Technical Efficiency and Cost-Ratios of State Health Care
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Evaluation of Tools and Metrics to Support Employer Selection of Health Plans
Research Report Final Report: Evaluation of Tools and Metrics to Support Employer Selection of Health Plans Soeren Mattke, Kristin R. Van Busum, Grant Martsolf Sponsored by the U.S. Department of Labor The research described in this report was sponsored by the U.S. Department of Labor, and was produced within RAND Health, a division of the RAND Corporation. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND—make a tax-deductible charitable contribution at www.rand.org/giving/ contribute.html R® is a registered trademark. © Copyright 2013 RAND Corporation This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see the RAND permissions page (http://www.rand.org/pubs/permissions.html). RAND OFFICES SANTA MONICA, CA • WASHINGTON, DC PITTSBURGH, PA • NEW ORLEANS, LA • JACKSON, MS • BOSTON, MA DOHA, QA • CAMBRIDGE, UK • BRUSSELS, BE Preface This Research Report was sponsored by the U.S. Department of Labor. It is based on a review of the trade and scientific literature and health insurers’ websites; an analysis of product and service offerings from a random sample of 70 health insurance companies; an expert panel meeting with 15 individuals representing a variety of perspectives, including academia, consumer advocacy groups, measures developers, and employer coalitions; and case study interviews with nine employers and business coalitions. -
Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety-Net Hospitals
Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety-Net Hospitals Prepared for the Commonwealth Fund Commission on a High Performance Health System Deborah Bachrach, Laura Braslow, and Anne Karl Manatt Health Solutions March 2012 THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM Membership David Blumenthal, M.D., M.P.P. Jon M. Kingsdale, Ph.D. Chair of the Commission Consultant Stuart Guterman Samuel O. Thier Professor of Executive Director Medicine and Professor of Health Gregory P. Poulsen, M.B.A. Vice President for Payment Care Policy Massachusetts General Senior Vice President and System Reform Hospital/Partners HealthCare System Intermountain Health Care The Commonwealth Fund and Harvard Medical School Neil R. Powe, M.D., M.P.H., M.B.A. Cathy Schoen, M.S. Maureen Bisognano, M.Sc. Chief, Medical Services Research Director President and Chief Executive Officer San Francisco General Hospital Senior Vice President for Institute for Healthcare Improvement Constance B. Wofsy Distinguished Research and Evaluation Professor and Vice-Chair of Medicine The Commonwealth Fund Sandra Bruce, M.S. University of California, San Francisco President and Chief Executive Officer Rachel Nuzum, M.P.H. Resurrection Health Care Louise Y. Probst, R.N., M.B.A. Senior Policy Director Executive Director Vice President for Federal Christine K. Cassel, M.D. St. Louis Area Business Health and State Health Policy President and Chief Executive Officer Coalition The Commonwealth Fund American Board of Internal Medicine and ABIM Foundation Martín J. Sepúlveda, M.D., FACP IBM Fellow and Vice President Michael Chernew, Ph.D. Integrated Health Services Professor IBM Corporation Department of Health Care Policy Harvard Medical School David A. -
Health Savings Accounts: Increasing Health Care Access in America? J
Loyola Consumer Law Review Volume 17 | Issue 4 Article 5 2005 Health Savings Accounts: Increasing Health Care Access in America? J. M. Razor Follow this and additional works at: http://lawecommons.luc.edu/lclr Part of the Health Law and Policy Commons Recommended Citation J. M. Razor Health Savings Accounts: Increasing Health Care Access in America?, 17 Loy. Consumer L. Rev. 419 (2005). Available at: http://lawecommons.luc.edu/lclr/vol17/iss4/5 This Feature Article is brought to you for free and open access by LAW eCommons. It has been accepted for inclusion in Loyola Consumer Law Review by an authorized administrator of LAW eCommons. For more information, please contact [email protected]. Health Savings Accounts: Increasing Health Care Access in America? By J.M. Razor* I. Introduction The number of people in the United States without health insurance coverage now exceeds forty-five million-accounting for more the fifteen percent of the population.1 Several proposals on the federal level aim to decrease the number of uninsured and underinsured Americans. 2 Some legislation would increase health * The author would like to thank those friends and colleagues who took the time to suffer through various drafts of this article. Your thoughts and commentary were greatly appreciated I CARMEN DENAVAS-WALT ET AL., U.S. DEP'T. OF COMMERCE, INCOME, POVERTY, AND HEALTH INSURANCE COVERAGE IN THE UNITED STATES: 2003 14 (2004). 2 During the last Congress, numerous bills addressed the issue. H.R. 2854, 108th Cong. (2003); Prescription Drug and Medicare Improvement Act of 2003, S. 1, 108th Cong. -
Paper Cuts: Reducing Health Care Administrative Costs
Paper Cuts: Reducing Health Care Administrative Costs The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Wikler, Elizabeth, Peter Bausch, and David M. Cutler. 2012. "Paper Cuts: Reducing Health Care Administrative Costs." Washington, DC: Center for American Progress. Published Version https://www.americanprogress.org/issues/healthcare/ report/2012/06/11/11658/paper-cuts/ Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:17190515 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA THE ASSOCIATED PRESS/J ASSOCIATED THE OH N R N ao UX Paper Cuts Reducing Health Care Administrative Costs Elizabeth Wikler, Peter Basch, and David Cutler June 2012 WWW.AMERICANPROGRESS.ORG Paper Cuts Reducing Health Care Administrative Costs Elizabeth Wikler, Peter Basch, and David Cutler June 2012 Contents 1 Introduction and summary 3 Administrative costs: Who pays how much? 7 The Health Insurance Portability and Accountability Act 11 Administrative simplification efforts in the Affordable Care Act 17 Recommendations: Coordinating opportunities for administrative simplification 27 Potential savings from recommendations 29 Conclusion 31 Appendix 37 About the authors and acknowledgements 38 Endnotes Introduction and summary Administrative costs in the U.S. health care system consume an estimated $361 billion annually—14 percent of all health care expenditures in our nation. At least half of this spending is estimated to be wasteful.1 In an era of government bud- get deficits and rising health care costs, the case for reducing the administrative complexity of health care is compelling. -
Interventions to Promote Health and Increase Health Care Efficiency: December 2015 Update
Washington State Institute for Public Policy 110 Fifth Avenue SE, Suite 214 ● PO Box 40999 ● Olympia, WA 98504 ● 360.586.2677 ● www.wsipp.wa.gov December 2015 Interventions to Promote Health and Increase Health Care Efficiency: December 2015 Update The Washington State Legislature directed the Summary Washington State Institute for Public Policy (WSIPP) to “calculate the return on investment WSIPP’s Board of Directors authorized WSIPP to work on a joint project with the MacArthur Foundation and to taxpayers from evidence-based prevention the Pew Charitable Trusts to extend WSIPP’s benefit- and intervention programs and policies."1 cost analysis to certain health care topics. An important Additionally, WSIPP’s Board of Directors goal is to determine whether there are strategies that authorized WSIPP to work on a joint project can help states control Medicaid and other health care with the MacArthur Foundation and Pew costs. We consulted with Washington State legislative Charitable Trusts to extend WSIPP’s benefit- staff to identify the specific health care topics of cost analysis to certain health care topics. interest. In this report, we present our new and We present findings for four new topics: 1) hospital– updated benefit-cost results for a variety of based programs to reduce cesarean sections; 2) school-, workplace-, and community-based obesity interventions to promote health and increase prevention programs; 3) accountable care health care efficiency. We consulted with organizations; and 4) patient cost sharing. We also Washington State legislative staff to identify summarize prior findings for six topics: 1) “lifestyle” the specific health care topics of interest. -
NCQA Guide to Health Care Quality
The essential guide to health care quality National Committee For Quality Assurance The essential guide to health care quality .ncqa.org ashington, DC National Committee For Quality Assurance W phone: 888-275-7585 www 1 NCQA The Essential Guide to Health Care Quality NCQA Table of Contents INTRODUCTION A Letter from Margaret E. O’Kane . 4 CHAPTER 1 What Is Health Care Quality? . 6 Sidebar: Is There Such a Thing as Too Much Care? . 9 CHAPTER 2 What Affects Health Care Quality? . 10 Sidebar: How Can Consumers Drive Better Quality Care?. 13 Sidebar: State Snapshots of Health Care Quality . 13 CHAPTER 3 Measuring Health Care Quality . 14 Sidebar: Consumers and Health Literacy . 16 Sidebar: Who Is Educating Consumers About Health Care Quality?. 16 CHAPTER 4 How Can the Way We Pay for Care Affect Quality? . 18 Sidebar: How Does Paying for Performance Reward Quality? . 19 CHAPTER 5 Reducing Medical Errors . 20 Sidebar: Patient Safety Law Seeks to Promote a Culture of Safety . 23 Sidebar: The 100,000 Lives Campaign . 23 CHAPTER 6 Using Health Information Technology . 24 Sidebar: The American Health Information Community. 26 Sidebar: Physician Practice Connections. 27 NCQA The Essential Guide to Health Care Quality CHAPTER 7 Managing Chronic Illness . 28 Sidebar: Medicare Health Support . 29 CHAPTER 8 What Is Government’s Role? . 30 Sidebar: Health Care Transparency . 33 Sidebar: Developing New Quality Measures. 33 CHAPTER 9 What Would the Ideal Health Care System Look Like? . 34 APPENDIX 1 Glossary . 36 APPENDIX 2 Government Agencies and Non-Profit Organizations . 38 M e a APPENDIX 3 s u r i n Key Publications and Resources . -
Linking Cost and Quality Measures
Efficiency and Value in Healthcare: Linking Cost and Quality Measures A PAPER COMMISSIONED BY THE NATIONAL QUALITY FORUM Andrew M. Ryan, Ph.D. Christopher P. Tompkins, Ph.D. November 14, 2014 This report is funded by the Robert Wood Johnson Foundation under grant #71278. Acknowledgements The authors would like to acknowledge the staff at the National Quality Forum, particularly Ashlie Wilbon, Taroon Amin, and Erin O’Rourke, for their contributions and assistance with this project. We would also like to acknowledge the outstanding contributions of the expert panel, particularly Joyce Dubow and Carole Flamm, the panel co-chairs. We would also like to acknowledge the research assistance of Jayme Mendelsohn. i Introduction from the National Quality Forum While the need to use cost and quality measures together to assess health system efficiency is well- established, there is currently no clear consensus among stakeholders or recognized state of the art on how to do so. To begin exploring the state of measurement science in this area, NQF commissioned this white paper to categorize the various methodologies for and challenges of linking cost and quality measures. To guide the development of this paper, NQF convened a multistakeholder expert panel to provide input through an iterative review process. The goal of this paper is to outline various approaches to measuring efficiency in health care, explore their current and potential uses, and determine possible paths forward. NQF has built much of its work around cost and resource use measurement on guidance established by prior work, including the Institute of Medicine’s definition of efficiency and NQF’s Patient Focused Episode of Care Model. -
Efficiency Measurement in Health Systems
Cover_WHO_nr46_Mise en page 1 5/01/17 12:06 Page 1 46 Efficiency is one of the central preoccupations of health policy-makers and managers, and EFFICIENCY SYSTEM HEALTH justifiably so. Inefficient care can lead to unnecessarily poor outcomes for patients, either Health System 46 in terms of their health, or in their experience of the health system. What is more, inefficiency anywhere in the system is likely to deny health improvement to patients who might have been treated if resources had been used better. Improving efficiency is therefore a compelling policy goal, especially in systems facing serious resource constraints. Efficiency Series The desire for greater efficiency motivates a great deal of decision-making, but the routine use of efficiency metrics to guide decisions is severely lacking. How to make measurement Health Policy To improve efficiency in the health system we must first be able to measure it and must therefore ensure that our metrics are relevant and useful for policy-makers and managers. In this book the authors explore the state of the art on efficiency measurement in health matter for policy and management systems and international experts offer insights into the pitfalls and potential associated with various measurement techniques. Edited by The authors show that Jonathan Cylus • The core idea of efficiency is easy to understand in principle - maximizing valued outputs relative to inputs, but is often difficult to make operational in real-life situations Irene Papanicolas • There have been numerous advances in -
Health Cost Containment and Efficiencies NCSL Briefs for State Legislators
Health Cost Containment and Efficiencies NCSL Briefs for State Legislators TABLE OF CONTENTS (Each individual brief in the series is numbered, #1-16 and includes page numbers specific to that brief, four to six page each) Cover Table of Contents Introduction Series I: Payment and Purchasing Reforms (Briefs No. 1-10) 1. Administrative Simplification in the Health System 2. Global Payments to Health Providers 3. Episode-of-Care Payments 4. Collecting Health Data: All-Payer Claims Databases 5. Accountable Care Organizations 6. Performance-Based Health Care Provider Payments 7. Equalizing Health Provider Rates: All-Payer Rate Setting 8. Use of Generic Prescription Drugs and Brand-Name Discounts 9. Prescription Drug Agreements and Volume Purchasing 10. Pooling Public Employee Health Care Series II: Delivery System and Health Promotion Reforms (Briefs No. 11-16) 11. Combating Fraud and Abuse 12. Medical Homes 13. Employer-Sponsored Health Promotion Programs 14. Public Health and Cost Savings 15. Health Care Provider Patient Safety 16. Medical Malpractice Health Cost Containment and Efficiencies NCSL Briefs for State Legislators May 2011 A series examining options for containing or reducing health costs and improving efficiency in health – expanded for 2011 he cost of health and health care in the United States 3. Episode-of-Care Payments for years has been a highly visible topic of discussion 4. Collecting Health Data: All-Payer Claims Databases Tfor consumers, employers, state and federal policy- makers, and the media. 5. Accountable Care Organizations 6. Performance-Based Health Care Provider Payments Innovations and Experiments Policymakers, especially at the state level, have spent a 7. -
Health Homes in Medicaid: the Promise and the Challenge
Health Homes in Medicaid: The Promise and the Challenge Barbara Ormond Elizabeth Richardson Brenda Spillman Judy Feder February 2014 Health Homes in Medicaid: The Promise and the Challenge Barbara Ormond Elizabeth Richardson Brenda Spillman Judy Feder Copyright © November 2013. The Urban Institute. All rights reserved. Except for short quotes, no part of this report may be reproduced or used in any form or by any means, electronic or mechanical, including photocopying, recording, or by information storage or retrieval system, without written permission from the Urban Institute. The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance problems facing the nation. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Doctor Photo from Tyler Olson/Shutterstock.com. Contents Executive Summary 1 Health Homes in Medicaid: The Promise and the Challenge 3 What is the Medicaid Health Homes Model? 3 What Are the Origins of the Health Home Concept? 4 How Are Health Homes Distinguished from Medical Homes? 5 Emphasis on Integrating Physical and Behavioral Health Care Services 5 Targeting Populations with Chronic Conditions 6 Reaching beyond the Clinical Care Setting 6 What Are the Main Challenges to Implementing Health Homes? 6 Culture Change 7 Communication 8 Targeting, Tracking, and Data 9 Payment Issues 11 Administrative Issues 11 Conclusion 12 References 15 Notes 16 Executive Summary Since passage of the Affordable Care Act (ACA), health care providers and insurers have been actively engaged in payment and delivery reform. They aim to improve the quality of health care while slowing growth in its costs. -
The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control, 92 Ind
University of California, Hastings College of the Law UC Hastings Scholarship Repository Faculty Scholarship 2016 The ouble-ED dged Sword of Health Care Integration: Consolidation and Cost Control Jaime S. King UC Hastings College of the Law, [email protected] Erin C. Fuse Brown Follow this and additional works at: https://repository.uchastings.edu/faculty_scholarship Recommended Citation Jaime S. King and Erin C. Fuse Brown, The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control, 92 Ind. L.J. 55 (2016). Available at: https://repository.uchastings.edu/faculty_scholarship/1553 This Article is brought to you for free and open access by UC Hastings Scholarship Repository. It has been accepted for inclusion in Faculty Scholarship by an authorized administrator of UC Hastings Scholarship Repository. The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control* ERIN C. FUSE BROWN AND JAIME S. KINGt The averagefamily offour in the United States spends $25,826 per year on health care. American health care costs so much because we both overuse and overpayfor health care goods andservices. The Affordable CareAct's cost controlpoliciesfocus on curbing overutilization by encouraginghealth care providersto integrate to pro- mote efficiency and eliminate waste, but the cost control policies largely ignore prices. This article examines this overlooked half of health care cost controlpolicy: risingprices and the policy levers held by the states to address them. We challenge the conventional wisdom that reducing overutilization through health care integra- tion will effectively reduce health spending. We argue that vertical integration -bringing together disparateproviders from hospitals to physicians-is a double- edged sword, with not only the potential to reduce wasteful and unnecessary use of services but also downside risks of increasingmarket consolidation and health care prices. -
Productivity and the Health Care Workforce
New America Foundation Next Social Contract Initiative and Economic Growth Program Productivity and the Health Care Workforce Shannon Brownlee, Joseph Colucci, and Thom Walsh October 2013 Executive Summary Since World War II, health care spending in the United States has grown rapidly – faster than in the rest of the developed world, and much faster than the US gross domestic product. With less than 5% of the world’s population, the US now accounts for 40% of global health spending, almost twice as much per capita as the next highest- spending country. American health outcomes, however, have not kept pace with spending. The United States compares remarkably poorly to other developed countries on such measures as life expectancy at birth, infant mortality, and other indicators of population health. In other words, we are spending more and more on health care for lower and lower returns in the form of better health. Despite a steady stream of medical innovations, productivity growth in the health care sector has been slow. There are several reasons for this poor productivity. Many tests and treatments (both new and old) are routinely put to use with little or no regard for whether they improve patient outcomes. Treating prostate cancer with proton beam therapy, for example, costs $50,000 per patient – roughly twice the cost of standard radiation treatment. Yet there is no evidence that proton beam therapy is any better for the patient’s chances of surviving cancer or avoiding serious side effects. There is also evidence that between one-tenth and one-third of tests and treatments are unnecessary or unwanted by patients.