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.
  • 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.

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  • 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 will explore 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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Can We Curb High Health Care Spending by Focusing on End-of-Life Care?

Why This Study Is Important

One quarter of annual Medicare spending is for beneficiaries in their last year of life, a fact that often leads observers to conclude that much of this spending is wasteful and that we could better control high health care spending by being more judicious with end-of-life care. But of course, to reduce wasteful spending in patients at the end of life, we would need accurate predictions of which patients will die and when. This study takes a closer look at the potential for eliminating wasteful spending at the end of life by examining spending for those who were expected to die soon and those who actually died.

What This Study Found

  • Death is highly unpredictable. People who seem very likely to die are not the same as those who end up dying. Overall, less than 10 percent of beneficiaries who died within the year had more than a 50 percent predicted probability of dying in the year. Even among beneficiaries admitted to the hospital, 20 percent of whom will die within the year, less than 4 percent of decedents had a predicted mortality risk above 80 percent when they entered the hospital.
  • Less than 5 percent of total Medicare spending is accounted for by individuals with a predicted one-year mortality risk above 50 percent. This share is much lower than the one quarter of Medicare spending on end-of life care for beneficiaries who actually died.
  • Beneficiaries who end up dying are sicker, and spending is higher for sicker individuals – both those who survive as well as those who die. Depending on the spending measure used, 30 to 50 percent of the concentration of spending at the end of life can be explained by the concentration of spending on the sick.

What These Findings Mean

To improve the value of our health care spending, it is necessary to assess how specific interventions affect quality of life and overall survival, all the while allowing for patient preferences regarding treatment decisions. The difficulty of predicting who will die, and when, means that for most patients the end-of-life period is known only in retrospect. While spending for people who die is very high, many sick patients also have high spending but survive. Furthermore, only a small share of overall spending is for people who have a very high probability of dying soon.

More About This Study

This study applied machine-learning techniques to Medicare claims data from 2007 for a random sample of Medicare beneficiaries to predict each beneficiary’s probability of dying in 2008, then analyzed spending by ex ante (predicted) mortality and by ex post (actual) mortality. Two spending measures are considered. The first looks backward from the date of death in 2008 and aggregates all spending incurred during a specific time period prior to death. Comparable spending for survivors is computed for a period of the same duration beginning with January 1, 2008. The second spending measure is forward looking for both decedents and survivors and aggregates all spending from January 1 until the date of death or the end of the analysis period. Sensitivity analyses that used a different mortality prediction algorithm and predicted mortality starting from a hospital admission date rather than the first of the year did not change the study’s findings materially.

Full Citation

Einav L, Finkelstein A, Mullainathan S, and Obermeyer Z. “Predictive Modeling of U.S. Health Care Spending in Late Life.” Science, 360:1462-5, June 29, 2018.

For more information about this study, contact Dr. Ziad Obermeyer at This email address is being protected from spambots. You need JavaScript enabled to view it..
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 summarizes a new study that takes a closer look at the idea of focusing on end-of-life spending as a way to trim wasteful health care spending.

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 will explore 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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