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Health Care Payment Approaches

News Release

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps. Because such an approach has the possibility to sharply cut hospital revenues, any cap would need to be set carefully as to not overly disrupt hospital operations.

Mar 12, 2020
Report

The Effects of Limiting Payments to Hospitals for Out-of-Network Care

There is growing interest among U.S. policymakers to use out-of-network payment limits to curb surprise medical bills and as a tool to control rising health care costs. How might such limits affect negotiated in-network prices and total payments for hospital care?

Mar 12, 2020
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel November 7th, 2019 Meeting

On November 7, 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.

Feb 7, 2020
Journal Article

Payment for Services Rendered: Updating Medicare's Valuation of Procedures

Medicare appears to be overpaying surgeons for post-operative care associated many medical procedures. Federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to patients

Jan 24, 2020
Journal Article

The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs

The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.

Dec 12, 2019
Report

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

The authors of this report examine the impact of providing additional health insurance subsidies or financing reinsurance from the savings resulting from restored federal cost-sharing reduction payments to insurers under the Affordable Care Act.

Sep 10, 2019
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel April 30, 2019 Meeting

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.

Sep 6, 2019
Report

Evaluation of California's Global Payment Program: Final Report

The Global Payment Program seeks to improve health care for California's uninsured by using federal funds to make prospective payments for inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program.

Aug 22, 2019
Journal Article

Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability

Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.

Aug 20, 2019
Report

Survey-Based Reporting of Post-Operative Visits for Select Procedures with 10- or 90-Day Global Periods: Final Report

For many surgeries and procedures, Medicare and most other insurers cover a bundle of services, including post-operative visits, during the global period. This survey was designed to capture the level of post-operative visits during this period.

Jul 31, 2019
Journal Article

How Are Medical Groups Identified as High Performing? The Effect of Different Approaches to Classification of Performance

To accurately identify "high-performing providers", a standard definition of high-performance and an agreed-upon approach to measurement are necessary.

Jul 24, 2019
Report

Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading

In this report, the authors assess the effects of disallowing the current practice of increasing only the premiums of silver-tiered individual market plans in response to discontinued federal payments of cost-sharing reductions (silver loading).

Jun 3, 2019
Periodical

RAND Review: May-June 2019

This issue describes RAND research efforts to help schoolkids suffering from trauma; to help health care providers get better, more meaningful feedback; and to use technology to improve the lives of displaced people throughout the world.

Apr 29, 2019
Report

Rural Physicians' Perspectives on the Medicare Quality Payment Program

The Centers for Medicare & Medicaid Services recently launched its Quality Payment Program (QPP), which changes how physicians are paid under Medicare. Researchers interviewed rural physicians to determine if their practices could successfully participate and how the program could be modified to support small rural practices.

Mar 5, 2019
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.

Feb 1, 2019
Multimedia

The Potential Impacts of Single-Payer Health Care

Controlling costs while improving health care access dominates policy debates in Congress. In this Congressional Briefing, Jodi Liu discusses what policymakers need to know about "Medicare-for-All" and other single-payer proposals, and their likely effects on cost and access.

Jan 23, 2019
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel October 30th 2018 Meeting

On October 30, 2018, 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.

Jan 18, 2019
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.

Dec 21, 2018
Dissertation

Three Essays in Health Economics: Towards Alternative Payment Models for High-Value, High-Cost Medical Treatments

Tests how two different payment models could help address the uncertainty about clinical benefits and the high upfront cost of some emerging therapies.

Dec 17, 2018
Report

Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment

An integrated approach to purchasing health care for U.S. Department of Defense and U.S. Department of Veterans Affairs could have important implications for access, quality, and costs but could face legislative, policy, or contractual challenges.

Nov 26, 2018

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