Health care system financing and organization
The health care systems financing and organization pillar includes research on Medicare Advantage; alternative payment models; pharmaceutical policy; nursing homes; private equity investments in health care; sbstance use disorder treatment; telehealth; and market consolidation. Below are examples of research, publications, faculty with relevant expertise, and CHPC briefs and initiatives related to research under the health care system financing and organization pillar.
Medicare Advantage (MA)
Over one-half of the elderly in the United States are enrolled in a Medicare Advantage (MA) health plan offered by a private health insurer that is paid for primarily by the federal government. Given the scale of the program ($462 billion of spending in 2024), MA has a profound effect on the elderly as well as the health professionals and organizations that treat them.
Our faculty conduct research examining the various aspects of the MA program, and policies that might improve its effectiveness and efficiencies, including:
- How to provide incentives to MA plans to deliver high-quality and cost-effective medical care (Drs. Colleen Carey, Amelia Bond, Dhruv Khullar)
- The impact of health insurer acquisitions of physician practices on patient risk scores, which affect how much funding MA health plans receive from the government. (Drs. Tyler Braun, Sean Nicholson, Michael Richards, Dhruv Khullar, Larry Casalino)
- Prescription drug access, pricing, and utilization in MA plans (Drs. Pragya Kakani, Amelia Bond, Colleen Carey)
- The impact of telehealth on patient outcomes in MA plans (Dr. Jiani Yu)
- The impact of specialized MA health plans that focus on dual-eligible Medicare and Medicaid enrollees (Drs. Yongkang Zhang and Beth McGinty)
- The effect of health insurer advertising on MA enrollment (Dr. Michael Richards)
Publications:
- Utilization and quality among Medicare Advantage beneficiaries with high vs low access to telehealth
- Medicare Advantage Enrollment in Nursing Homes: 2010–2023
Faculty:
Amelia Bond; Dhruv Khullar; Colleen Carey; Robert Tyler Braun; Sean Nicholson; Michael Richards; Lawrence Casalino; Pragya Kakani; Jiani Yu; Beth McGinty; Yongkang Zhang
CHPC Initiatives:
Alternative Payment Models
Alternative payment models (including Accountable Care Organizations [ACOs]), reward clinicians and health care organizations for meeting quality targets, and managing patient care more efficiently, allowing them to share in the savings they generate. Our faculty analyze data to determine whether alternative payment models achieve cost savings.
Publications:
- Long-Term Spending of Accountable Care Organizations in the Medicare Shared Savings Program
- Budgetary Impact of the Medicare Shared Savings Program on Traditional Medicare
Faculty:
Amelia Bond; Yasin Civelek; William Schpero; Lawrence Casalino; Dhruv Khullar
Pharmaceutical Policy
Our faculty research the impact of policies targeting prescription drugs and biosimilars on coverage, price, prescribing and patient access.
Publications:
- Real-World Evidence for Medicare Drug Price Negotiations
- Trends in Prescription Drug Coverage Restrictions in Medicare, Medicaid, and Commercial Insurance Plans, 2011-2019
- Improved Insurance Coverage Increased Biosimilar Semglee’s Market Share After The FDA’s Interchangeability Designation
- Changes in Mifepriston Use at Pharmacies After Removal of the FDA In-person Dispensing Requirement
- Implications of Artificial Intelligence-Powered Ambient Scribes
- Prescription Monitoring Program Mandates and Opioids Dispensed to Patients Dying of Cancer
Faculty:
Pragya Kakani; Colleen Carey; Sean Nicholson; Amelia Bond
CHPC Initiatives:
- Insight Panel Survey on Most Favored Nation Drug Pricing
- Journalism Series: Supporting Data-Driven Journalism on Prescription Drug Policy
Nursing Homes
Nursing homes provide important post-acute and long-term care for an aging U.S. population. Research and policies are needed to ensure patients are able to access high quality nursing home care. Our faculty research the impact of the COVID-19 pandemic, staffing standards/trends and policies on nursing homes and the provision of quality care for nursing home residents. Our faculty leverage machine learning on longitudinal data to identify factors associated with nursing home closures and develop predictive model/approach to proactively identify nursing homes at risk for closure and target policy interventions to preserve access to care.
Publications:
- A Longitudinal Machine-Learning Approach to Predicting Nursing Home Closures in the U.S.
- State variation in staffing and characteristics of nursing homes most impacted by new federal standards
- Staffing Conditions In US Nursing Homes Before, During, And After The COVID-19 Pandemic
- Telehealth Use at the End-of-Life Among US Nursing Home Residents
- Clinicians who Practice Primarily in Nursing Homes and the Quality of Care for Residents with Alzheimers Disease and Related Dementias
- Clinician Volume and Outcomes Among Patients Admitted to Nursing Homes for Postacute Care
- Behavioral health as a palliative care priority in long-term services and supports: A cross-sectional study of staff.
- Assessing Facility, Resident, and Financial Characteristics Associated with HUD 232–Sponsored Loan Participation in Nursing Homes
Faculty:
Robert Tyler Braun; Mark Unruh; Arian Jung
CHPC Research Brief:
CHPC Initiative:
- Journalism Series: Supporting Data-Driven Journalism on Nursing Home Policies
Private Equity Investments in Health Care
Private equity firms have increasingly acquired health care organizations in recent years. Our faculty research acquisition patterns in different health care sectors and the impact of private equity acquisition on quality of care, profits, financial stability, health care spending and patient outcomes.
Publications:
- Private equity acquisitions of home health agencies
- Private Equity–Owned Hospices Report Highest Profits, Lowest Patient Care Spending Compared With Other Ownership Models
Faculty:
CHPC Research Brief:
CHPC Initiative:
Substance Use Disorder Treatment
Substance use disorder (SUD) is treatable but care remains difficult to access because treatment is not well integrated with the health care system. Our faculty research the impact of policies related to insurance coverage, requirements on medications used to treat SUD, telemedicine, and medical cannabis laws on substance use disorder treatment. Other research related to substance use can be found under mental health and addiction policy health policy research priority.
Publications:
- State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23
- State Prior Authorization Prohibitions and Buprenorphine Retention Among Privately Insured Patients
- The Impact of Medical Cannabis Laws on Cannabis and Opioid Use Disorder Treatment and Overdose-Related Health Care Utilization Among Adults With Chronic Noncancer Pain
- Developing and validating measures of take-home methadone with administrative data
- Impact of State Telemedicine Policies on Substance Use Disorder Treatment During the COVID-19 Pandemic
Faculty:
Beth McGinty; Kayla Tormohlen; Yuhua Bao; Jiani Yu; Ali Jalali; Shashi Kapadia; Kristen Underhill; Colleen Barry
CHPC Research Brief:
Telehealth
Coverage for telehealth has expanded in recent years, particularly after the COVID-19 pandemic. Our faculty research the impact of telehealth on health care utilization, spending, and quality and patient outcomes across a number of different patient populations and care settings (Medicare, Medicare Advantage, nursing homes, home health care, substance use disorder treatment).
Publications:
- Primary Care Telehealth and Patient Utilization, Quality, and Spending in Traditional Medicare
- Utilization and quality among Medicare Advantage beneficiaries with high vs low access to telehealth
- Telehealth Use at the End-of-Life Among US Nursing Home Residents
- Understanding Home Health Agencies’ Perspectives Toward Telehealth Use Among Home Health Stakeholders in the Post–COVID-19 Era: Qualitative Interview Study
- Impact of State Telemedicine Policies on Substance Use Disorder Treatment During the COVID-19 Pandemic
Faculty:
Market Consolidation
Consolidation of different parts of the health care system has been growing in the U.S. Our faculty study the impact of market consolidation among different sectors of the health care system.
Publications:
- The impact of vertical integration on health care delivery and costs: Evidence from physician–pharmacy integration
- The impact of health insurer acquisitions of physician practices on prices and patient visits
- Strategic Selection and Pricing Power: Optum’s Acquisition of Ambulatory Surgery Centers and Physician Practices
Faculty:
Pragya Kakani; Robert Tyler Braun; Lawrence Casalino; Michael Richards; Sean Nicholson; Amelia Bond; Dhruv Khullar