Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration

The next pandemic could be caused by the flu— and experts estimate it could kill 33 million people and cost trillions of dollars. This documentary hones in on the importance of improving flu vaccines and efforts to develop a universal flu vaccine.


This study will use major claims databases from the U.S., The Netherlands and Germany to explore the need to improve the accuracy of health plan payments in private health insurance markets and understand the impact of several possible approaches for making such improvements. Focusing on patients for whom actual plan spending is either very significantly above or below the risk adjusted payment for the patient (positive and negative residual spenders), the investigators will describe patient characteristics that may affect spending and model how remedial strategies such as residual spending reinsurance, changes to risk-adjustment factors and policies to address high drug costs would affect the performance of the payment system. Findings hold the potential to improve payment accuracy and promote more efficient functioning of private health insurance markets.


This study will use data from the Massachusetts Group Insurance Commission to (1) quantify the system-wide effects of tiered network benefit designs on referrals, hospital choice, health care use and spending, and (2) assess how these impacts vary with the design of the tiered networks, urban/rural market location and the competitiveness of the local physician market. Different tiered network designs to be studied include the size of the relative copayment differentials across tiers, tiering at the level of the physician group vs. individual physician, and whether tiering includes primary care physicians as well as specialists. Findings can inform the design and implementation of tiered networks and enhance understanding of the market conditions that may facilitate or inhibit impact.


Considerable evidence shows that hospital mergers raise the prices hospitals are able to negotiate with private insurers, but there is little evidence about the impact on patients covered by Medicaid. Hospitals may use the added private revenue to expand care for Medicaid patients, or they may shift care away from Medicaid patients to higher-profit privately insured patients. This study will investigate how hospital mergers in New York over the 2006-2012 period affected Medicaid access, Medicaid quality, and disparities in access and quality for Medicaid patients relative to privately insured patients. Because antitrust regulators may consider differential impacts on underserved populations when reviewing potential mergers, the findings may be important for antitrust policy. The work may also inform investments in safety net care in response to mergers.


By covering all low-income women regardless of pregnancy status, the ACA Medicaid expansions could lead to better preconception care, more prenatal care, longer coverage for postpartum care and better birth outcomes. This study will compare changes in these types of outcomes for mothers in states that expanded Medicaid and states that did not, and will assess whether there are racial/ethnic differences in these impacts. Findings could help to inform remaining non-expansion states' decisions regarding Medicaid expansion.


While new technological advances can lead to improvements in health care, rapid unchecked adoption of these technologies is also a leading driver of growth in U.S. health care spending. This study will use a mix of public- and private-sector health care claims to estimate a structural model of MRI market entry, pricing and market share. Model parameters will be used to simulate the impacts of possible policies to constrain overinvestment, and findings will be generalized beyond the MRI setting to consider adoption of other types of health care technology.


Payments from medical device manufacturers to providers may influence physician decisions about device use, possibly leading to overuse or use of more expensive devices. Focusing on high-dollar physician preference devices, this study will examine the pattern of payments from medical device manufacturers to physicians and estimate the causal impact of such payments on use of promoted devices, negotiated prices, and patient outcomes. Findings can help to inform policy discussions about industry payments.


Many drugs in the development pipeline offer the potential to cure patients but will almost certainly enter the market with very high price tags. This study will extend ICER's current value assessment framework to tackle difficult conceptual and methodological issues related to establishing fair, value-based initial prices for these drugs. The work will be applied to a real-world case study of an emerging potential cure and incorporated into an update of ICER's value assessment framework. Findings will also be shared with international technology assessment organizations.