Physician EHR Adoption and Potentially Preventable Hospital Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010-2013.

Objective: To test for correlation between the growth in adoption of ambulatory electronic health records (EHRs) in the United States during 2010-2013 and hospital admissions and readmissions for elderly Medicare beneficiaries with at least one of four common ambulatory care-sensitive conditions (ACSCs).

Data Sources: SK&A Information Services Survey of Physicians, American Hospital Association General Survey and Information Technology Supplement; and the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013.

Study Design: Fixed effects model estimated the relationship between hospital referral region (HRR) level measures of physician EHR adoption and ACSC admissions and readmissions.

Meaningful Use of Electronic Health Records and Medicare Expenditures: Evidence from a Panel Data Analysis of U.S. Health Care Markets, 2010-2013.

Objective: To determine if recent growth in hospital and physician electronic health record (EHR) adoption and use is correlated with decreases in expenditures for elderly Medicare beneficiaries.

Data Sources: American Hospital Association (AHA) General Survey and Information Technology Supplement, Health Information Management Systems Society (HIMSS) Analytics survey, SK&A Information Services, and the Centers for Medicare & Medicaid Services (CMS) Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013.

Study Design: Fixed effects model comparing associations between hospital referral region (HRR) level measures of hospital and physician EHR penetration and annual Medicare expenditures for beneficiaries with one of four chronic conditions.

Geographic variation in health IT and health care outcomes: A snapshot before the meaningful use incentive program began.

Background: The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes the Meaningful Use (MU) incentive program, was designed to increase the adoption of health information technology (IT) by physicians and hospitals. Policymakers hope that increased use of health IT to exchange health information will in turn enhance the quality and efficiency of health care delivery. In this study, we analyze the extent to which key outcomes vary based on the levels of health ITness among physicians and hospitals before the HITECH and MU programs led to increases in adoption and changes in use.

Obtaining providers' 'buy-in' and establishing effective means of information exchange will be critical to HITECH's success.

In enacting the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act, Congress set ambitious goals for the nation to integrate information technology into health care delivery. The provisions called for the electronic exchange of health information and the adoption and meaningful use of health information technology in health care practices and hospitals. We examined the marketplace and regulatory forces that influence HITECH's success and identify outstanding challenges, some beyond the provisions' control.

Nonfinancial barriers and access to care for U.S. adults.

Objective: To identify prevalences and predictors of nonfinancial barriers that lead to unmet need or delayed care among U.S. adults.

Generic utilization and cost-sharing for prescription drugs.

Purpose: The purpose of this study is to estimate the own- and cross-price elasticity of brand-name outpatient prescription drug cost-sharing for maintenance medications and to estimate the effects of changes in the price differential between generic and brand-name prescription drugs.

Methodology/approach: We first review the literature on the effects of an increase in brand-name drug patient cost-sharing. In addition, we analyze two examples of utilization patterns in filling behavior associated with an increase in brand-name cost-sharing for patients in employer-sponsored health plans with chronic illness.

Differences in prevalence, treatment, and outcomes of asthma among a diverse population of children with equal access to care: findings from a study in the military health system.

Objective: To assess racial and ethnic differences in asthma prevalence, treatment patterns, and outcomes among a diverse population of children with equal access to health care.

Design: Retrospective cohort analysis.

Setting: The Military Health System.

The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

Objective: To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics.

Data Source: We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas.

Study Design: We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance.

Beyond affordability: the impact of nonfinancial barriers on access for uninsured adults in three diverse communities.

Most proposals to improve access for uninsured adults focus on removing financial barriers to health care. Health services researchers have long recognized, however, that access to care is a multidimensional concept consisting of both financial and nonfinancial dimensions. While financial barriers faced by those without health insurance have been well-documented, it is not known to what degree nonfinancial barriers limit access for those without coverage.

Hispanics and health insurance coverage: the rising disparity.

Background: Many reports have focused attention on the rising percentage of adults in the United States without health insurance. This hides the fact that the uninsured rate for non-Hispanic nonelderly adults has held fairly steady since 1983, while the rate for Hispanics has increased.

Objectives: To document the trends in the coverage rate by source of coverage for different population groups between 1983 and 2003 and suggest how changes in the composition of these groups have contributed to these trends.

Who enrolls in community-based programs for the uninsured, and why do they stay?

Faced with growing numbers of uninsured people, many communities are developing local programs to provide coverage or improve access. Some might predict that only those with health problems would participate; however, little is known about who enrolls. This paper examines participation and retention in three different community programs aimed at low-income uninsured adults.

A copayment increase for prescription drugs: the long-term and short-term effects on use and expenditures.

This study estimates the effects of an increase in an outpatient prescription drug copayment using a natural experiment based upon a large firm that implemented such an increase. The findings suggest that the primary effect of a copayment increase is attenuation of the trend in prescription drug utilization. We also find an initial reduction in expenditures, with the effects on spending diminishing.

Donated care programs: a stopgap measure or a long-run alternative to health insurance?

In the absence of broad federal health care reform, interest has grown in local solutions to the problem of providing health care to the uninsured. Community-based donated medical care models have emerged as one alternative. We examine the early experience of a donated care program in southern Maine called CarePartners.

Who enrolls in a program for parents of publicly insured children?

Although interest in expanding SCHIP coverage to parents has grown over the past five years, few such expansions have actually been implemented. State governments and health plan administrators remain concerned that these expansions will attract only high-risk enrollees, resulting in costly premiums that require large subsidies. We examine characteristics of enrollees in an SCHIP-like expansion program in Alameda County, California.

Overlap in HMO physician networks.

Health maintenance organizations' (HMOs') restrictions on the size of their physician networks may facilitate cost containment and quality improvement activities but may also impede access to care and impose barriers to those wishing to switch health plans or jobs. We examine the extent, variation, and predictors of overlap in HMO physician networks. We predict that people who switch HMOs have a reasonable likelihood (50 percent) of being able to retain their physician.

Who walks through the door? The effect of the uninsured on hospital use.

Hospitals are concerned about the implications of an increase in the number of uninsured people. Using data from the 1999 Medical Expenditure Panel Survey (MEPS), we calculate what percentage of hospital inpatient, emergency department, and outpatient visits are accounted for by uninsured people and predict how those shares would change under three different scenarios. We find that although the burden of the uninsured would remain a severe problem for some hospitals, it would not likely increase much for most of them.

Medigap premiums and Medicare HMO enrollment.

Objective: Markets for Medicare HMOs (health maintenance organizations) and supplemental Medicare coverage are often treated separately in existing literature. Yet because managed care plans and Medigap plans both cover services not covered by basic Medicare, these markets are clearly interrelated. We examine the extent to which Medigap premiums affect the likelihood of the elderly joining managed care plans.