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Costs/Payments Topics
- Cost and Quality
- Provider Payment Methods
- Equity Issues for Vulnerable Populations
- Changes to Organization of Care
- Selected Publications
Selected Projects
Examining Health Care Costs and Provider Payment Methods
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Mathematica strives to improve the public wellbeing by bringing the highest standards of quality, objectivity, and excellence to bear on our research on health care costs and provider payment methods. We study issues in the following areas at the state, national and program levels: |
Cost Drivers and the Cost-Quality Relationship
Prices charged by providers and the quantity of services used are important drivers of overall health care costs. Determinants of use include the underlying health of the population, that population’s propensity to use health care, and the availability of expensive new medical technologies. Some of these technologies have positive effects on quality and others remain unproven. Different methods of organization can also impact the effectiveness, and therefore cost, of health care.
Related publications:
"Massachusetts Health Care Cost Trends: Trends in Health Expenditures" (June 2011)
"Could There Be a Role for Home Telemedicine in the U.S. Medicare Program?” (March 2011)
"Value for the Money Spent? Exploring the Relationship Between Medicaid Costs and Quality" (August 2010)
Related projects:
Controlling Cost and Improving Care for New York State’s Medicare and Medicaid Dual Eligibles
Evaluating the Medicare Coordinated Care Demonstration
Rehospitalization in New York State and Implications for Avoidable Cost
More on cost drivers and the cost-quality relationship
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Provider Payment Methods and Their Impacts
Most health care providers in the United States are paid on the basis of individual services supplied, even though traditional fee-for-service methods don’t control costs and don’t actively promote quality. In recent years, purchasers have augmented these basic payment techniques by adding performance metrics to adjust payments. In some cases, purchasers pay for health care on a capitated, at-risk basis, through arrangements such as health maintenance organizations (HMOs). Mathematica has examined all these forms of payment to learn how changes in financial incentives influence delivery and the outcomes and costs of care.
Related publications:
"Necessary But Not Sufficient: The HITECH Act and Health Information Technology’s Potential to Build Medical Homes” (June 2010)
"Medical Homes: Will They Improve Primary Care?" Reforming Health Care, Brief # 6 (June 2010)
"Provider Payment: Trends and Methods in the Massachusetts Health Care System" (February 2010)
Related projects:
Developing Resource Use Reports for Medicare Fee-for-Service Claims
Modeling the Impact of Medicare and Broader Payment Reform Initiatives
Implementation Support for Health Systems Payment Reform Demonstration Proposals and Related Demonstration
More on provider payment methods and their impacts
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Equity issues in Payment Policy
Some populations have more extensive needs, or other characteristics that make them vulnerable to adverse outcomes. These populations include those with severe chronic illness or disability, cognitive impairments, low incomes, or other characteristics (such as race or ethnicity) that may leave them vulnerable to discrimination. Mathematica has examined equity issues associated with designing effective payment policies.
Related publications:
"Prescription Drug Use and Cost Among Medicaid Beneficiaries with Disabilities and Chronic Illnesses" (September 2011)
"Study of Rhode Island's Uninsured: Current Costs and Future Opportunities" (March 2010)
"Reducing Racial and Ethnic Disparities in Health Care: Partnerships Between Employers and Health Plans" (July 2009)
Related projects:
Examining the Medicare Care Management Performance Demonstration
Effectiveness of Language Services in Hospital Emergency Departments
Medicaid Mental Health Services Program and Analytic Reports
More on equity issues in payment policy
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