This webinar offered an overview of our health system’s price problem and shared a reporter's toolkit for covering the issue in their communities — including strategies, data sources and crowdsourcing tips.
The Boston Globe published a front-page story on the growing demand for biological samples used in drug development and other medical research—and the growing interest of patients in controlling their own genetic material. This ongoing NECIR investigation is supported by a NIHCM grant.
The Boston Globe published a story on the growing field of genetic testing, highlighting the changes in FDA regulations that are allowing for easier access to tests, the potential harm caused by unreliable tests and the growing costs associated with increased use. This ongoing investigation is supported by a NIHCM grant.
This New England Center for Investigative Reporting story in The Boston Globe exposed issues in the genetic testing field, including conflicts of interest, lack of regulation by the FDA and a high incidence of inaccurate results for noninvasive prenatal tests.
Reveal’s Will Evans and Christina Jewett report on how a lapse in FDA oversight allowed one company to sell millions of dollars in counterfeit implants to a nationwide network of surgeons.
A NIHCM Foundation Journalism Grant is supporting the public engagement campaign for the To Err is Human documentary to raise awareness of medical errors—now the third leading cause of death in the U.S.—and efforts to improve patient safety.
In this essay, Steven Lieberman reviews the ACO landscape in both the public and private sectors and examines the major obstacles confronting these emerging organizations.
This Research Insights highlights key findings from a study of how changing insurance carriers affects patient-physician relationships. The findings include an increase in emergency department visits by Medicaid patients in the month after they change insurers.
This study will examine trends and correlations in nursing homes’ self-reported measures of quality and more objective measures obtained from independent organizations to assess whether Medicare quality scores are inflated. Results will inform recommendations to improve the rating system, benefitting patients, medical providers and payers.
Technology has revolutionized consumerism, allowing us to make on-the-go purchasing decisions with user-friendly apps and easy access to product data. We're also increasingly sophisticated about monitoring our health, turning mobile devices into wellness tools with calorie trackers and fitness monitors. While the health care industry has largely lagged behind this transformation, more and more companies are finding ways to help consumers take charge of their health and make smart decisions about their health care.
This NIHCM-funded study used data from Virginia’s largest Medicaid managed care plan to evaluate the effects of integrated case management on health service use, cost, racial disparities, and goal setting and accomplishment. By examining various subgroups of enrollees and differential impacts according to the type of case management used, the work is providing insights into the effective design of case management interventions for the Medicaid population.
Joe Carlson has been awarded the 17th Annual Trade Journalism Award for his story “Bad for Business” in Modern Healthcare. This exposé on hospital finance reveals that hospitals have been losing money on patient care for the last 25 years and suggests financial strategies that might help hospitals and their patients.
Annual spending for cancer treatment in the U.S. is set to reach $184 billion by 2020. The large and growing bill has raised concerns that fee-for-service payments for oncology are promoting over-treatment and use of more expensive drugs irrespective of patient benefit.
This webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, explored the potential of transparency to improve health care outcomes, while asking why such efforts haven't always met expectations.
The number of cancer survivors in the U.S. is projected to grow by 31 percent in just a decade, and while rapid scientific advances are increasing survival, they’re also adding cost and complexity to treatment decisions. This webinar explored new ways to deliver and pay for cancer care.
This NIHCM-sponsored research shows that in markets where the supply of orthopedists is more concentrated private payers pay higher prices for knee replacement surgery.
The U.S. now spends $2.5 trillion annually on health care, accounting for well over 17 percent of GDP and growing rapidly with challenging fiscal consequences. Despite the imperative to control spending, we face much uncertainty about how to move to a more sustainable path. Political opposition threatens implementation of the Affordable Care Act, and many of its cost-control measures are still unproven.
Carol Patton has been awarded the 18th Annual Trade Journalism Award for her report "Coupon Overdose" in Human Resource Executive. She finds that employers are starting to combat co-pay drug coupons that drive up pharmacy-benefit costs by implementing a variety of policies that promote the use of generic drugs to control costs while still ensuring quality patient care.
The Center for Public Integrity has been awarded the 19th Annual Health Care Print Journalism Award in the General Circulation category for the investigative series “Cracking the Codes,” by Fred Schulte, Joe Eaton, David Donald and Gordon Witkin. The series analyzes Medicare billing and coding practices, uncovering how some medical professionals are billing at sharply higher rates than their peers and collecting billions of dollars of questionable fees as a result.
This NIHCM-funded study took a deep dive into new private-sector claims data to explore variation in the prices hospitals negotiate with private payers, seeking to understand the factors drivering this variation, including hospital and insurance market concentration, clinical quality and other characteristics of the hospital. Findings are relevant to efforts to improve health system performance and promote value.
Marshall Allen and Alex Richards have been awarded the 17th Annual Health Care Print Journalism Award in the General Circulation category for their Las Vegas Sun series "Do No Harm: Hospital Care in Las Vegas." This investigation revealed the dangers patients in the Las Vegas-area have unknowingly encountered in delivery rooms, surgical suites and intensive care units, including thousands of cases of deadly infections, injury, and death associated with stays in Las Vegas hospitals.
This Research Insights summarizes findings from a study showing that a small percentage of nursing homes—particularly larger and for-profit facilities—are using self-reported scores to inflate their ratings in Medicare's five-star nursing home rating system.
This webinar, hosted by USC Annenberg’s Center for Health Journalism, toured the existing evidence on pay for performance and took a hard look at claims that it will boost quality and curb spending.
With Medicaid expanding to cover more low-income adults, some Medicaid programs are experimenting with integrated case management (ICM) to help these patients address their specific medical, social and behavioral needs. A study led by Gloria Bazzoli and supported by a NIHCM research grant finds that ICM can decrease health service use by high-risk patients and lower spending for low-risk patients. This one-page Research Insights reviews the key takeaways from the published Medical Care article.
This Health Matterswebinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, aimed to inspire journalists to rethink their own coverage of certain issues in light of Dr. Ezekiel Emanuel's provocative essay for The Atlantic.
As part of the work to investigate ways to identify primary care patients who are at high risk, this analysis explored the predictive power of asking physicians whether they would be surprised if the patient died in the next 12 months. Though this question in isolation failed to identify the majority of patients who subsequently died in that time frame, physician predictions were more strongly associated with 1-year mortality than other known correlates such as patient age and comorbidities, suggesting that incorporating this physician judgement into more advanced predictive algorithms may be a fruitful direction for future research.
In this essay, Dr. Jacobson and Dr. Newhouse present findings from their recent research on how physicians have responded to reductions in Medicare payments for chemotherapy drugs. Their work documents an increase in chemotherapy use rates and a switch from the drugs whose reimbursement declined to a drug that offered a higher profit for physicians.
In this chart story, we review key projections for Medicare and Social Security, identify trends that are unsustainable, and explain how growing entitlement and interest spending affect the federal budget.
In this essay, David Dranove, a Federal Trade Commission expert witness, explains how prospective analysis of merger outcomes has been sharpened to account for selective contracting and the effects of mergers on bargaining leverage between hospitals and payers.
An Honorable Mention for the 18th Annual Health Care Research Award has been awarded to “Full Coverage for Preventive Medications after Myocardial Infarction” in the New England Journal of Medicine in 2011. The paper looks into whether eliminating out-of-pocket costs would increase medication adherence after myocardial infarction and finds that the elimination of copayments did not significantly reduce rates of the trial's primary outcome. Additionally, enhanced prescription coverage improved adherence and rates of first major vascular events and decreased patient spending without increasing overall health costs.
Research team: Niteesh Choudhry, Jerry Avorn, Robert Glynn, Elliott Antman, Sebastian Schneeweiss, Michele Toscano, Lonny Reisman, Joaquim Fernandes, Claire Spettell, Joy Lee, Raisa Levin, Troyen Brennan, William Shrank
This data brief closely examines the budgetary implications of government spending on health entitlement programs.
With support from a NIHCM Foundation Journalism Grant, ProPublica continues its investigative reporting on the U.S. health care system, including ongoing investigations on patient safety and the Medicare program.
One percent of the U.S. population accounts for nearly 23 percent of overall health care spending, and 5 percent are responsible for a full 50 percent of spending. This chart story uses takes a closer look at the top spenders, noting factors driving their higher spending and examining the persistence of spending patterns over time.
We know that health care spending is highly concentrated, with just 5 percent of the population accounting for 50 percent of spending. But what else do we know about these high spenders? This chart story synthesizes the latest data on patterns in personal health spending, including the persistence of individual spending over time.
Haydn Bush has been awarded the 19th Annual Trade Journalism Award for the series “Health Care’s Costliest 1%” in Hospitals & Health Networks. The investigation looks at how patients at the top of the health care utilization pyramid consume an increasingly larger share of resources each year and at the role of patients, hospitals, physicians and communities.
This chart story pulls together essential facts on how much the federal government is spending on mandatory health care programs, how that spending affects the budget, and the hard spending and revenue trade-offs necessary to improve our fiscal outlook.
Dr. Laurence Baker and his colleagues, with support from NIHCM research grants, have produced a series of papers examining the relationship between provider market power and private prices in a variety of scenarios. This Research Insights highlights the key takeaways from four published papers.
This Research Insights pulls out the key findings and policy recommendation on unexpected medical bills as published in the New England Journal of Medicine.
This NIHCM-funded study will explore whether Medicare beneficiaries give their primary care physicians higher ratings for the care experience if these physicians have a general practice style characterized by more provision of low-value services. Results will help to increase the effectiveness of demand- and supply-side interventions to improve the value of health care services.
Tiered physician networks are one potential strategy to control health care costs while maintaining patient choice. Here’s how they work: health plans sort physicians into tiers based on the quality and cost-efficiency of the care they provide. Patients are incentivized by lower copayments to choose higher tier physicians. A paper by Anna Sinaiko, supported by a NIHCM research grant, looks at whether tiers are actually influencing patient choice of physician.
This Research Insights summarizes findings from a study showing that a patient is more likely to choose a hospital that owns her doctor’s practice - even if the costs are higher and the quality lower than at other local hospitals.
Rick Young and his team have been awarded the 7th Annual Television and Radio Journalism Award for their FRONTLINE documentary “Hunting the Nightmare Bacteria” on PBS. This investigation highlights the rise in deadly drug-resistant bacteria, including antibiotic overuse and the role drug companies play in the development of new antibiotics.
In this essay, Dr. Meier argues that widening the reach of palliative care could increase value in the health care system.
This NIHCM-funded study will apply state-of-the-art machine learning techniques to electronic health record data to develop predictive models that: (1) identify patients at high risk of becoming high users, and (2) predict which patients are likely to achieve better health outcomes and/or lower health care utilization in response to high-risk care management (HRCM). Results will contribute to more effective and efficient HRCM programs, helping to provide better care at lower cost.
This Health Matters webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, looked at groundbreaking new research on what private insurance plans are paying for common procedures in markets across the country and how those prices are influenced by provider consolidation.
One in five American kids lives below the federal poverty line—a start that leads to health disparities and life-long achievement gaps. Services like home visits for new mothers have been proven to mitigate the impact of poverty on young kids, and a new model is shaking up the way these services are financed.
This NIHCM-sponsored research documents significantly higher private prices for a range of surgical and medical procedures and specialties in markets with higher concentration of physician practices.
Anyone following the news, even casually, knows that our federal government is spending vastly more than it is taking in, resulting in huge annual deficits that must be covered by borrowing. We now borrow about 41 cents for every dollar we spend and have reached our legal debt limit of more than $14 trillion, forcing contentious standoffs over raising the debt ceiling.
In this essay, John Iglehart surveys the landscape for nurse practitioners, noting the latest developments in the scope of practice debate and showing where the tide might be turning.
In this essay, Dr. James Robinson presents results from his latest work showing that the prices hospitals charge to private insurers for 6 common procedures are 30 to 50 percent higher when the hospital is located in a market where it faces less competition from other hospitals.
Reference pricing, tiered provider networks and narrow networks—three benefit design strategies gaining favor among employers and health plans trying to slow cost growth. While these designs aim to encourage value-informed consumer choices, some perceive them as overly restrictive.
Less than one in five patients reports having seen information comparing prices and quality across health plans or providers, and the burden of health care spending continues to mount. This webinar highlighted strategies to guide consumers toward high-value health care.
In this essay, Maya MacGuineas reviews the budget projections and comments on Administration proposals for addressing the fiscal crisis. She also describes a new set of recommendations from the Peterson-Pew Commission on Budget Reform calling for immediate and bold steps designed to stabilize our federal debt at 60 percent of GDP by 2018.
Elisabeth Rosenthal was awarded the 21st Annual Health Care Print Journalism Award in the General Circulation category for her New York Times series “Paying Till It Hurts.” Her work investigates the convoluted and often surprising story of the American medical bill through a collection of interviews with patients, physicians, economists, and hospital and industry officials.
This webinar explored current approaches to payment reform that offer insight for future federal and state policies.
This study continues earlier research also funded by NIHCM examining how physician practice consolidation affects care delivery, spending and quality for Medicare patients and PPO prices for the privately insured. Results are expected to inform policy discussions about provider consolidation and market power.
This NIHCM-funded study is exploring physician practice patterns for cancer services that tend to be overused in order to understand whether overuse is pervasive across the medical decisions of individual physicians or more limited to specific services. Results will inform efforts to reduce overuse.
Building on prior NIHCM-funded research documenting significant persistence in individual physicians’ use of inappropriate cancer services, this study will examine the overuse of non-recommended services for patients with advanced cancer, where patient preferences might be expected play a larger role than physician practice patterns. Results will inform efforts to reduce overuse of low-value services.
In this podcast, Gary Schwitzer interviews Brian Nosek of the University of Virginia's Center for Open Science. They discuss the Center's work to improve the quality, reproducibility, and transparency of scientific research, and the implications of flawed research reaching the public through news stories.
In this podcast, Gary Schwitzer interviews John Fauber a reporter writing for the Milwaukee Journal Sentinel with support from MedPage Today. They discuss Fauber's investigations on conflicts of interest, including how he approaches tough questions about financial relationships between industry and researchers and clinicians.
In this podcast, Gary Schwitzer interviews Dr. Jennifer Miller, PhD, one of the creators of the "Good Pharma Scorecard," which ranks new drugs and their manufacturers on the transparency of clinical trial information for those new drugs. The first scorecard results found that clinical trial disclosures for new drugs remain below legal and ethics standards, with wide variation in practices among drugs and their sponsors.
In this podcast, Gary Schwitzer interviews Dr. John Ioannidis, who holds the C.F. Rehnborg Chair in Disease Prevention and is the co-director of the Meta-Research Innovation Center at Stanford University. They discuss why most published research findings are false and why journalists need to do a better job explaining the uncertainty of science to the public.
Gary Schwitzer interviews Vinay Prasad, MD, a hematologist-oncologist at the Oregon Health and Sciences University on his views on the problems in health care, including the cost of cancer drugs and over-promotion of screening tests.
ProPublica continues to explore how patient privacy violations are affecting patients and the medical care they receive.
Half of U.S. health spending goes to care for just 5 percent of patients, and any effort to improve the efficiency of our health care dollars must prioritize these patients. Speakers discussed coverage and care for the high-cost, high-need population.
In this essay, James Robinson lays out evidence that reference pricing has both guided patients to select high-value providers and compelled costlier hospitals to lower their prices to remain competitive.
This briefing in Washington, DC, featured forward-thinking leaders whose expertise spans the public and private sectors to share insights on how to foster innovation and build a brighter future for health care in America.
This issue brief sheds light on the factors behind increased spending on private insurance.
This Health Matters webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, provided an overview of trends in hospital consolidation, clarified what’s at stake for consumers and offered journalists fresh new ideas for reporting on this story.
With another presidential election on the horizon, the perennial debate over reforming federal entitlement programs has begun to resurface. Policy prescriptions are bound to vary along the political spectrum, but failing to come to agreement and act will threaten our long-term fiscal health. This chart story breaks down the latest numbers on spending for Medicare, Medicaid and the Affordable Care Act.
High out-of-pocket spending—now averaging $1,000 per person annually—is symptomatic of a broader problem: health spending for all categories of care is on the rise, everyone is bearing a share of the burden, and alleviating that burden will require strong resolve to control overall spending.
This issue brief pinpoints health care's high-spenders, a crucial group to study in order to develop strategies to reduce overall spending growth.
Just 5 percent of the population accounts for nearly 50 percent of health care spending. This chart story examines the latest data showing the extreme concentration of health spending and the traits and sectors associated with high levels of spending.
Mark Duggan and Fiona Scott Morton have been awarded the 17th Annual Health Care Research Award for their paper "The Effect of Medicare Part D on Pharmaceutical Prices and Utilization" published in the American Economic Review in 2010. This study shows that private prescription drug plans were able to use tools such as formularies and price negotiation to extract lower prices for branded drugs in the first year of the Medicare Part D program and casts doubt on policies that rely on consumers bearing a greater portion of costs as a means to force competition and lower prices. The work has direct relevance to policy debates over how to encourage competition in the purchase of health care services.
This cover story in The New York Times, written by Kevin Quealy and Margot Sanger-Katz, features a groundbreaking study on prices and spending in private insurance. This study, led by Yale University's Zack Cooper, was supported by grants from NIHCM Foundation and The Commonwealth Fund.
In this essay, Dr. Frakt explains how the balance of market power between hospitals and insurers affects premiums. His review of the evidence drawn from prior research on this topic indicates that excessive market power of hospitals is a significant worry as we seek to contain premium growth.
This Capitol Hill briefing brought together leaders who have served in Democratic and Republican Administrations, led and advised major health care companies, and spurred improvements in health policy for many decades. They shared their insights on the outlook for health policy post-election and their experiences spearheading the transformation of health care payment and delivery.
This health policy briefing on Capitol Hill brought together top health care leaders with diverse business and policy expertise.
This Health Matters webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, explored the implications of the shift from paying for volume toward paying for value in health care. Panelists assessed the mixed track record of Accountable Care Organizations and other early results from alternative payment models.
This NIHCM-funded study is using data from the Massachusetts All Payer Claims Database to describe referral patterns across the state and to evaluate the impact of global payments on referrals and spending. Results are expected to inform the development of ACOs and other delivery/payment system innovations.
This comprehensive analysis of claims data from three national insurers documents the extensive variation in the prices that hospitals receive for the same procedure. Payment rates vary not only across and within hospital markets but also within individual hospitals, suggesting that the relative bargaining power of hospitals and insurers plays a role in price determination. The work also establishes that monopoly hospitals are paid higher prices and are more likely to obtain contracts that place them at lower financial risk, whereas hospital prices are lower and contracts are more likely to be based on prospectively determined rates when the insurer market is more concentrated. Finally, analysis of hospital mergers over a five-year period demonstrates post-merger hospital price increases, with the largest impact observed when merging facilities are in closer proximity to one another.
In this essay, Dr. Sinaiko explains the latest developments and research and offers her thoughts on the ways this approach may evolve in the future.
This briefing brought top public- and private-sector health care leaders and policy experts to Capitol Hill to share their unique perspectives on efforts to drive value in health care.
This Washington, DC briefing on Capitol Hill featured experts from policy, business and academia sharing their insights on how to improve health outcomes for Americans while managing the cost of care.
This data brief pulls together the most current data available from multiple sources to provide an overview of national health spending.
In this data brief we examine why we spend more than $8,000 per person on health care and the factors driving spending growth.
Allison Lipitz-Snyderman and colleagues have shed new light on why cancer patients receive non-recommended care. Their study, supported by a NIHCM research grant, finds that use of low-value services is driven by physician preference, with little influence from the particular characteristics of a given patient.
This Health Matters webinar, hosted by USC Annenberg's Center for Health Journalism with support from NIHCM Foundation, offered insights into what’s driving pharmaceutical prices, explained how these costs impact patients and consumers, and suggested ways in which journalists can cover this evolving story.
Joe Carlson has been awarded the 20th Annual Trade Journalism Award for his Modern Healthcare investigation of the disconnect between costs and outcomes, “You Don’t Always Get What You Pay For.” He found that in many cases, the hospital with the lower average cost for inpatient and outpatient PCI procedures also had a lower readmission rate for PCI patients.