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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 434 Research Studies DisplayedMarkovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Chua KP, Linder JA
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
The authors used 2018 commercial and Medicaid claims to assess inappropriate prescribing of antibiotics. In their analysis, 22% of antibiotic claims were inappropriate. Azithromycin had an outsized role in inappropriate prescribing. They concluded that broad-based stewardship initiatives remain important given widespread inappropriate prescribing of all antibiotics.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Chua KP, Linder JA .
Prevalence of inappropriate antibiotic prescribing by antibiotic among privately and publicly insured non-elderly US patients, 2018.
J Gen Intern Med 2021 Sep;36(9):2861-64. doi: 10.1007/s11606-020-06189-z..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Medicaid, Health Insurance
Roberts ET, Glynn A, Donohue JM
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
In this study, the investigators examined take-up of the Low-Income Subsidy (LIS) and Medicaid among Medicare beneficiaries who qualified for both programs. They went beyond prior analyses that reported average enrollment by program by 1.) examining whether LIS take-up mirrored Medicaid enrollment at income levels where individuals qualified for limited Medicaid benefits that had low take-up rates and 2.) highlighting opportunities for policy reforms to increase participation in both programs.
AHRQ-funded; HS026727.
Citation: Roberts ET, Glynn A, Donohue JM .
The relationship between take-up of prescription drug subsidies and Medicaid among low-income Medicare beneficiaries.
J Gen Intern Med 2021 Sep;36(9):2873-76. doi: 10.1007/s11606-020-06241-y..
Keywords: Medicaid, Medicare, Medication, Low-Income, Health Insurance
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation: Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
Moloci NM, Si Y, Norton EC
Predicting losses from Medicare Shared Savings Program departures.
Researchers conducted an observational study to understand how accountable care organization (ACO) exit could affect Shared Savings Program (SSP) financial performance. They found that nearly 80% of ACOs were still active at the end of 2016. Among the subset that faced contract renewal in 2019, 40% were known to have exited the SSP. By 2022, ACOs that exited in 2019 could cost the SSP $186.9 million in lost savings. If the exit rate observed in 2019 continues, the SSP could suffer $396.8 million in lost savings by 2022.
AHRQ-funded; HS024525; HS024728.
Citation: Moloci NM, Si Y, Norton EC .
Predicting losses from Medicare Shared Savings Program departures.
J Gen Intern Med 2021 Aug;36(8):2490-91. doi: 10.1007/s11606-020-06424-7..
Keywords: Medicare, Health Insurance, Healthcare Costs
Escarce JJ, Wozniak GD, Tsipas S
Effects of the Affordable Care Act Medicaid expansion on the distribution of new general internists across states.
The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices. Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Findings showed that physicians in one specialty group, general internal medicine, were increasingly likely to locate in expansion states after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine, while women and United States medical graduates did not alter their pre-expansion location patterns. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all of their residents regardless of insurance coverage.
AHRQ-funded; HS025750.
Citation: Escarce JJ, Wozniak GD, Tsipas S .
Effects of the Affordable Care Act Medicaid expansion on the distribution of new general internists across states.
Med Care 2021 Jul;59(7):653-60. doi: 10.1097/mlr.0000000000001523..
Keywords: Medicaid, Health Insurance, Provider: Physician, Workforce
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
This AHRQ-authored paper estimates insurance disparities across non-standard employment categories and determines how coverage disparities shifted following health reform in 2014. Data on working-age adults was analyzed from the 2010-2012 and 2015-2017 MEPS. Uninsurance decreased after health reform for all groups of nonstandard workers with a 10-14% point decline. Uninsurance remained high for all freelance workers at 30.8%, full-time temporary workers (25.1%) and part-time workers (17.9%) compared to full-time workers (11.9%). Lower uninsurance in a Medicaid expansion state was found for all categories of workers.
AHRQ-authored.
Citation: Berdahl TA, Moriya AS .
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
J Gen Intern Med 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Policy, Uninsured, Medicaid, Low-Income
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
AHRQ-funded; HS000029.
Citation: Eisenberg MD, Meiselbach MK, Bai G .
Large self-insured employers lack power to effectively negotiate hospital prices.
Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
Zachrison KS, Boggs KM, Gao j
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
The objective of this study was to determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, the investigators tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission. The investigators concluded that among ED-to-ED transfers, pediatric patients with public or without insurance were more often kept for observation or admission at the second hospital after transfer.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Gao j .
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
Acad Pediatr 2021 Jul;21(5):877-84. doi: 10.1016/j.acap.2020.11.010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Health Insurance, Emergency Department
Roberts ET, Desai SM
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
The objective of this paper was to assess changes in physicians' provision of care to duals (low-income individuals with Medicare and Medicaid) in response to a policy that required Medicaid to fully pay Medicare's cost sharing for office visits with these patients. This policy-a provision of the Affordable Care Act-effectively increased payments for office visits with duals by 0%-20%, depending on the state, in 2013 and 2014.
AHRQ-funded; HS026727; HS026980.
Citation: Roberts ET, Desai SM .
Does Medicaid coverage of Medicare cost sharing affect physician care for dual-eligible Medicare beneficiaries?
Health Serv Res 2021 Jun;56(3):528-39. doi: 10.1111/1475-6773.13650..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care, Healthcare Costs, Low-Income
Chow JY, Nijhawan AE, Mathews WC
Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014.
The purpose of this study was to investigate whether gaining inpatient healthcare coverage had an effect on hospitalization rates among persons with HIV following implementation of the Affordable Care Act in 2014. Hospitalization data from 2015 were obtained on adults receiving longitudinal care at HIV clinics; all patients were previously uninsured and supported by the Ryan White HIV/AIDS Program (RWHAP) in 2013. Findings showed that acquiring inpatient coverage was not associated with a change in hospitalization rates.
AHRQ-funded; 290201100007C.
Citation: Chow JY, Nijhawan AE, Mathews WC .
Hospitalization rates among persons with HIV who gained Medicaid or private insurance after the Affordable Care Act in 2014.
J Acquir Immune Defic Syndr 2021 Jun 1;87(2):776-80. doi: 10.1097/qai.0000000000002645..
Keywords: Human Immunodeficiency Virus (HIV), Hospitalization, Medicaid, Health Insurance, Access to Care, Policy
Roberts ET, James AE, Sabik LM
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
Medicaid serves as a supplemental insurer for eleven million low-income Medicare beneficiaries, known as duals. For these beneficiaries, Medicaid pays for Medicare’s out-of-pocket costs, including premiums, deductibles and coinsurance. This paper examined opportunities to close these gaps in Medicaid coverage and discussed how these reforms could complement other efforts to modernize Medicaid for low-income Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, James AE, Sabik LM .
Modernizing Medicaid coverage for Medicare beneficiaries with low income.
JAMA Health Forum 2021 Jun;2(6). doi: 10.1001/jamahealthforum.2021.0989..
Keywords: Medicaid, Medicare, Low-Income, Health Insurance, Policy
Fung V, McCarthy S, Price M
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
This study examined whether the Affordable Care Act (ACA) primary care fee bump for dual-eligible Medicare-Medicaid beneficiaries impacted primary care physicians (PCP) acceptance of duals. The authors assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017. The fee bump was not consistently associated with increases in dual caseloads.
AHRQ-funded; HS024725.
Citation: Fung V, McCarthy S, Price M .
Payment discrepancies and access to primary care physicians for dual-eligible Medicare-Medicaid beneficiaries.
Med Care 2021 Jun;59(6):487-94. doi: 10.1097/mlr.0000000000001525..
Keywords: Primary Care, Medicaid, Medicare, Health Insurance, Payment, Access to Care
Lyu PF, Chernew ME, McWilliams JM
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Using commercial claims and data on health system membership and Medicare accountable care organizations (ACOs) participation, investigators found some abrupt, large price increases for independent primary care practices that joined health system-led ACOs but were not acquired by systems. These price jumps were rare, however, increasing prices by just 4 percent, on average, among all independent practices in system-led ACOs. The price jumps were more consistent with an extension of existing pricing power from systems to some independent practices than with a major expansion of system market power.
AHRQ-funded; HS024072; HS027531.
Citation: Lyu PF, Chernew ME, McWilliams JM .
Soft consolidation In Medicare ACOs: potential for higher prices without mergers or acquisitions.
Health Aff 2021 Jun;40(6):979-88. doi: 10.1377/hlthaff.2020.02449..
Keywords: Medicare, Health Insurance, Healthcare Costs
Geissler KH, Lubin B, Ericson KMM
The association of insurance plan characteristics with physician patient-sharing network structure.
This study compared differences in the physician patient-sharing network structure by insurance type (HMO versus PPO). The researchers used information from commercially insured enrollees in the 2011 Massachusetts All Payer Claims Database. They examined whether the association of physician patient-sharing network measures indicated whether a patient is enrolled in an HMO or PPO. They found that patients enrolled in HMOs see physicians who are central and densely embedded in the patient-sharing network. There were small but significant differences in the physician patient-sharing network as experienced by patients with HMO versus PPO insurance.
Citation: Geissler KH, Lubin B, Ericson KMM .
The association of insurance plan characteristics with physician patient-sharing network structure.
Int J Health Econ Manag 2021 Jun;21(2):189-201. doi: 10.1007/s10754-021-09296-4..
Keywords: Health Insurance
Chhabra KR, Fan Z, Chao GF
The role of commercial health insurance characteristics in bariatric surgery utilization.
The goal of this study was to understand relationships among insurance plan type, out-of-pocket cost sharing, and the utilization of bariatric surgery among commercially insured patients. Over 73,000 commercially insured members of the IBM MarketScan commercial claims database who underwent bariatric surgery from 2014-17 were retroactively reviewed. Findings showed that insurance plan types with higher cost sharing have lower utilization of bariatric surgery.
AHRQ-funded; HS025778; HS000053.
Citation: Chhabra KR, Fan Z, Chao GF .
The role of commercial health insurance characteristics in bariatric surgery utilization.
Ann Surg 2021 Jun;273(6):1150-56. doi: 10.1097/sla.0000000000003569..
Keywords: Health Insurance, Obesity, Obesity: Weight Management, Surgery, Healthcare Costs, Healthcare Utilization
Michel KF, Spaulding A, Jemal A
Associations of Medicaid expansion with insurance coverage, stage at diagnosis, and treatment among patients with genitourinary malignant neoplasms.
Health insurance coverage is associated with improved outcomes in patients with cancer. However, it is unknown whether Medicaid expansion through the Patient Protection and Affordable Care Act (ACA) was associated with improvements in the diagnosis and treatment of patients with genitourinary cancer. The objective of this study was to assess the association of Medicaid expansion with health insurance status, stage at diagnosis, and receipt of treatment among nonelderly patients with newly diagnosed kidney, bladder, or prostate cancer.
AHRQ-funded; HS026372.
Citation: Michel KF, Spaulding A, Jemal A .
Associations of Medicaid expansion with insurance coverage, stage at diagnosis, and treatment among patients with genitourinary malignant neoplasms.
JAMA Netw Open 2021 May 3;4(5):e217051. doi: 10.1001/jamanetworkopen.2021.7051..
Keywords: Cancer, Medicaid, Health Insurance
Powell D, Goldman D
Disentangling moral hazard and adverse selection in private health insurance.
This study used claims data from a large firm which changed health insurance plan options to isolate moral hazard from plan selection to estimate a discrete choice model to predict household plan preferences and attrition. The authors found the estimates imply that 53% of the additional medical spending observed in the most generous plan in their data relative to the least generous is due to adverse selection. They found that quantifying adverse selection by using prior medical expenditures overstates the true magnitude of selection due to mean reversion.
AHRQ-funded; HS023628.
Citation: Powell D, Goldman D .
Disentangling moral hazard and adverse selection in private health insurance.
J Econom 2021 May;222(1):141-60. doi: 10.1016/j.jeconom.2020.07.030..
Keywords: Health Insurance, Healthcare Costs
Roberts ET, Glynn A, Cornelio N
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Cost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance, resulting in a supplemental coverage cliff. The authors estimated that Medicaid beneficiaries affected by this cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. They recommended expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies to lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Glynn A, Cornelio N .
Medicaid coverage 'cliff' increases expenses and decreases care for near-poor Medicare beneficiaries.
Health Aff 2021 Apr;40(4):552-61. doi: 10.1377/hlthaff.2020.02272..
Keywords: Medicaid, Medicare, Healthcare Costs, Low-Income, Health Insurance
Mellor JM, McInerney M, Sabik LM
Misclassification of Medicaid participation by dual eligibles: evidence from the Medicare Current Beneficiary Survey.
Previous studies show that survey-based reports of Medicaid participation are measured with error, but no prior study has examined measurement error in an important segment of the Medicaid population-low-income adults enrolled in Medicare. Using the Medicare Current Beneficiary Survey, the investigators examined whether respondent self-reports of Medicaid enrollment matched administrative records and present several key findings.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Sabik LM .
Misclassification of Medicaid participation by dual eligibles: evidence from the Medicare Current Beneficiary Survey.
Med Care Res Rev 2021 Apr;78(2):113-24. doi: 10.1177/1077558719858839..
Keywords: Medicaid, Health Insurance
Peltz A, Kan K, Garg A
Racial and ethnic differences in managed care enrollment among US children.
The authors used national survey data to compare rates of HMO enrollment, by race and ethnicity, for children with commercial and public coverage. They found that, when adjusted for sociodemographic characteristics, Hispanic children with public coverage, non-Hispanic Black children with commercial coverage, and Hispanic children with commercial coverage were more likely to be enrolled in HMOs than non-Hispanic White children. They recommended future study to examine the degree to which the observed national imbalance in HMO enrollment results from state-specific policies, family preferences, or coverage affordability.
AHRQ-funded; HS026385.
Citation: Peltz A, Kan K, Garg A .
Racial and ethnic differences in managed care enrollment among US children.
JAMA Netw Open 2021 Apr;4(4):e214162. doi: 10.1001/jamanetworkopen.2021.4162..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Health Insurance, Racial and Ethnic Minorities
Anderson KE, Shugarman LR, Davenport K
Regulation of provider networks in response to COVID-19.
The authors anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. They suggested that telehealth will have a larger role in care delivery than in the pre-pandemic period, and that regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
AHRQ-funded; HS000029.
Citation: Anderson KE, Shugarman LR, Davenport K .
Regulation of provider networks in response to COVID-19.
Am J Manag Care 2021 Apr;27(4):e101-e04. doi: 10.37765/ajmc.2021.88614..
Keywords: Health Insurance, Policy, Access to Care, Healthcare Delivery, COVID-19
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
The authors assessed how beneficiary premiums, expected out-of-pocket costs, and plan finances in the Medicare Advantage (MA) market are related to coding intensity. The study sample included beneficiaries enrolled in both MA and Part D from 2008-2015; Medicare claims and drug utilization data for Traditional Medicare beneficiaries were used to calibrate an independent measure of health risk. The authors found that, while coding intensity increased taxpayers' costs of the MA program, enrollees and plans both benefitted but with larger gains for plans. They concluded that the adoption of policies to adjust more completely for coding intensity would likely affect both beneficiaries and plan profits.
AHRQ-authored.
Citation: Jacobs PD, Kronick R .
The effects of coding intensity in Medicare Advantage on plan benefits and finances.
Health Serv Res 2021 Apr;56(2):178-87. doi: 10.1111/1475-6773.13591..
Keywords: Medicare, Health Insurance, Healthcare Costs, Policy
Moniz MH, Peahl AF, Fendrick AM
Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women.
This study compared postpartum contraceptive use among women who had high, low, or no cost sharing for different types of contraception. The authors conducted a retrospective cohort analysis of commercially insured women undergoing childbirth from 2014 to 2018 using Optum's (Eden Prairie, MN) de-identified Clinformatics Data Mart database. The women were included if they had continuous enrollment for 12 months postpartum. Among 25,298 plans with cost sharing data, 172,941 women were identified, including 47.7% with no cost sharing, 13.1% in low cost sharing, and 39.2% in high cost sharing plans. Women in no cost sharing plans had a higher predicted probability of using long-acting reversible contraceptives and a lower predicted probability of no prescription method use than those in low or high cost sharing plans. There was no difference in short interpregnancy intervals between the plan cost sharing types.
AHRQ-funded; HS025465.
Citation: Moniz MH, Peahl AF, Fendrick AM .
Cost sharing, postpartum contraceptive use, and short interpregnancy interval rates among commercially insured women.
Am J Obstet Gynecol 2021 Mar;224(3):282.e1-82.e17. doi: 10.1016/j.ajog.2020.08.109..
Keywords: Healthcare Costs, Women, Health Insurance, Access to Care, Sexual Health
Rabideau B, Eisenberg MD, Reid R
Effects of employer-offered high-deductible plans on low-value spending in the privately insured population.
Enrollment in plans with high deductibles has increased more than seven-fold in the last decade. This study uses individual-level insurance claims data (2008-2013) and plausibly exogenous changes in plan offerings within firms over time to estimate the intent-to-treat and local-average treatment effects of high-deductible plan offerings on spending on 24 low-value services received in the outpatient setting.
AHRQ-funded; HS000029.
Citation: Rabideau B, Eisenberg MD, Reid R .
Effects of employer-offered high-deductible plans on low-value spending in the privately insured population.
J Health Econ 2021 Mar;76:102424. doi: 10.1016/j.jhealeco.2021.102424..
Keywords: Health Insurance, Healthcare Costs