Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Data Insights

    The second part in this ACEs infographic series, this infographic explores the challenges facing children and families and provides actionable guidance to nurture resilience and support caregivers and parents.

    Part 1 Part 2
  • Data Insights

    The COVID-19 pandemic has placed a spotlight on the link between systemic racism and health in many communities. This new NIHCM infographic clarifies the relationship between long-standing social and economic inequities and health disparities affecting Black Americans, over the life course and in relation to COVID-19.

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  • Data Insights

    Globally, outdoor air pollution is attributed to 4.2 million deaths every year. This infographic explores air pollution in America and the unequal impact it has on Black and Latinx communities. It also looks at the current solutions that are already available to improve air quality.

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  • Awards

    We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards. This year’s awards are virtual because of the COVID-19 pandemic, yet we invite you to meet the winners and learn about their award-winning work. NIHCM is also announcing the largest grant program in our history — $1 million to support work in journalism and research.

    Meet the Winners Press Release
  • Data Insights

    This infographic highlights the health challenges faced by the homeless community and outlines short and long term solutions to improve the health and well-being of these individuals, through social, economic and housing interventions.

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  • Data Insights

    This new Data Insights highlights the rapid rise in overdose deaths involving cocaine and methamphetamine, illustrates the geographic variations in utilization and death rates, and quantifies the increasing burden that these drugs are placing on the hospital system.

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Events

September 23, 2020
Latino Graphic

This webinar will highlight how systemic racism, the challenges of immigration, language barriers and other factors harm the health and well-being of Latinos.

September 10, 2020
Protecting Our Children

This webinar brought together experts to provide insight on early childhood development, ACEs and COVID-19’s impact on children.

In the News

September 2020
Population Health Spotlight
september-newsletter 8

How Do Tiered Physician Networks Influence Different Types of Patients in Choosing a Doctor?

Why This Study Is Important

In their effort to control health care costs and premiums, private health insurers are increasingly using tiered provider networks and differential cost sharing to channel patients to physicians judged to provide high quality care efficiently. This study advances the existing knowledge about this benefit design by examining how tiered networks affect the physician choices made by different types of patients. Understanding differential patient responses to tiering incentives can help insurers to refine their tiered network strategies so that they are most effective at steering high spending patients to high value physicians, thereby maximizing the potential for savings.

What This Study Found

  • Physicians in the lowest performance tiers lost market share among older and sicker patients who were selecting new physicians and among new male patients. Compared to physicians in the average performing tier, low performing physicians earned a 10 percent lower market share among new patients who were both older and sicker and a 15 percent lower share among new male patients.
  • Patients’ loyalty to their own physicians is pervasive. Across all groups of patients studied, people already seeing a physician in a low performance tier were no more likely to switch away from that doctor than were patients seeing physicians with better performance rankings.

What These Findings Mean

  • By influencing new provider choices of older and sicker patients, who are more likely to be high health care utilizers, tiered networks hold promise as a viable strategy for increasing the value of our overall health care spending.
  • Tiering strategies are likely to be most effective when targeting patients who are selecting a new doctor. It will be very difficult to change established patient-provider relationships, even when physicians are low performers.

More About This Study

This study used enrollment and claims data for non-Medicare individuals enrolled in five private health plans in Massachusetts in 2009 and 2010, all of which included a tiered physician network. Unique physician identifiers permitted tracking of individual physicians across plans. Regression models examined variation in each physician’s market share of new patients by plan and in the percent of the physician’s patients by plan who changed to another doctor in the same specialty, stratified by patient age group, risk category and gender. Models controlled for the physician’s tier ranking by plan and by year and included a full set of fixed effects for health plan, physician specialty, year and individual physician. Model identification was achieved by the variation in how specific health plans ranked individual physicians in their tiered networks.

Full Citation

Sinaiko AD. “Variations in Patient Response to Tiered Physician Networks,” American Journal of Managed Care, 22(6):420-25. 2016.

For more information about this study, contact Dr. Anna Sinaiko at asinaiko[at]hsph.harvard.edu.
For more information about the NIHCM Foundation Investigator-Initiated Research Grant Program, contact Dr. Julie Schoenman at 202-296-4426.

Read More

Tiered physician networks are one potential strategy to control health care costs while maintaining patient choice. Here’s how they work: health plans sort physicians into tiers based on the quality and cost-efficiency of the care they provide. Patients are incentivized by lower copayments to choose higher tier physicians. A paper by Anna Sinaiko, supported by a NIHCM research grant, looks at whether tiers are actually influencing patient choice of physician. 

Events

September 23, 2020
Latino Graphic

This webinar will highlight how systemic racism, the challenges of immigration, language barriers and other factors harm the health and well-being of Latinos.

September 10, 2020
Protecting Our Children

This webinar brought together experts to provide insight on early childhood development, ACEs and COVID-19’s impact on children.

In the News

September 2020
Population Health Spotlight
september-newsletter 8

Grants

Journalism GrantsJournalism Grant Program

The deadline for the 2020-2021 round of grant making has passed. NIHCM will notify the grant winners in the fall.

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NYTUpshotLogo

Investigator-Initiated Research Grant Program

The deadline for the 2020-2021 round of grant making has passed. Finalists have been notified.

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Awards

The 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

We are honored to announce the winners for the 26th Annual Health Care Research and Journalism Awards.

Learn More