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

    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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  • Data Insights

    This infographic delves into an emerging public health emergency involving rapidly rising rates of stimulant use and related overdose deaths, which has been occurring in the shadow of the opioid crisis.

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  • News

    NIHCM would like to provide you and your organizations with a list of resources concerning COVID-19 and vulnerable populations. We will continually update this list.

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Events

August 21, 2020
Environmental

This webinar will bring together experts to provide insights on air pollution and environmental injustice during a time of increased inequality.

August 11, 2020
Racism and Health Graphic

This webinar discussed how systemic racism harms health, and how solutions-based approaches at the state and community level are making a difference.

In the News

August 2020
Population Health Spotlight
August Newsletter

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

August 21, 2020
Environmental

This webinar will bring together experts to provide insights on air pollution and environmental injustice during a time of increased inequality.

August 11, 2020
Racism and Health Graphic

This webinar discussed how systemic racism harms health, and how solutions-based approaches at the state and community level are making a difference.

In the News

August 2020
Population Health Spotlight
August Newsletter

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 will be selected in the coming month.

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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