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Pharmaceutical innovation policy involves managing a tradeoff between high prices for new products in the short-term and stronger incentives to...
- July 2021
- Article
Medical Debt in the U.S., 2009–2020
By: Ray Kluender, Neale Mahoney, Francis Wong and Wesley Yin
Importance: Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care policies.
Objective: To measure the amount of medical debt nationally and by... View Details
Objective: To measure the amount of medical debt nationally and by... View Details
- June 2, 2021
- Article
The CMS New Rule on Ambulatory Surgical Centers Earns Only Partial Credit
By: Junaid Nabi and Robert S. Kaplan
The Centers of Medicare and Medicaid Services (CMS) recently announced that it will be removing more...
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- 2021
- Working Paper
Which Markets (Don't) Drive Pharmaceutical Innovation? Evidence From U.S. Medicaid Expansions
By: Craig Garthwaite, Rebecca Sachs and Ariel Dora Stern
Pharmaceutical innovation policy involves managing a tradeoff between high prices for new products in the short-term and stronger incentives to develop products for the future. Prior research has documented a causal relationship between market size and pharmaceutical...
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- Article
Mandate Outcomes Reporting
By: Robert S. Kaplan and Michael E. Porter
Currently, few health care providers measure and report their patient outcomes, which leads to several problems. Attempts to introduce price transparency without outcomes transparency could trigger a “race to the bottom.” Should Medicare coverage be expanded to...
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- July 2019
- Article
Evaluation of Economic and Clinical Outcomes Under Centers for Medicare & Medicaid Services Mandatory Bundled Payments for Joint Replacements
By: Derek A. Haas, Xiaoran Zhang, Robert S. Kaplan and Zirui Song
In 2016, the Centers for Medicare & Medicaid Services (CMS) launched its first mandatory bundled payment program, the Comprehensive Care for Joint Replacement (CJR) model, by randomizing metropolitan statistical areas (MSAs) into the payment model. The paper analyzed...
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- February 2019
- Article
Does It Matter If Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending
By: Leemore S. Dafny
There is limited empirical evidence about the impact of for-profit health insurers on various outcomes. I study the effects of conversions to for-profit status by Blue Cross Blue Shield (BCBS) affiliates in 11 states, spanning 28 geographic markets. I find both the...
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- August 2017
- Case
CareMore Health System
By: Robert S. Huckman and Brian W. Powers
CareMore Health System—a physician-founded care delivery system and health plan—had developed and refined an innovative care model for at-risk seniors enrolled in Medicare managed care (i.e., Medicare Advantage) plans. CareMore's President, Sachin Jain, and his...
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- August 2017
- Supplement
CareMore Health System (B)
By: Robert S. Huckman and Brian W. Powers
This supplement to “CareMore Health System (A)” discusses the company's early experience introducing its managed Medicaid model in the Des Moines, Iowa, market. It also provides an update on the Memphis program discussed in the (A) case.
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- February 2012 (Revised June 2013)
- Case
Moving to Universal Coverage: Health Care Reform in Massachusetts
By: Michael E. Porter and Jennifer F Baron
State health care reform in Massachusetts has involved a phased process, focusing first on coverage expansion and then turning to delivery system innovation and cost containment. In 2006, the state adopted an individual mandate to obtain health care coverage which,...
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- April 2008 (Revised May 2008)
- Case
Commonwealth Care Alliance: Elderly and Disabled Care
By: Michael E. Porter and Jennifer F Baron
Individuals enrolled in both Medicare and Medicaid, known as dual eligibles, are among the highest-cost beneficiaries in the US. Commonwealth Care Alliance, a small nonprofit insurer and care delivery system in Massachusetts, operated under a public demonstration...
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- July 1996 (Revised February 2021)
- Case
THG Management Services
By: Regina E. Herzlinger and D. Scott Lurding
The two entrepreneurial founders of a Medicaid managed-care firm are considering how and where to expand and whether they should manage risk for hospitals that want to enter the managed-care sector or own it.
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