Medicaid has become a major payer in the United States and now covers over 62 million Americans, including those eligible for both Medicaid and Medicare. As a shared federal-state program, Medicaid serves low-income and disabled populations across the country with varying provisions. Recent policy changes aimed at extending states’ plan flexibility have stimulated the creation of a variety of natural experiments in several areas, including payment policy, long-term care, and the effects of Medicaid policy on opioid use.
We have worked with numerous insurers, national and regional, to understand the effects of their changes in reimbursement and organizational structure on care quality and utilization. Most of these studies are observational, and some involve case studies with faculty at Harvard Business School.
Physician Behavior, Organizational Arrangements, and Clinical Practice
Changes in health care costs depend, in part, on how physicians are organized and paid as well as on external events that might influence their behavior. Current HCP studies utilize natural experiments to better understand how physician factors influence care outcomes and utilization. Faculty investigate the potential impact of changing reimbursement for primary care services and how incentives aimed at individual physicians affect the quality of care.
Prescription drug costs are a persistent focus of policy concern. The government has a large influence in the workings of this market through insurance design (Medicare, Medicaid, and the Marketplaces) and FDA regulations. Faculty are engaged in the study of Medicare drug payment policy, FDA regulatory design and private insurance purchasing of prescription drugs.
Role of the Consumer
Over the last decade, there has been increasing interest in how patients (“consumers”) can play more active roles in their own health and health care. We have been studying whether consumers can effectively use price and quality information to select their providers, and are now in the midst of numerous studies of “convenience-care” options such as retail clinics and direct-to-consumer telemedicine and how these impact health care costs, quality, and access.