National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
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AHRQ Research Studies Date
Topics
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- Anxiety (1)
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- Dental and Oral Health (1)
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- Health Services Research (HSR) (3)
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- Provider: Physician (1)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (7)
- Racial and Ethnic Minorities (6)
- Sexual Health (1)
- Skin Conditions (1)
- Social Determinants of Health (1)
- Substance Abuse (1)
- Surgery (2)
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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
1 to 25 of 87 Research Studies DisplayedAdmon LK, Dalton VK, Kolenic GE
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
This study analyzed data from 2016 to 2017 on delivery-related, early, and late postpartum severe maternal morbidity (SMM) among individuals with commercial insurance by race and ethnicity and perinatal mood and anxiety disorder (PMAD) status. This cross-sectional study of deidentified claims data from the Optum Clinformatics Data Mart evaluated rates of SMM during 3 pregnancy periods among individuals aged 15 to 44 years. The study sample comprised of 100,982 individuals with a mean age of 31.6 years. SMM rates were compared for pregnancies with and without complications, with blood transfusions being the number one indicator for pregnancy and postpartum periods with SMM. Rates of SMM with and without blood transfusion varied by race and ethnicity and PMAD status. Higher rates of SMM were identified among Black individuals compared with White individuals for the pregnancy, early postpartum, and late postpartum periods, respectively. Higher rates of blood transfusion were also identified in each of the 3 periods among individuals with PMADs compared to individuals without PMADs.
AHRQ-funded; HS027640.
Citation: Admon LK, Dalton VK, Kolenic GE .
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
JAMA Netw Open 2021 Dec;4(12):e2137716. doi: 10.1001/jamanetworkopen.2021.37716..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Pregnancy, Health Insurance, Racial and Ethnic Minorities, Anxiety
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation: Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Markovitz AA, Ayanian JZ, Sukul ED
The Medicare Advantage Quality Bonus Program has not improved plan quality.
The authors analyzed insurance claims from the period 2009-2018 from the nation's largest Medicare Advantage (MA) claims database. They evaluated changes in performance on nine claims-based measures of quality before and after the start of the bonus program and with adjustment for differential pre-period trends. They found that program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures, and no significant change in overall quality performance, suggesting that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Sukul ED .
The Medicare Advantage Quality Bonus Program has not improved plan quality.
Health Aff 2021 Dec;40(12):1918-25. doi: 10.1377/hlthaff.2021.00606..
Keywords: Medicare, Health Insurance
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
AHRQ-funded; HS025422.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM .
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Rasmussen PW, Anderson D
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
The Affordable Care Act (ACA) individual health insurance marketplaces rely on purchasers to make informed choices to impose price and quality discipline on a complex array of insurance products. A sudden and minimally expected policy shock in the fall of 2017-the termination of direct federal payment for cost-sharing reduction (CSR) subsidies-led to a substantial change in the relative prices of silver and gold plans on the Covered California insurance marketplace. In this study, the investigators used the Covered California enrollment and product files from 2014 to 2018 in a retrospective data analysis of plan choice.
AHRQ-funded; HS026835.
Citation: Rasmussen PW, Anderson D .
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
Milbank Q 2021 Dec;99(4):1059-87. doi: 10.1111/1468-0009.12518..
Keywords: Health Insurance
Jacobs PD, Hill SC
AHRQ Author: Jacobs PD, Hill SC
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
This study calculated Marketplace premiums as a percentage of family income among middle-class families with incomes of 401-600% of poverty. The ACA premiums have been increasing since inception, with half of this population paying at least 7.7% of their income for the lowest-cost bronze plan, increasing to 11.3% in 2019. By 2019 half of the near elderly ages 55-64 would have paid at least 18.9% of their income for the lowest-cost bronze plan in their area. Results suggest that after the American Rescue Plan Act which temporarily expanded tax credit eligibility for 2021 and 2022 runs out, families will again face substantial financial burdens.
AHRQ-authored.
Citation: Jacobs PD, Hill SC .
ACA marketplaces became less affordable over time for many middle-class families, especially the near-elderly.
Health Aff 2021 Nov;40(11):1713-21. doi: 10.1377/hlthaff.2021.00945..
Keywords: Health Insurance, Healthcare Costs
Jiang DH, Mundell BF, Shah ND
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
The authors sought to provide a systematic literature review of the impact of high deductible health plans (HDHPs) on the utilizations of services required for optimal management of diabetes and subsequent health outcomes. They found that, although HDHPs reduce some health care utilization and costs, they appear to do so at the expense of limiting high-value care and medication adherence.
AHRQ-funded; HS025517; HS024075; HS025164; HS025402.
Citation: Jiang DH, Mundell BF, Shah ND .
Impact of high deductible health plans on diabetes care quality and outcomes: systematic review.
Endocr Pract 2021 Nov;27(11):1156-64. doi: 10.1016/j.eprac.2021.07.001..
Keywords: Health Insurance, Diabetes, Chronic Conditions, Outcomes, Quality of Care, Patient-Centered Outcomes Research
Lipton BJ, Finlayson TL
AHRQ Author: Decker SL
The association between Medicaid adult dental coverage and children's oral health.
This study examined the association of Medicaid adult dental coverage and children’s oral health as Medicaid-eligible children are more likely to experience tooth decay than children in higher-income families. Data from the 1996-2016 National Health and Nutrition Examination Survey and the 2003, 2007, and 2011-12 waves of the National Survey of Children’s Health was used. Adult dental coverage was associated with a 5-percentage-point reduction in the prevalence of untreated caries among children after Medicaid-enrolled adults had access to dental coverage for at least one year. Children under twelve years of age were the most affected.
AHRQ-authored.
Citation: Lipton BJ, Finlayson TL .
The association between Medicaid adult dental coverage and children's oral health.
Health Aff 2021 Nov;40(11):1731-39. doi: 10.1377/hlthaff.2021.01135..
Keywords: Children/Adolescents, Dental and Oral Health, Medicaid, Health Insurance, Access to Care
Aouad M, Brown TT, Whaley CM
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Investigators examined the heterogeneous effects of reference pricing, a health insurance reform introduced by the California Public Employees' Retirement System (CalPERS), on the distribution of spending by patients and insurers. Using the changes-in-changes approach to estimate the quantile treatment effects (QTE) of the program across different medical procedures, they found that the QTE vary across the patient spending distributions, with a range of positive and negative estimates of the QTE, depending on the medical procedure considered.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Understanding the distributional impacts of health insurance reform: evidence from a consumer cost-sharing program.
Health Econ 2021 Nov;30(11):2780-93. doi: 10.1002/hec.4410..
Keywords: Health Insurance, Healthcare Costs
Abdus S
AHRQ Author: Abdus S
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
This study examines financial burdens of out-of-pocket prescription drug expenditures across different levels of deductibles, focusing on low-income adults with multiple, prevalent chronic conditions. The results of this study suggest that for low-income adults with multiple chronic conditions who are enrolled in employer-sponsored high-deductible plans, out-of-pocket prescription drug costs may still result in significant financial hardships. The key takeaway point of this paper for general internists is that for patients with chronic conditions, out-of-pocket costs of prescription drugs could be excessively burdensome if they are enrolled in high-deductible plans.
AHRQ-authored.
Citation: Abdus S .
Financial burdens of out-of-pocket prescription drug expenditures under high-deductible health plans.
J Gen Intern Med 2021 Sep;36(9):2903-05. doi: 10.1007/s11606-020-06226-x..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Medication
Hero JO, Sinaiko AD, Peltz A
In New England, partisan differences In ACA marketplace participation and potential financial harm.
This study examined how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. Using data from a large insurer in New England, findings showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers. However, results suggested that party effects on decision making may inversely relate to the magnitude of the financial consequence.
AHRQ-funded; HS024700.
Citation: Hero JO, Sinaiko AD, Peltz A .
In New England, partisan differences In ACA marketplace participation and potential financial harm.
Health Aff 2021 Sep;40(9):1420-29. doi: 10.1377/hlthaff.2021.00624..
Keywords: Health Insurance, Healthcare Costs
Markovitz 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