With a $1.5 million grant from the Laura and John Arnold Foundation, the Health Care Cost Institute launched the State Health Policy Grant Program to support six independent research projects analyzing how states are implementing the Affordable Care Act (ACA) and other reforms to improve their health care systems. The research projects were done by independent researchers using HCCI’s repository of commercial claims data for over 50 million insured Americans.

Grant Recipients

University of California, Berkeley (Dr. Timothy Brown, Dr. James Robinson, and Dr. Christopher Whaley): Using Data to Lower Costs: California’s Reference-Based Payment Experience and Implications for Other States

  • This paper estimates that if just three health insurers—Aetna, Humana, and UnitedHealthcare—adopted a reference-based payments program for colonoscopies, U.S. medical spending would decrease by approximately $95 million per year. These estimates were modeled on the health care savings of the California Public Employees’ Retirement System (CalPERS). A set of interactive maps allows employers and insurers to investigate the effectiveness of such programs in local markets across the U.S.

University of California, San Francisco (PI: Dr. Ulrike Muench): Does Independent Scope of Practice Affect Prescribing Outcomes, Healthcare Costs, and Utilization?

  • Prices for primary care services fell by 1 to 4 percent in states that passed independent scope-of-practice laws from 2008-2012, allowing nurse practitioners to treat patients without a supervising physician. However, spending on health care increased during this time. Higher total health care costs may be a result of increased volume in services, which may stem from increased access to care.

University of Chicago (PI: Dr. Rena Conti): The Impact of Provider Consolidation on Outpatient Prescription Drug-Based Cancer Care Spending

  • The consolidation of outpatient practices between 2003 and 2013 drove significant increases in cancer treatment spending in large part because of the additional facility fees that hospital outpatient departments and their affiliated clinics are able to charge insurers. Consolidation also appears to increase the use of more expensive medicines and other outpatient care components.

University of Colorado Denver (Co-PIs: Drs. Benjamin Miller and Lynn VanderWielen): Mental Health Parity’s Limited Impact on Utilization and Access for Health Plan Beneficiaries

  • The passage of the Mental Health Parity and Addiction Equity Act (MHPAEA) has had little to no effect on access and use of mental health services for patients with depression, bipolar, or schizophrenia. When examining comparison of states with minimal parity laws prior to implementation of MHPAEA, the number of visits to mental health providers did not increase as would be expected if parity had increased access to care. Results from this research highlight the limitations of mental health parity; specifically, parity laws may not have had their intended effect of increasing access and utilization of mental health services.

University of Nebraska Medical Center (PI: Dr. Fernando Wilson): An Examination of Private Payer Reimbursements to Primary Care Providers for Healthcare Services Using Telehealth, United States 2009–2013

  • While telehealth claims submitted by primary care providers have increased from 1,246 claims in 2009 to 2,558 in 2013, they continue to be reimbursed at lower rates. Many states permit reimbursements for telehealth services, but only six states have passed laws that mandate reimbursement parity between telehealth and non-telehealth care. (COMPLETED)

University of Washington (PI: Dr. Bianca Frogner): Does Unrestricted Access to Physical Therapy Reduce Utilization and Health Spending?

  • Seeing a physical therapist as the first point of care for lower back pain reduces potentially costly services later on, including emergency department visits and use of prescription opioids, according to an analysis of patient claims data in six states in the northwestern region of the U.S. patients who sought physical therapy first for lower back pain had significantly lower costs, including out-of-pocket costs, for physician, outpatient, hospital, and pharmacy care compared to patients who saw another type of provider.This work was done in collaboration with colleagues at The George Washington University.