Three quarters of Medicare’s 47 million beneficiaries are enrolled in the traditional fee-for-service (FFS) program. The remainder receive benefits through private health plans, primarily health maintenance organizations (HMOs)  as part of a program currently known as Medicare Advantage. In 2011, more than 12 million beneficiaries, or approximately 26 percent of all Medicare beneficiaries, were enrolled in Medicare Advantage. HCFO-funded research on costs and quality in Medicare Advantage helps to provide insights to policymakers during a time when the program is responding to changes mandated by the Patient Protection and Affordable Care Act.

In 2008, approximately 7.4 million children in the United States received health insurance coverage through the State Children's Health Insurance Program (SCHIP). SCHIP coverage expansions and widening eligibility standards can lead to the substitution of private coverage for public insurance coverage, a phenomenon known as crowd-out. In a HCFO-funded study, Helen Levy, Ph.D., and her colleagues set out to explore whether the crowd-out effect of SCHIP could result in a financial windfall for families.

Jack Hadley, Ph.D., is a professor and senior health services researcher of health administration and policy at the George Mason University College of Health and Human Services. As a long-standing HCFO grantee, Dr. Hadley has been a principal investigator on five HCFO grants.

Glen Mays, Ph.D., M.P.H., and Sharla Smith, M.P.H., published “Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths,” July 2011, in Health Affairs early view online.

Lawrence Casalino, Ph.D., and colleagues published “US Physician Practices Versus Canadians: Spending Nearly Four Times as Much Money Interacting with Payers,” August 2011, in Health Affairs.

Grantees in the News

Following recent publication in Health Affairs, a HCFO-funded study led by Richard Kronick, Ph.D., was featured on the “Healthwatch” blog of The Hill. The article, "Study: Volume, not cost, drives up Medicaid spending," detailed the study's findings on state variations in Medicaid spending. The research found that high-spending states do not pay more for each procedure or service, but that Medicaid patients in these states receive a higher volume of services.

HCFO-funded research led by Glen Mays, Ph.D., M.P.H., of the University of Arkansas for Medical Sciences, was highlighted on the website of Medscape Medical News following recent publication in Health Affairs. The article, "Increased Public Health Spending Decreases Mortality," details Mays's finding that increased spending on public health results in measurable decreases in death from preventable causes.  The study was funded through a public health special solicitation through the HCFO program in 2005.

HCFO-funded work led by Lawrence Casalino, M.D., Ph.D., of Weill Cornell Medical College, has been highlighted in several media outlets. The study found that physicians in the United States spend four times the amount of money interacting with insurance companies than their colleagues in Canada. The findings were published in Health Affairs and generated significant media interest in both the United States and Canada.

HCFO News

A HCFO issue brief, "Considerations Related to Pricing Individual and Small Group Health Insurance under Health Reform," was recently featured on the Health Reform Source website, an initiative of the Henry J. Kaiser Family Foundation. Health Reform Source is an online gateway explaining, analyzing, and tracking the implementation of the Patient Protection and Affordable Care Act. The brief was also highlighted in the July 25, 2011 newsletter (page 2) of the State Health Access Data Center (SHADAC) and the State Health Access Reform Evaluation (SHARE). The brief is based on an April 2011 meeting among researchers, policymakers, insurers, actuaries, and analysts to discuss the Affordable Care Act’s multiple provisions related to rate review and risk, which are expected to affect insurance premiums in the individual and small group markets.

RWJF Releases

The Robert Wood Johnson Foundation released the content alert “Driving Down the Price Up North” on August 4. It highlights findings from a HCFO-sponsored study led by Lawrence Casalino.

Events

HCFO Webinar: Getting and Using Medicare Data: What I Wish I Had Known Before I Started My Research

Medicare data has long been an important resource for researchers and policymakers who study the U.S. health care system. The process of acquiring and using data, however, can be complex to navigate. The Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program, in collaboration with AcademyHealth’s Methods Council, is pleased to offer a webinar on best practices for obtaining and using Medicare data for research. Two experienced HCFO researchers, Jack Hoadley of Georgetown University and Jim Reschovsky of the Center for Studying Health System Change, will share some of their accumulated wisdom in getting and working with Medicare data in their research. In addition, Barbara Frank from the Research Data Assistance Center (ResDAC) at the University of Minnesota will provide additional resources, tips, and best practices drawn from her organization’s role as a CMS contractor assisting researchers in obtaining and working with Medicare data. This webinar is intended for both new and experienced researchers.

Date: September 27, 2011
Time: 1:00 PM-2:30 PM EDT
To register visit:  http://www.academyhealth.org/Training/ResourceDetail.cfm?itemnumber=7362

Virtual Poster Session – View Posters Voted in by 2011 Annual Research Meeting Participants

HCFO Webinar: Getting and Using Medicare Data: What I Wish I Had Known Before I Started My Research

2nd Annual Workshop on Health IT and Economics, October 21-22, Washington, D.C.

Registration Now Open for AHRQ’s Full-Day HCUP Data Users’ Workshop