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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 20 of 20 Research Studies Displayed
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
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
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.
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
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.
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
Graves JA, Nshuti L, Everson J
Breadth and exclusivity of hospital and physician networks in US insurance markets.
The goal of this study was to quantify network breadth and overlap among primary care physician (PCP), cardiology, and general acute care hospital networks for employer-based (large group and small group), individually purchased (marketplace), Medicare Advantage (MA), and Medicaid managed care (MMC) plans. The main outcomes measured were percentage of in-network physicians and/or hospitals within a 60-minute drive from a hypothetical patient in a given zip code (breadth), and the number of physicians and/or hospitals within each network that overlapped with other insurers' networks, expressed as a percentage of the total possible number of shared connections (exclusivity). Networks were categorized by network breadth size and analyzed by insurance type, state, and insurance, physician, and/or hospital market concentration level, as measured by the Hirschman-Herfindahl index. Markets with concentrated primary care and insurance markets had the broadest and least exclusive primary care networks among large-group commercial plans. Markets with the least concentration had the narrowest and most exclusive networks. Rising levels of insurer and market concentration were associated with broader and less exclusive healthcare networks. The authors suggest that this means that patients could switch to a lower-cost, narrow network plan without losing-in-network coverage to their PCP.
AHRQ-funded; HS025976; HS026395.
Citation: Graves JA, Nshuti L, Everson J . Breadth and exclusivity of hospital and physician networks in US insurance markets. JAMA Netw Open 2020 Dec;3(12):e2029419. doi: 10.1001/jamanetworkopen.2020.29419..
Keywords: Health Insurance, Learning Health Systems, Health Systems, Primary Care, Hospitals, Healthcare Delivery
Zhou RA, Beaulieu ND, Cutler D
Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states.
The purpose of this study was to characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population. Investigators concluded that a growing share of physicians were part of a health system from 2012 to 2016.
Citation: Zhou RA, Beaulieu ND, Cutler D . Primary care quality and cost for privately insured patients in and out of US health systems: evidence from four states. Health Serv Res 2020 Dec;55(Suppl 3):1098-106. doi: 10.1111/1475-6773.13590.
Keywords: Primary Care, Quality of Care, Health Insurance, Healthcare Costs
Soylu TG, Goldberg DG, Cuellar AE
Medicare access and CHIP reauthorization act in small to medium-sized primary care practices.
Despite major efforts to transition to a new physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), little is known about how well practices are prepared. This study aimed to understand how small and medium-sized primary care practices in the Heart of Virginia Healthcare (https://www.vahealthinnovation.org/hvh/) perceived their quality incentives under MACRA.
Citation: Soylu TG, Goldberg DG, Cuellar AE . Medicare access and CHIP reauthorization act in small to medium-sized primary care practices. J Am Board Fam Med 2020 Nov-Dec;33(6):942-52. doi: 10.3122/jabfm.2020.06.200142..
Keywords: Children's Health Insurance Program (CHIP), Medicare, Primary Care, Health Insurance
Melnikow J, Evans E, Xing G
Primary care access to new patient appointments for California Medicaid enrollees: a simulated patient study.
Investigators evaluated variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California and its relationship to emergency department (ED) use after Medicaid expansion. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used. The investigators found that access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Further, counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees.
Citation: Melnikow J, Evans E, Xing G . Primary care access to new patient appointments for California Medicaid enrollees: a simulated patient study. Ann Fam Med 2020 May;18(3):210-17. doi: 10.1370/afm.2502..
Keywords: Primary Care, Access to Care, Medicaid, Health Insurance, Emergency Department, Healthcare Utilization
Lin SC, Yan PL, Moloci NM
Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs.
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, the investigators evaluated the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15.
AHRQ-funded; HS024728; HS024525; HS025165; HS025875.
Citation: Lin SC, Yan PL, Moloci NM . Out-of-network primary care is associated with higher per beneficiary spending in Medicare ACOs. Health Aff 2020 Feb;39(2):310-18. doi: 10.1377/hlthaff.2019.00181..
Keywords: Healthcare Costs, Primary Care, Medicare, Health Insurance
Lines LM, Li NC, Mick EO
Emergency department and primary care use in Massachusetts 5 years after health reform.
The goal of this study was to identify characteristics of insured Massachusetts residents associated with primary care sensitive (PCS) emergency department (ED) use, and compare such use for public versus private insurees. The researchers used data on people under age 65 taken from the Massachusetts All-Payer Claims Data for 2011-2012. Their conclusions indicate that public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
Citation: Lines LM, Li NC, Mick EO . Emergency department and primary care use in Massachusetts 5 years after health reform. Med Care 2019 Feb;57(2):101-08. doi: 10.1097/mlr.0000000000001025..
Keywords: Emergency Department, Health Insurance, Policy, Primary Care
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
Citation: Bradley CJ, Neumark D, Walker LS . The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia. J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Value, Vulnerable Populations
Higuera L, Carlin CS, Dowd B
Narrow provider networks and willingness to pay for continuity of care and network breadth.
This study examined choices of health plans in a private health insurance exchange where consumers choose among one broad network and four narrow network plans. The willingness to pay for a network that covers consumers' usual source of care was between $84 and $275/month (for primary care) and between $0 and $115/month (for specialists). The investigators also found that, given that a network covers their usual source of care, consumers show aversion only to the narrowest networks.
Citation: Higuera L, Carlin CS, Dowd B . Narrow provider networks and willingness to pay for continuity of care and network breadth. J Health Econ 2018 Jul;60:90-97. doi: 10.1016/j.jhealeco.2018.06.006..
Keywords: Access to Care, Decision Making, Health Insurance, Primary Care
Fraze T, Lewis VA, Rodriguez HP
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
The authors examined how accountable care organizations (ACOs) addressed the nonmedical needs of their patients. They found that ACOs most commonly addressed the need for transportation, housing, and food insecurity, which they identified through the primary care visit or care transformation programs. They concluded that their findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations.
Citation: Fraze T, Lewis VA, Rodriguez HP . Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients. Health Aff 2016 Nov;35(11):2109-15. doi: 10.1377/hlthaff.2016.0727.
Keywords: Social Determinants of Health, Patient-Centered Healthcare, Health Insurance, Healthcare Delivery, Primary Care, Public Health
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
Citation: Luo Z, Chen Q, Annis AM . A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes. J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Zuvekas SH, Cohen JW
AHRQ Author: Zuvekas SH, Cohen JW
Fee-for-service, while much maligned, remains the dominant payment method for physician visits.
Recent concerted efforts have sought to shift provider payment away from fee-for-service and toward risk-based alternatives. Despite these efforts, fee-for-service not only remains the dominant payment method but has continued to grow, with nearly 95 percent of all physician office visits in 2013 reimbursed in this fashion.
Citation: Zuvekas SH, Cohen JW . Fee-for-service, while much maligned, remains the dominant payment method for physician visits. Health Aff 2016 Mar;35(3):411-4. doi: 10.1377/hlthaff.2015.1291.
Keywords: Health Insurance, Payment, Primary Care
Annis AM, Holtrop JS, Tao M
Comparison of provider and plan-based targeting strategies for disease management.
The researchers described and contrasted the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. They concluded that both provide advantages and that an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
Citation: Annis AM, Holtrop JS, Tao M . Comparison of provider and plan-based targeting strategies for disease management. Am J Manag Care 2015 May;21(5):344-51.
Keywords: Care Management, Primary Care, Health Insurance, Healthcare Delivery
Bailey SR, O'Malley JP, Gold R
Receipt of diabetes preventive services differs by insurance status at visit.
This study examined the association between having Medicaid health insurance and receiving diabetes preventive care during an office visit. They found that the lack of insurance was associated with a lower probability of receiving recommended diabetes preventive services that are due during a clinic visit.
Citation: Bailey SR, O'Malley JP, Gold R . Receipt of diabetes preventive services differs by insurance status at visit. Am J Prev Med 2015 Feb;48(2):229-33. doi: 10.1016/j.amepre.2014.08.035..
Keywords: Medicaid, Diabetes, Prevention, Primary Care, Health Insurance
Fiscella K, Geiger HJ
Caring for the poor in the 21st century: enabling community health centers for a new era.
This article discusses various challenges facing community health centers (CHCs) in the 21st century. These include: potential erosion of the Medicaid prospective payment system, the failure of many States to expand Medicaid, the growth of accountable care organizations, the growth of high deductible health insurance for the privately insured, and increased competition for primary care clinicians.
Citation: Fiscella K, Geiger HJ . Caring for the poor in the 21st century: enabling community health centers for a new era. J Health Care Poor Underserved. 2014 Nov;25(4):2044-52. doi: 10.1353/hpu.2014.0182..
Keywords: Low-Income, Primary Care, Medicaid, Health Insurance
DeVoe JE, Angier H, Burdick T
Health information technology: an untapped resource to help keep patients insured.
This commentary provides guiding principles for HIT infrastructure development to support health insurance enrollment and re-enrollment. It also describes how HIT and health information exchange could be used to organize and communicated this information to patients.
Citation: DeVoe JE, Angier H, Burdick T . Health information technology: an untapped resource to help keep patients insured. Ann Fam Med. 2014 Nov-Dec;12(6):568-72. doi: 10.1370/afm.1721..
Keywords: Electronic Health Records (EHRs), Health Insurance, Health Information Technology (HIT), Patient-Centered Healthcare, Primary Care
Heintzman J, Bailey SR, Hoopes MJ
Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults.
The researchers sought to compare the agreement of electronic health records (EHR) data versus Medicaid claims data in documenting adult preventive care. For services performed in the primary care setting, EHR data compared favorably to Medicaid claims in documenting the percentage of patients with service receipt; services that were referred out were less frequently observed in the EHR.
Citation: Heintzman J, Bailey SR, Hoopes MJ . Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults. J Am Med Inform Assoc. 2014 Jul-Aug;21(4):720-4. doi: 10.1136/amiajnl-2013-002333..
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Prevention, Primary Care
Schiff GD, Puopolo AL, Huben-Kearney A
Primary care closed claims experience of Massachusetts malpractice insurers.
The researchers studied patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. In Massachusetts, most primary care claims filed were related to alleged misdiagnosis.
Citation: Schiff GD, Puopolo AL, Huben-Kearney A . Primary care closed claims experience of Massachusetts malpractice insurers. JAMA Intern Med 2013 Dec 9-23;173(22):2063-8. doi: 10.1001/jamainternmed.2013.11070..
Keywords: Primary Care, Medical Errors, Health Insurance, Patient Safety, Medical Liability