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

    Mental illness has become more common over the last decade, particularly among 18- to 25-year-olds. This Data Insights looks at trends in mental health and their implications for the future.

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  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

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  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

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  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • Awards

    NIHCM Foundation hosted the 25th Annual NIHCM Awards at the Organization of American States in Washington, D.C. to recognize outstanding health care research and journalism.

    Press Release Winners Finalists
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

November 18, 2019
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Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
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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.

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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

November 18, 2019
alliance-image-111819

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this webinar will explore the current landscape of the long-term care delivery system.

November 13, 2019
Rural-Health-Webinar-Graphic

This webinar explored how leaders are leveraging the unique strengths of rural communities to develop and implement promising solutions.

In the News

November 2019
Population Health Spotlight
aces-in-the-news 4

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. A small number of applicants will be invited to submit a full proposal in September.

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Awards

Winners Named in the 25th Annual Research and Journalism Awards

Winners Announcment 2018 1

Congratulations to all of the winners of the 25th Annual NIHCM Foundation Research and Journalism Awards! The winners and finalists were honored at a banquet in Washington, DC, in May.

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