Grant: #73050

Grantee Institution: Massachusetts Health Policy Commission

Principal Investigator: David Auerbach, Ph.D.

Grant Period: October 1, 2015 – December 31, 2016

Budget: $299,513 

Project Aim: To understand what was required to shift substantial numbers of consumers to higher-value care settings for several “shoppable” conditions.

Key Findings:

  • The most influential factors in choosing health care were out-of-pocket costs, physician referrals, and quality ratings on the patient’s hospital of choice.
  • Patients prioritized quality of care over cost as their perceived risk increased; maternity care was most influenced by physician referral while cancer treatment and orthopedic procedures were chosen by quality ratings.

Project Description:

Recent analyses showed that nearly half of discharges from major teaching hospitals in Massachusetts (MA) were non-emergency, non-transfer episodes suggesting that there was an over-reliance on hospital-based care and higher cost teaching hospitals. Data from other states suggest this was also a growing concern nationwide. Because there is no association between higher cost providers and quality, the choice of hospitals for elective and non-emergent procedures could present a shoppable moment with significant implications for cost containment in MA.  The researchers employed hospital discharge and claims data, focus groups, an online survey using unfolding choice scenario methodology, and key informant interviews to examine consumer perspectives on the value of different care settings (most notably community health systems versus academically affiliated systems) for services that are high volume and of varying cost, can be planned in advance, and may be performed in a broad set of care settings.  They conducted their study in MA and three other metropolitan areas, examining how consumer perceptions of value vary across cost, quality, and other factors such as wait-time and travel distance. The goal of this project was to inform discussions of benefit designs and non-financial levers that could drive a shift in care to less expensive settings.

This project was funded as part of the Robert Wood Johnson Foundation’s solicitation “Optimizing Value in Health Care: Consumer-focused Trends from the Field,” which supported studies that addressed consumer perceptions of value in the new and emerging health care landscape.


Investigating consumer hospital choice: Demand and supply-side levers could address health care costs 
Healthcare | January 2019