Rachana Seelam
This article discusses results from a 2016 survey of Gulf Coast residents to explore potential vulnerabilities and resilience-building capacities in the region.
Patient Functional Status at Transplant and Its Impact on Posttransplant Survival of Adult Deceased-donor Kidney Recipients 2019

Kevin Bui, Vikram Kilambi, James R. Rodrigue, Sanjay Mehrotra
Insights from the survival analyses recommend possible inclusion of functional status into Scientific Registry of Transplant Recipients' risk-adjusted models.
Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability 2019

Claire E. O'Hanlon, Christopher Whaley, Deborah Anne Freund
Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.
Detecting and Reducing Post-Traumatic Stress Among Children Exposed to Domestic Violence: A Multi-Agency Early Intervention Program 2019

Clare Stevens, Lynsay Ayer, Melissa Marie Labriola, Sara-Laure Faraji, Elizabeth Ebright
This study examined the Child Trauma Response Team and its efforts to reduce PTSD symptoms among children exposed to domestic violence.
Understanding Which Teenagers Benefit Most From a Brief Primary Care Substance Use Intervention 2019

Elizabeth J. D'Amico, Layla Parast, Karen Chan Osilla, Rachana Seelam, Lisa S. Meredith, William G. Shadel, Bradley D. Stein
A brief primary care intervention can be effective over the long-term for adolescents who report problems from alcohol and marijuana use.
PTSD Symptoms Are Differentially Associated with General Distress and Physiological Arousal: Implications for the Conceptualization and Measurement of PTSD 2019

Grant N. Marshall, Lisa H. Jaycox, Charles C. Engel, Andrea Richardson, Sunny J. Dutra, Terence M. Keane, Raymond C. Rosen, Brian P. Marx
Relations between PTSD symptom clusters and PTSD symptoms were examined with respect to general distress and physiological arousal.
Obesity Prevention Interventions and Implications for Energy Balance in the United States and Mexico: A Systematic Review of the Evidence and Meta-Analysis 2019

Andrea Richardson, Christine Chen, Roland Sturm, Gulrez Shah Azhar, Jeremy N. V. Miles, Jody Larkin, Aneesa Motala, Susanne Hempel
Obesity is preventable and yet continues to be a major risk factor for chronic disease. This review searched the vast literature on obesity prevention interventions to assess their effects on daily energy consumed and energy expended.
Business Cycles and Admissions to Substance Abuse Treatment 2019

Johanna C. MacLean, Brady P. Horn, Jonathan Cantor
The relationship between business cycles and health is theoretically complex. In a seminal paper, Ruhm (2000) outlined a series of economic mechanisms through which business cycles may influence health.
Using Claims-Based Estimates of Post-Operative Visits to Revalue Procedures with 10- and 90-Day Global Periods 2019

Andrew W. Mulcahy, Harry H. Liu, Teague Ruder, Susan L. Lovejoy, Katie Merrell, Ateev Mehrotra
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.
Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report 2019

Courtney A. Gidengil, Andrew W. Mulcahy, Ateev Mehrotra, Susan L. Lovejoy
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.
Claims-Based Reporting of Post-Operative Visits for Procedures with 10- or 90-Day Global Periods: Final Report 2019

Ashley M. Kranz, Teague Ruder, Ateev Mehrotra, Andrew W. Mulcahy
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.
Profile of Institutional Review Board Characteristics Prior to the 2019 Implementation of the Revised Common Rule 2019

Sandra H. Berry, Dmitry Khodyakov, David Matthew Grant, Alexandra Mendoza-Graf, Elizabeth Bromley, Gina Karimi, Barbara Levitan, Karin Liu, Sydne Newberry
This report details the results of surveys of institutional research board (IRB) chairs, administrators, and members, as well as principal investigators, to obtain baseline information on their demographics and their attitudes about their IRB's efficacy and efficiency and the likely effects of proposed changes to the Revised Common Rule. Where possible, the authors also compare the survey results with the 1998 Bell Report.
Measuring Health Care Utilization in Medicare Advantage Encounter Data: Methods, Estimates, and Considerations for Research 2019

Andrew W. Mulcahy, Melony E. Sorbero, Ammarah Mahmud, Asa Wilks, Jennifer Gildner, Anne Hornsby, Arthur Pignotti
This report describes methodologies, estimates, and technical considerations related to measuring health care utilization in Medicare Part C encounter data (ED). The primary aim of the report is to provide technical details for researchers on the structure and scope of ED and on the methodological steps and analytical decisions necessary to assess utilization of health care services using ED.
How Are Medical Groups Identified as High Performing? The Effect of Different Approaches to Classification of Performance 2019

Sangeeta C. Ahluwalia, Cheryl L. Damberg, Ann C. Haas, Paul G. Shekelle
To accurately identify "high-performing providers", a standard definition of high-performance and an agreed-upon approach to measurement are necessary.
Co-Design of Services for Health and Reentry (CO-SHARE): An Experience-Based Co-Design (EBCD) Pilot Study with Individuals Returning to Community from Jail and Service Providers in Los Angeles County 2019

Peter Mendel, Lois M. Davis, Susan Turner, Gabriela Armenta, Cedric Farmer, Cheryl Branch, Glenn Robert
Individuals returning to the community from jail often face difficulties accessing the varied health, social, and other services required to improve reentry and reduce recidivism. This report describes a pilot study, the Co-Design of Services for Health and Reentry (CO-SHARE), that engaged returning individuals and service providers who support reentry to collaborate on improving health and reentry services in Los Angeles County.

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