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.
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • 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.

    Press Release Watch the Video
  • 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
  • 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

January 27, 2020
SDOH-webinar-graphic-012720

This webinar will explore public and private sector efforts to improve health outcomes by addressing social determinants of health.

December 19, 2019
shutterstock_560761723_1

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this rapid response webinar explained the December 18th ruling from the Fifth Circuit on the Affordable Care Act.

Watch the Recording

In the News

January 2020
Population Health Spotlight
newsletter-loneliness-kas_10

After Changing Insurance Carriers, Do Patients Change Physicians and Use Emergency Departments More?

Why This Study Is Important

Health insurance exchanges are intended to encourage consumers to shop annually for the health plan that best meets their needs, resulting in a high potential for plan switching. Such transitions can affect the stability of patient-physician relationships and subsequent health care use, particularly in an environment where provider networks vary from plan to plan. This study documents how changing from one insurer to another in the Massachusetts health exchange affected patients’ use of physicians they had not previously seen and their use of emergency department (ED) visits.

What This Study Found

  • Visits to new primary care physicians (PCPs) increased significantly for patients changing insurers relative to patients staying with the same insurer.
  • For patients initially covered by Medicaid, the monthly rate of visits to new PCPs increased by an average of more than 200 percent after changing insurers, and their rate of visits to new specialists rose by almost 50 percent.
  • For patients initially covered by private insurance, changing carriers was associated with a nearly 50 percent increase in new PCP visits while visits to new specialists fell slightly. The overall decline in new specialist visits was caused by lower use among patients who faced higher deductibles after changing plans.
  • These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year.
  • The rate of ED visits increased significantly for Medicaid patients in the month of their insurance transition, relative to levels seen in the four to twelve months before the transition, but quickly returned to baseline levels.

What These Findings Mean

Continuously insured patients may need to change which physicians they use after changing insurers. The impact of the insurance change dissipates over time as patients establish ongoing relationships with new providers. The temporary increase in ED visits coinciding with a change in Medicaid carriers suggests that these patients are uncertain about where to seek care during the transition period and might benefit from improved guidance from carriers.

More About This Study

The study population is drawn from non-elderly adults in Massachusetts who were continuously insured during at least three years from 2010 to 2013. Each person’s index insurer was identified as of January 2011 and those changing insurance carriers during the next two years were tagged as switchers. Propensity scoring was used to create a matched sample of more than 632,000 switchers and non-switchers, and difference-in-difference models were estimated to assess the impact of insurance switching on monthly rates of visits to new PCPs, new specialists and EDs in the year after the switch. Models controlled for comorbidities before the insurance change; a measure of socioeconomic disadvantage in the patient’s geographic area; patient age and gender; plan type; and employer size and self-insurance status for those with private coverage. Several subgroup and sensitivity analyses were conducted to investigate the robustness of the results.

Full Citation

Barnett ML, Song Z, Rose S, Bitton A, Chernew ME, and Landon BE. “Insurance Transitions and Changes in Physician and Emergency Department Utilization: An Observational Study.” Journal of General Internal Medicine, published online, May 18, 2017.

For more information about this study, contact Dr. Bruce Landon at landon[at]hcp.med.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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This Research Insights highlights key findings from a study of how changing insurance carriers affects patient-physician relationships. The findings include an increase in emergency department visits by Medicaid patients in the month after they change insurers.

Events

January 27, 2020
SDOH-webinar-graphic-012720

This webinar will explore public and private sector efforts to improve health outcomes by addressing social determinants of health.

December 19, 2019
shutterstock_560761723_1

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this rapid response webinar explained the December 18th ruling from the Fifth Circuit on the Affordable Care Act.

Watch the Recording

In the News

January 2020
Population Health Spotlight
newsletter-loneliness-kas_10

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

Nine new grantees for the 2019-2020 funding cycle have been announced! We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

Now Accepting Entries for the 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

Submit your research or reporting published in 2019 by February 3, 2020 for a chance to win up to $20,000. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

Learn More and Apply