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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
26 to 47 of 47 Research Studies DisplayedGeissler 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
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
AHRQ-funded; HS024075.
Citation: Chen G, Lewis VA, Gottlieb D .
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Polsky D, Wu B
Provider networks and health plan premium variation.
The purpose of this study was to examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. The investigators concluded that physician network breadth and hospital network breadth contributed positively to plan premiums.
AHRQ-funded; HS025976.
Citation: Polsky D, Wu B .
Provider networks and health plan premium variation.
Health Serv Res 2021 Feb;56(1):16-24. doi: 10.1111/1475-6773.13447..
Keywords: Health Insurance, Healthcare Costs, Policy, Access to Care
Jacobs PD
AHRQ Author: Jacobs PD
The impact of Medicare on access to and affordability of health care.
Jacobs used MEPS data and the National Health Interview Survey to test for changes in access to care and affordability around age sixty-five and found that Medicare eligibility is associated with a reduction in reports of being unable to get necessary care as well as a reduction in not being able to get needed care because of the cost. The author concluded that incremental Medicare expansions could have positive access and affordability benefits for enrollees compared with the insurance options available to them before they turn sixty-five.
AHRQ-authored.
Citation: Jacobs PD .
The impact of Medicare on access to and affordability of health care.
Health Aff 2021 Feb;40(2):266-73. doi: 10.1377/hlthaff.2020.00940..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Healthcare Costs, Health Insurance
Hill CE, Reynolds EL, Burke JF
Increasing out-of-pocket costs for neurologic care for privately insured patients.
This study examined out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Patients with a neurologist visit or diagnostic test from 2001 to 2016 were identified from a large, privately insured health care claims database. Inflation-adjusted OOP costs were assessed. The database identified 3,724,342 patients. The most frequent services used were E/M (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. The range of OOP costs in 2016 varied considerably. For example, for an MRI, the 50th percentile paid $103.10 and the 95th percentile paid $875.40.
AHRQ-funded; HS022258.
Citation: Hill CE, Reynolds EL, Burke JF .
Increasing out-of-pocket costs for neurologic care for privately insured patients.
Neurology 2021 Jan 19;96(3):e322-e32. doi: 10.1212/wnl.0000000000011278..
Keywords: Healthcare Costs, Health Insurance, Neurological Disorders
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Spivack SB, Murray GF, Rodriguez HP
Avoiding Medicaid: characteristics of primary care practices with no Medicaid revenue.
Primary care access for Medicaid patients is an ongoing area of concern. Most studies of providers' participation in Medicaid have focused on factors associated with the Medicaid program, such as reimbursement rates. Few studies have examined the characteristics of primary care practices associated with Medicaid participation. In this study, the investigators used a nationally representative survey of primary care practices to compare practices with no, low, and high Medicaid revenue.
AHRQ-funded; HS024075.
Citation: Spivack SB, Murray GF, Rodriguez HP .
Avoiding Medicaid: characteristics of primary care practices with no Medicaid revenue.
Health Aff 2021 Jan;40(1):98-104. doi: 10.1377/hlthaff.2020.00100..
Keywords: Medicaid, Health Insurance, Payment, Primary Care, Provider
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Hammad Mrig E
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
This paper proposes that Pierre Bourdieu's theories of capital and symbolic power can be integrated with fundamental cause theory to address limitations in the latter theory, making it more useful in health disparities research. This work deepens appreciation for the durable relationship between socioeconomic status and health. Study results reveal the multiple and complex mechanisms that play a role in access to healthcare services, which has significant implications for how we think about the role of health policy in addressing health disparities.
AHRQ-funded; HS017589.
Citation: Hammad Mrig E .
Integrating fundamental cause theory and Bourdieu to explain pathways between socioeconomic status and health: the case of health insurance denials for genetic testing.
Sociol Health Illn 2021 Jan;43(1):133-48. doi: 10.1111/1467-9566.13195..
Keywords: Social Determinants of Health, Disparities, Health Insurance, Access to Care, Genetics, Policy
Grosse SD, Ji X, Zuvekas
AHRQ Author: Zuvekas SH
Spending on young children with autism spectrum disorder in employer-sponsored plans, 2011-2017.
This study looked at spending trends on young children with autism spectrum disorder (ASD) in employer-sponsored plans from 2011 to 2017. This cross-section analysis examined claims data from large-employer-sponsored health plans and assessed changes in annual expenditures by service type for children ages 3-5 enrolled for 1 year or more, and with two or more claims with ASD billing codes within a calendar year and compared it to all children. Mean spending per children with ASD increased by 51% in 2017 US dollars in 2017, while for all children the increase was 8%. ASD spending accounted for 41% of spending growth for children ages 3-7 during 2011-2017. Outpatient behavioral intervention-related spending increased by 376% during the time period, while spending on all other services increased by 2%.
AHRQ-authored.
Citation: Grosse SD, Ji X, Zuvekas .
Spending on young children with autism spectrum disorder in employer-sponsored plans, 2011-2017.
Psychiatr Serv 2021 Jan;72(1):16-22. doi: 10.1176/appi.ps.202000099.
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Keywords: Children/Adolescents, Autism, Health Insurance, Healthcare Costs
Fraze TK, Beidler LB, Briggs ADM
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
Researchers sought to understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. After conducting semi-structured interviews with Medicare ACOs, they found that ACOs were using care plans for patients with complex needs, but their use of care plans did not always meet the best practices; ACOs were adapting use of care plans to better fit the needs of patients and providers.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
J Gen Intern Med 2021 Jan;36(1):147-53. doi: 10.1007/s11606-020-06122-4..
Keywords: Implementation, Evidence-Based Practice, Medicare, Health Insurance, Healthcare Delivery