Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration

Works Published by Research Grantees in 2019

Dissecting Racial Bias in an Algorithm Used to Manage the Health of Populations

This study discovered racial bias in a commercial medical algorithm used to guide care decisions for millions of people, finding that it overlooked nearly 50,000 chronic diseases in black patients. The algorithm used cost as a metric to identify patients who needed more care coordination, but as black patients incur lower medical costs due to unequal access to care, the algorithm scored white patients the same as black patients with more diseases.

Hospital Prices Grew Substantially Faster Than Physician Prices for Hospital-Based Care in 2007-14

Health care spending for the privately insured rose 20% overall from 2007 to 2014, and hospital prices paid by private insurers for inpatient and outpatient care grew much more quickly than the prices paid to the physicians who provide care in these settings. For all inpatient care, hospital prices grew by 42 percent compared to 18 percent for physician prices. The same pattern was observed for four specific high-volume hospital-based procedures.

Research Insights

Overuse of Health Care by Commercially Insured Adults Varies Persistently by Region

Systemic overuse of health care follows regional patterns that are highly persistent over time, according to an analysis of commercial health insurance claims from 2010 to 2015. The researchers recommend addressing structural and system-wide factors that contribute to a "culture of overuse" rather than trying to curb overuse of specific individual services.

Research Insights

Reducing Inappropriate Imaging Can Lead to Substantial Savings

An analysis of diagnostic imaging claims for privately insured patients with back, knee and shoulder pain found significant levels of inappropriate use of MRIs and X-rays, relative to clinical guidelines, for certain common conditions. Over 60% of MRIs provided to patients with uncomplicated, non-traumatic low back pain were inappropriate.

Research Insights

Access to Low-Cost LARCs Reduced Teen Births

Teen birth rates declined after Title X clinics in Colorado began providing free or low-cost access to long-acting reversible contraceptives (LARCs) in 2009. The authors estimated that there were 6,800 fewer births to women aged 15 to 29 over the life of the program, with the largest impacts for teens.

Research Insights

Could Expanding Access to Contraception Improve Economic Outcomes?

This policy memo aimed at journalists, policymakers and the general public summarizes evidence on the short-term impacts of access to LARCs and makes the case for more comprehensive program evaluation plans and better data that would enable researchers to also assess longer-term impacts on women's economic outcomes. This piece was re-published by PBS NewsHour.

The eQuality Toolkit: Clinical Skills for Providing Inclusive Care to LGBTQ Patients

The eQuality Toolkit is a training manual to help medical schools update their curriculum and providers to improve their clinical skills with respect to inclusive care for lesbian, gay, bisexual, transgender and queer-identified (LGBTQ) patients and individuals born with differences of sex development. 

Determining Value-Based Prices for Potential Cures: A Review of the Options

This article describes methodological challenges in employing cost-effectiveness analysis to suggest value-based price levels for potential cures and proposes alternative ways to modifying cost-effectiveness analysis to develop more appropriate value-based prices for cures.

Neonatal Abstinence Syndrome Rates Associated With Higher Unemployment and Mental Health Clinician Shortages

Higher long-term unemployment and higher mental health clinician shortages are significantly associated with higher rates of neonatal abstinence syndrome in county-level trend data from 8 diverse states. The work suggests the importance of addressing such social determinants of health as an additional lever in the efforts to reduce neonatal abstinence syndrome.

The Opioid Epidemic: Successes and Challenges in Enactment of State Laws and Policies

Through an assessment of prescription drug monitoring programs and naloxone programs in 10 states, this study identified success factors and challenges in passing and implementing state laws aimed at the opioid crisis. Success factors included having an identifiable champion, using stakeholders' personal stories to garner buy-in, providing ongoing education and feedback to PDMP users, and being inclusive in engaging diverse stakeholders. Challenges included divided state legislatures and physician pushback.

Catching Them Red-Handed: Optimizing the Nursing Homes' Rating System

This paper uses linear programming and simulation methods to determine the optimal inspection process that CMS should use to minimize the number of nursing homes that can inflate their star ratings, and to develop an efficient and effective audit process for detecting and deterring rating inflation on the self-reported measures.

Winners and Losers Under Proposals to Simplify Drug Plan Choice in Medicare Part D

Within the context of Medicare Part D markets, this paper evaluated the welfare impacts of three policies designed to encourage beneficiaries to enroll in plans that would be more optimal for their situations. A policy that attempts to simplify the choice set by restricting the number of plans offered is harmful to many consumers, whereas providing personalized information to beneficiaries about their choices is beneficial to many.