AcademyHealth member research was featured in the February Health Affairs issue on the theme of “Hospitals, Health IT, and More.” In the issue, 18 AcademyHealth members shared timely studies on emerging trends, from insights on hospital performance to insurance costs to telemedicine's role in increasing health care access.
Health Systems & Hospitals
Many AcademyHealth members studies focused on health systems and hospitals. In one study, members found that hospital costs are growing much faster than physician prices, noting that this rapid price hike has policy implications. They recommended reducing hospital costs, which will in turn reduce health care spending. Another member, Caroline Thirukumaran, Ph.D., led a study at the University of Rochester that looked at the Comprehensive Care for Joint Replacement program. The study analyzed the performance of safety-net hospitals in the first year of the program. They found that safety-net hospitals often dealt with complex patients, causing them to have lower performance rates and putting them at risk for penalties. In response, they recommended a flexible approach that compensates for additional challenges safety-net hospitals face. Other research looked at acute care visits, comparing the number of visits to the emergency department (ED) versus primary care offices. During 2002-2015, primary care visits fell drastically, while ED visits increased.
Insurance & Medicare
Health insurance and spending was another area of focus for AcademyHealth researchers. One study looked at trends in health spending growth for people who were privately insured, concluding that spending varies substantially and requires further research about what could be driving growth. Researchers from Stanford and Harvard examined Rhode Island’s 2010 Affordability Standards, which imposed price controls on contracts with health providers and required increased spending in important preventative areas. They found that this strategy was effective, as spending decreased and quality of care increased.
Other new research focused on Medicare. AcademyHealth members Robert Berenson, M.D., and Paul Ginsburg, Ph.D., worked together on a study of the Medicare physician fee schedule. To improve the system, they recommended making the fee schedule part of value-based payment. A related study was led by AcademyHealth member Adam Markovitz, M.D., Ph.D., who worked with members at the University of Michigan, to examine the effects of risk adjustment in the Medicare Shared Savings Program. While risk adjustment successfully deterred coding increases, authors noted that it could discourage accountable care organizations from caring for high-risk beneficiaries. Another study looked at mental health spending, finding that insurers paid less for in-network mental health services in their commercial and Medicare Advantage plans than fee-for-service Medicare paid for identical services.
Other research examined the qualifying conditions for using medical cannabis, finding that chronic pain was one of the main reasons. Also, medical cannabis treatment has proven to be mostly effective, but a nationwide patient registry would be helpful for further study on this topic. Member Daniel Hartung, M.P.H., led a team that researched multiple-sclerosis therapies. They found that policy makers need to consider the growing cost of these therapies. Rising costs for these therapies block access to many people and leads to growing cost-sharing burdens. Adding to this issue’s pharmaceutical research, Thomas Hwang, M.A., and researchers at Harvard Medical School looked at the impact of a priority review program for rare pediatric diseases. The priority review program didn’t increase the rate of drugs starting or completing clinical testing. However, the faster review times did allow drugs for rare pediatric diseases to progress more quickly through all phases of testing.
Access to Health Care
Other members focused on access to health care — in the United States and globally. Cynthia LaRouge, Ph.D., worked with her colleagues to study how telemedicine can be expanded to Latin American countries. Jaime Smith, principle researcher and statistician at Surescripts in Arlington, VA, looked at disparities in access to e-prescription after hurricanes, comparing levels of access after different hurricanes.
Thanks to all the AcademyHealth members who contributed to the relevant and timely research in February’s Health Affairs issue, as well as all the researchers who helped advance our knowledge of these important issues.