The mission of the Cecil G. Sheps Center for Health Services Researchis to improve the health of individuals, families, and populations by understanding the problems, issues and alternatives in the design and delivery of health care services. Based at the University of North Carolina Division of Health Affairs, it does this work through research into the access, adequacy, organization, cost and effectiveness of health care and by sending this information to policy makers and the public.
One of its initiatives is the Rural Health Research Program, which tracks problems Americans in rural areas have in accessing care, and it keeps a tally of rural hospitals that have closed in recent years. The center also houses the North Carolina Institute of Medicine.
Other initiatives of the Sheps Center address aging, disability, and long-term care; health workforce research and policy; medical practice and prevention; healthcare organization research; health disparities; primary care research; child and adolescent health services; mental health and substance abuse services; health care economics and finance; and general health services research.
The Center for Health Insurance Reforms is based at the Georgetown University Health Policy Institute and produces evidence-based research, analysis and advice designed to improve access to affordable and adequate health insurance. It conducts research on issues related to health policy and health services. HPI is affiliated with Georgetown’s public policy graduate programs (the McCourt School of Public Policy). CHIR staff members provides policy expertise and technical assistance to federal and state policymakers, regulators and others. They are also well versed sources in topics related to health insurance underwriting, marketing and products, and the complex state and federal rules governing the health insurance marketplace.
Center for Value Based Insurance Design at University of Michigan: The center says the basic premise of value-based insurance design (VBID) seeks to improve health outcomes by remove barriers to essential, high-value health services by suggesting, for example, that copayments and deductibles force some consumers and patients not to get needed medications or treatments.
Nondiscrimination rules require public notice: An article from the law firm Epstein Becker Green explains the steps health care provider organizations need to take to comply with the nondiscrimination rules under the Affordable Care Act’s Section 1557. The article says that in May 2016, the U.S. Department of Health and Human Services issued a final rule, “Nondiscrimination in Health Programs and Activities” implementing the nondiscrimination provisions in the ACA’s Section 1557. The rule was effective on July 18, 2016. By October 16, 2016, health care providers needed to notify the public of their compliance with these nondiscrimination provisions by posting nondiscrimination notices in multiple languages.
The Coalition to Protect Patient Choice is an advocacy organization that opposes insurance company mergers and that reportedly is funded by the hospital industry. CPPC was founded by David Balto, a former trial attorney in the Antitrust Division of the federal Department of Justice and former policy director of the Bureau of Competition at the Federal Trade Commission. The CPPC website has a collection of articles, videos, and testimony on how health insurance mergers could affect consumers. Journalists should use this material with caution and note that Balto has said the source of CPPC’s funding is ‘not relevant.’
Consumers Union Health Care Value Hub In March 2015, Consumers Union started the Health Care Value Hub to address issues related to health care costs and quality. The hub is a networking and resource center for those working to reduce the cost of care and improve the value the health care system delivers. Funded by the Robert Wood Johnson Foundation, the hub will provide research-based information and tools for those seeking to reduce costs and increase health care quality. Lynn Quincy will serve as hub director.
Many consultants specializing in human resources and health care strategies have experts and reports on health policy and health insurance. Many of these firms conduct regular surveys on employers’ strategies and much of this material is available online. Here are just a few of them:
Avalere. This health care consulting company produces dozens of reports on the strategies health providers and health systems use to improve the delivery of care, boost quality and cut costs. Among other topics, recent reports have addressed the shift from volume- to value-based care, health policy, big data, pharmaceutical costs, health insurance premium trends, health information technology, the state and federal health insurance marketplaces, risk sharing and alternative payment models.
Employee survey shows that as deductibles and out-of-pocket costs rise, perceived value of benefits falls
A report from benefits consulting firm Mercer shows that health insurance benefits are an important element of employers’ efforts to attract and retain employees. But the perceived value of health insurance benefits is declining among workers who complain about rising out-of-pocket costs in high deductible plans.
Most workers responding to the 2013 Mercer Workplace Survey agreed that benefits are just as important to them as their salaries. But among some workers, such as those who were under age 50, only 30 percent said their health insurance benefits were “definitely worth it.” In 2011, 45 percent of workers under age 50 said their health insurance benefits were “definitely worth it.” Mercer conducted the survey of 1,506 participants in retirement plans offered by U.S. companies and who also have health benefits from those companies.
The survey results showed that workers in companies with 500 or fewer employees were more likely than those in large companies of 2,000 or more workers to report that their health benefits had been scaled back, the report showed. A trend to scale back health benefits reflects efforts by smaller companies to control health benefit costs by increasing the deductibles and copayments for health insurance coverage, Mercer said.
The Health Care Cost Institute HCCI is an independent, nonprofit organization researching and reporting on health care spending and utilization based on data for more than 50 million Americans who are privately and covered under Medicare Advantage plans. HCCI established Guroo, a health care price comparison website for consumers. The federal Centers for Medicare & Medicaid Services has designated HCCI as Qualified Entity to gather data to evaluate the performance of health care providers and suppliers and produce public reports on their performance. entitled to hold Medicare data for the 50 million individuals covered by the program.
Health Care Pricing Project This website is devoted to explaining the research done in 2015 based on health insurance claims data from the Health Care Cost Institute. Journalists covering hospital consolidations or writing about variation in hospital prices will find the HCPP data will help them understand what influences health spending for the majority of Americans. Three large health insurers (Aetna, Humana and UnitedHealthcare) contributed health care usage data from 92 billion health insurance claims from 88 million people, representing 27.6 percent of all Americans with employer-sponsored coverage. The data are particularly useful because most health care policy researchers work with Medicare data, which represents only about 16 percent of the U.S. population.
Drivers of 2015 Health Insurance Premium Changes The American Academy of Actuaries has released the Health Practice Council's new issue brief providing an overview of the factors underlying general premium rate setting and highlighting the major drivers behind why 2015 premiums could differ from those in 2014 under the Affordable Care Act (ACA).
eHealth Insurance Price Index The eHealth Health Insurance Price Index is designed to report on what consumers actually pay for insurance under the Affordable Care Act. eHealth operates a private health insurance exchange. Updated daily and showing what individuals actually pay without subsidies, the index shows that health insurance under the ACA is more expensive than it was before the ACA became effective on Jan. 1, 2014, eHealth reported. As of Feb. 24, the average premium for an individual health plan selected through eHealth without a subsidy was $274 per month, an amount that is 39 percent higher than what the average individual paid before the ACA became effective, eHealth said.
Factors Affecting 2014 Medical Costs Price Waterhouse Coopers is an accounting and consulting firm, and each year its Health Research Institute (HRI) projects how much health care costs will rise for the coming year. For 2014, HRI has said the medical costs will rise by 6.5 percent, a modest increase. The reason for this low rate of increase is aggressive cost-control measures that employers are implementing, new sites and models for delivering health care, and the effect of the Affordable Care Act (ACA) all will affect prices, HRI said. Among the factors affecting cost increase are more health care providers are delivering care in retail clinics and hospitals are reducing readmissions, HRI said. Other factors constraining costs are the recession that began in 2009, the move to have consumers beare more financial responsibility for health care costs, and new delivering models such as accountable care organizations, HRI said. More information is available from HRI’s report.
PriceWaterhouseCooper’s Health Research Institute (HRI) projects a 6.8 percent increase in health care spending for 2015, a slight increase from the 6.5 percent that HRI projected in 2013. For its cost trend analysis, HRI measured spending growth in the employer-based market, which provides health insurance for about 150 million Americans. HRI did not review fluctuations in the individual market, including new plans sold on the public exchanges. One factor causing an increase in spending is that the nation is recovering from the economic downtown that began in 2007 and 2008. In addition, other factors are helping to moderate growth such as increased efficiency among physicians and hospitals who are standardizing processes to lower costs and increase quality, HRI said. Also, insurers are using more “at-risk” payments that hold health care providers financially accountable for patient outcomes, the report said.
Other factors slowing cost increases are lower employment in health care administration and clinical delivery since 2011, a demand by the federal government and large employers to control spending by shifting financial responsibility to consumers. Among employers PwC surveyed, 85 percent have implemented or are considering an increase in employee cost sharing over the next three years. And 18% of employers offer high-deductible health plans as the only insurance option for their employees, the HRI report said.
Reference Pricing: Will Price Caps Help Contain Health Care Costs? On Nov. 18, 2013, a panel of experts addressed a new strategy employers have begun known as "reference pricing" to help reduce health care costs. Under this benefit design, employees get insurance plans that set price caps on certain services and procedures. Enrollees are allowed to use any provider. But if they use providers with fees higher than the "reference price," they must pay the difference between the reference price limit, determined by the employer or insurer, and the actual charge. The transcript and video are available here. The event was sponsored by the Alliance for Health Reform and WellPoint.
The Private Exchange Evaluation Collaborative The Private Exchange Evaluation Collaborative (PEEC) was formed in the fall of 2013 to provide employers with unbiased, comparative information about private insurance exchanges and to help employers make more informed decisions about exchanges. The sponsoring organizations are the Employers Health Coalition, the Midwest Business Group on Health, the Northeast Business Group on Health, the Pacific Business Group on Health, and Price waterhouse Coopers. Employers of all sizes are interested in determining how private health insurance exchanges can help them cut health care costs and reduce the administrative burden of offering health care benefits employees, retirees, and family members. While many studies have shown that employers are interested in learning more about private exchange options for active and retired workers, insurance brokers, benefit consultants, health insurers and other vested interests run most private exchanges. PEEC says it is an independent, objective initiative designed to support employers in developing private exchange strategies and evaluating potential choices among exchange vendors.
Florida Health Care Coalition: The Florida Health Care Coalition is a group of Florida employers representing nearly two million employees and their family members. Its mission is to educate employers, consumers, health plans, and providers to help them improve the quality of health care delivered in the Sunshine State and nationwide.
National Business Group on Health: Founded in 1974, NBGH represents large employers’ interests on national health policy issues, health care, and health insurance. Produces an annual survey on employers’ costs and strategies.
National Business Coalition on Health: NBCH is a national membership organization representing employer- and purchaser-led health care coalitions that is dedicated to value-based purchasing of health care.
Midwest Business Group on Health: MBGH is one of the nations leading non-profit business groups. It represents more than 115 large, public, and private employers providing health benefits to more than 4 million employees and their family members.
St. Louis Area Business Health Coalition: BHC has more than 40 employers seeking to improve the health of their employees and family members enhance the overall quality and value of their investments in health benefits.
Pacific Business Group on Health: PBGH is one of the oldest regional business groups and helps purchasers nationwide improve the quality of health care and moderate health care cost increases. It has 60 member companies providing health insurance to 10 million Americans and their dependents.
Although the nation’s health care foundations may serve many different fields, such as health services, policy research, and public health, their work often supports the development and use of evidence to increase the quality, accessibility, and value of health care, all of which are important to employers and health insurers.
The Commonwealth Fund: Founded in 1918, the Commonwealth Fund promotes a high-performing health care system that improves access to care, quality of care, and efficiency, particularly for those who are most vulnerable, such as those with low-incomes, the uninsured, minorities children, and the elderly.
Kaiser Family Foundation: Founded in 1991, KFF is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The foundation is not associated with Kaiser Permanente or Kaiser Industries.
Missouri Foundation for Health: MFH is a conversion foundation created in 2000. It’s one of the largest of its kind in the country and includes in its focus identifying and filling the gaps in the myriad public and private health care services already available to the uninsured and underinsured in its region.
National Institute of Health Care Management: A nonprofit, nonpartisan organization, the NIHCM foundation conducts research, policy analysis and educational activities on a variety of health care issues and fosters dialogue between the private health care industry and government. It also awards grants each year for excellence in health care research and journalism.
Robert Wood Johnson Foundation: RWJF is the nation’s largest philanthropy devoted solely to the public’s health, and its work includes Aligning Forces for Quality (AF4Q), an effort in 16 geographic areas in which it works with employers and others to improve efficiency and the delivery of care.
Ober Kaler: This firm specializes in business and health law and has an extensive practice devoted to human resources and benefits law.
The ECRI Institute applies scientific research to identify which medical procedures, devices, drugs, and processes are best. The goal behind ECRI’s work is to improve patient care through "The Discipline of Science" and "The Integrity of Independence," the institute stays. Among the reports it issues every year are two health journalists should note: One covers the top 10 health technology hazards and the other addresses the top 10 patient safety concerns.
Patient Advocate Foundation (PAF) is a nonprofit organization that provides professional case management services to patients with chronic, life threatening, and debilitating illnesses to help them access care and health insurance when needed. PAF case managers serve as liaisons between patients and their insurers, employers or creditors to resolve insurance, job retention or debt crisis matters stemming from a diagnosis. The PAF seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment, and preservation of their financial stability. For journalists, PAF and the National Patient Advocate Foundation could be sources of patient sources. As the advocacy affiliate of the PAF, the NFAF translates the experiences of patients who have been denied access to affordable, quality health care into national and state policy initiatives.
Physicians for a National Health Program is the only association of physicians dedicated exclusively to implementing a sing-payer national health insurance program. As a single-issue organization with more 20,000 members and chapters nationwide, it advocates for a universal, comprehensive single-payer national insurance. The group educates physicians and other health care professionals about the benefits of single-payer, citing lower administrative costs and providing health insurance for all Americans regardless of income. For journalists, the PNHP has a variety of commentaries on its web site and will identify physicians who are ready to speak about single-payer health insurance and the failures of the current health insurance system.
The Health Initiative Coordinating Council (HICCup), a nonprofit organization that started the Way to Wellville Challenge in 2014. The challenge is five-year effort to improve health in five small cities in the United States. In an article by Wendell Potter at the Center for Public Integrity, HICCup Founder Esther Dyson said she started HICCup to address many of the inefficiencies in the health care and health insurance systems. “It’s crazy that people lose their health and then have to pay so much in agony and pain and disrupted lives, not to mention money, to recover it—if they ever do,” she told Potter. HICCup solicited applications from 42 cities in 26 states and chose to focus on Clatsop County, Ore.; Muskegon, Mich.; Lake County, Calif.; Niagara Falls, N.Y; and Spartanburg, S.C.
Catalyst for Payment Reform (CPR) is an independent, nonprofit corporation working for large employers and other health care purchasers to foster improvements in payment for health services and to promote higher-value health care. CPR seeks to promote and reward high‐quality, patient‐centered care that is cost‐effective and reduces disparities; to ensure patients receive the “right care, at the right time, from the right provider,” incorporating the values and preferences of patients; to foster improvement and innovation; and, to slow the growth of the cost of health care.
Families USA, a nonprofit organization, says it is a national voice for health care consumers and that it is dedicated to achieving high-quality, affordable health care and improved health for all. Founded in 1981, Families USA has more than 50 staff members who do public policy analysis, advocacy work and collaborate with other organizations to promote a patient-centered health system. The organization also produces policy reports, fact sheets, issue briefs, and does health policy research. For journalists, one of its strengths is collecting and sharing consumers’ stories about their experience with the health system.
The National Academy of Social Insurance is a nonprofit organization that focuses on social insurance programs such as health policy, long-term care, Medicare, Medicaid, Social Security, unemployment insurance and workers' compensation and disability insurance.
The National Health Council is made up of more than 100 national health-related organizations and businesses, the NHC's core membership includes the nation’s leading patient advocacy organizations, which control its governance. Other members include professional and membership associations, nonprofit organizations with an interest in health, and major pharmaceutical, medical device, health insurance, and biotechnology companies.
The National Academy for State Health Policy (NASHP) is an independent, nonprofit organization of state health policymakers dedicated to achieving excellence in health policy and practice in the states. NASHP convenes state leaders to solve problems and share solutions, conduct policy analyses and research, disseminate information on state policies and programs, and provide technical assistance to states. The academy works on a wide range of issues including behavioral health, care coordination, children’s health, delivery system reform, insurance eligibility and enrollment, health IT, insurance exchanges, long term and chronic care, Medicaid, oral health, payment reform, population and public health, primary care and medical homes, quality and performance measurement.
The Gary and Mary West Health Policy Center is a nonprofit, non-partisan organization in Washington, D.C., that provides education and policy proposals designed to improve the health care system. Funded by philanthropists Gary and Mary West, the center is part of West Health, four organizations that seek to make high-quality health care more accessible at a lower cost to all Americans. West Health also includes the Gary and Mary West Health Institute, a nonprofit medical research organization seeking more effective ways to deliver care; the for-profit Gary and Mary West Health Investment Fund, and West Health Incubator, which invests in and provides expertise to businesses doing work similar to that the policy center. In 2014, the center funded an analysis by researchers from the Center for Studying Health System Change and RAND on price transparency. The resulting report, Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending (pdf), showed how three policy changes could save $100 billion over ten years.
The APCD Council is a collaborative of government, private, nonprofit, and academic organizations focused on improving the development and deployment of state-based all payer claims databases (APCDs). The council provides technical assistance to states developing these databases and is coordinated by the Institute for Health Policy and Practice (IHPP) at the University of New Hampshire (UNH) and the National Association of Health Data Organizations (NAHDO). It has an interactive map of the United States showing where states have developed these databases and the APCD Showcase APCD Showcase, a collection of examples from state databases.
NASHCO (National Alliance of State Health Co-Ops) is a trade association for the nonprofit health insurance co-ops formed after the passage of the Affordable Care Act. The ACA included provisions for co-ops, which are nonprofit consumer oriented and operated plans (co-ops) that offer health insurance and operate to stimulate competition among health insurers. These member-operated health plans were established in 24 states although one has since disbanded.
The Center for Advancing Health (CFAH) seeks to increase consumer’s engagement in their health care. By listening to patient perspectives, the center’s staff develops resources to help all consumers participate fully in their health and health care. The center also publishes the Health Behavior News Service, which covers peer-reviewed studies on health disparities, patient engagement research, and the effects of behavior on health. Founded in 1992, this nonprofit organization in Washington, D.C., gets support from individuals and foundations.
Fellows at the University of Pennsylvania’s Leonard Davis Institute analyze the medical, economic, and social issues that influence how health care is organized, financed, managed, and delivered in the United States.
The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization founded in 1990 that is dedicated to improving health care quality. NCQA develops quality standards and performance measures for many health care entities, including health plans and physician groups, that allow these entities to measure quality, analyze results, and improve patient outcomes. Among its undertakings are the Healthcare Effectiveness Data and Information Set (HEDIS), a tool most health plans use to evaluate their performance against 75 measures. Employers use HEDIS scores to evaluate plans and compare one against others. NCQA also produces the annual State of Health Care Quality.
The Health Care Incentives Improvement Institute (HCI3) seeks to improve health care quality and value by introducing evidence-based financial incentive programs and by redesigned payments to provides to make them more equitable and effective. HCI3 is a nonprofit organization whose board of directors includes physicians, employers, and health plan executives. The organization says it has created a range of programs to:
Measure health outcomes
Reduce preventable defects in care delivery
Promote a team-based approach to caring for patients
Realign provider payment incentives around quality
Reward excellence in care delivery
Report examines steps governors, Medicaid directors can take to improve health care delivery in the states
The State Health Care Cost Containment Commission, a project of the University of Virginia’s Miller Center, released a report: Cracking the Code on Health Care Costs, that examines how governors Medicaid directors, insurance commissioners, and human resource directors can improve the delivery of care in the states. The report promotes the idea that care can be more integrated, coordinated, patient-centered and cost-effective. It is written for state health care leaders across the nation and should serve as a resource for journalists covering state health reform efforts.
Public policy organizations
Medicare Payment Advisory Commission (MedPAC) is a nonpartisan agency that provides the U.S. Congress with analysis and policy advice on payments Medicare makes to private health plans participating in the Medicare Advantage program and to individual providers getting fee-for-service payment. In its thorough reports, MedPAC analyzes issues related to access to health care services for Medicare members and the quality of care Medicare providers deliver.
This interactive map from Health Research Institute (HRI) provides state-by-state predictions of market filings for 2015, forming a preliminary picture of who will participate in health exchanges and what premiums might look like.
Catalyst for Payment Reform report This report from CPR, titled Using Education, Collaboration, and Payment Reform to Reduce Early Elective Deliveries: A Case Study of South Carolina’s Birth Outcomes Initiative, examines how the South Carolina Medicaid program used a policy of non-payment for early elective deliveries to improve birth outcomes. After the state Medicaid program formed a partnership with the state’s largest commercial insurer, the two sides decided not to pay for certain early elective deliveries and thus saved millions of dollars in neonatal intensive care unit costs and other charges. South Carolina was the first state in the nation to adopt such a program, CPR said.