Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Health Care Systems, JAMA / 26.06.2018 Interview with: A Jay Holmgren Doctoral Student, Health Policy and Management Harvard Business School What is the background for this study? What are the main findings? Response: Post-acute care, care that is delivered following an acute care hospitalization, is one of the largest drivers of variation in US health care spending. To address this, Medicare has created several payment reform systems targeting post-acute care, including a voluntary bundled payment program known as the Model 3 of the Bundled Payment for Care Improvement (BPCI) Initiative for post-acute care providers such as skilled nursing facilities, long-term care hospitals, or inpatient rehabilitation facilities. Participants are given a target price for an episode of care which is then reconciled against actual spending; providers who spend under the target price retain some of the savings, while those who spend more must reimburse Medicare for some of the difference. Our study sought to evaluate the level of participation in this program and identify what providers were more likely to participate. We found that fewer than 4% of eligible post-acute care providers ever participated in the program, and over 40% of those who did participate dropped out. The providers more likely to remain in the program were skilled nursing facilities that were higher quality, for-profit, and were part of a multi-facility organization. (more…)
Author Interviews, BMJ, Health Care Systems, Hospital Readmissions / 01.04.2014 Interview with: dr_karen_e_lasser Karen E Lasser, MD MPH Associate Professor of Medicine Boston University School of Medicine, Boston, MA What are the main findings of the study? Dr. Lasser: After controlling for variables that could affect the risk of readmission, we found that:
  1. There was a slightly increased risk of all-cause readmission in Massachusetts (MA) relative to control states (New York and New Jersey) post-reform.
  2. Racial and ethnic disparities in all-cause readmission rates did not change in MA relative to control states.
  3. However, both blacks and whites in counties with the highest uninsurance rates had a decreased risk of readmission following MA health reform relative to blacks and whites in counties with lower uninsurance rates.
Author Interviews, Cost of Health Care, Health Care Systems / 12.03.2014 Interview with: Liane J. Tinsley, MPH Associate Research Scientist Department of Epidemiology New England Research Institutes, Inc. Watertown, MA 02472 What are the main findings of the study? Answer: For this study, we analyzed health insurance data from a cohort of community-dwelling individuals between the ages of 30-79 at baseline, in Boston, MA. Massachusetts health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage in our study population. Despite being targeted by the law, the working poor (those currently working for pay, either part- or full-time and earning less than 200% of the US federal poverty threshold for household size) continued to report lower rates of insurance coverage following reform (13.3% without insurance), compared to the both non-working poor (4.7% without insurance) and the not poor (5.0% without insurance). (more…)