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  • September 2022
  • Article

Giving a Buck or Making a Buck? Donations by Pharmaceutical Manufacturers to Independent Patient Assistance Charities
By: Leemore Dafny, Christopher Ody and Teresa Rokos
The federal Anti-Kickback Statute prohibits biopharmaceutical manufacturers from directly covering Medicare enrollees’ out-of-pocket spending for the drugs they manufacture, but manufacturers may donate to independent patient assistance charities and earmark donations...  View Details
Keywords: Cost Sharing; Prescription Drugs; Drug Spending; Medicare; Dual Eligibility; Cost; Health Care and Treatment; Philanthropy and Charitable Giving; Pharmaceutical Industry
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  • August 2022 (Revised January 2023)
  • Case

Icario Health: AI to Drive Health Engagement
By: David C. Edelman
Icario Health has built a market-leading artificial intelligence (AI) engine to help health insurers drive better health behaviors for their members, enabling the insurers to improve their Medicare performance.  View Details
Keywords: Marketing; Health Care and Treatment; AI and Machine Learning; Health Industry; United States
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  • September 2022
  • Article

Trends in Remote Patient Monitoring Use in Traditional Medicare
By: Mitchell Tang, Carter Nakamoto, Ariel Dora Stern and Ateev Mehrotra
Remote patient monitoring (RPM), the collection by patients of physiological measurements that are automatically sent to their health care practitioners, has been touted as a promising tool for improving chronic disease management. Interest in RPM has grown because of...  View Details
Keywords: Medicare; Remote Monitoring; Reimbursement; Health Care and Treatment; Health Industry
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  • 2022
  • Working Paper

How Do Copayment Coupons Affect Branded Drug Prices and Quantities Purchased?
By: Leemore S. Dafny, Kate Ho and Edward Kong
Drug copayment coupons to reduce patient cost-sharing have become nearly ubiquitous for high-priced brand-name prescription drugs. Medicare bans such coupons on the grounds that they are kickbacks that induce utilization, but they are commonly used by...  View Details
Keywords: Prescription Drugs; Coupons; Impact; Health Care and Treatment; Markets; Price; Spending; Pharmaceutical Industry; United States
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  • 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...  View Details
Keywords: Ambulatory Care; Payment Policy; Health Care and Treatment; Governing Rules, Regulations, and Reforms
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  • March 2021 (Revised July 2021)
  • Case

Aledade
By: Regina E. Herzlinger, Samyukta Mullangi and Nicholas Samonas
To truly supercharge growth, should Aledade take a step back and focus on product development?  View Details
Keywords: Health Care; Health Care Costs; Health Care Delivery; Health Care Entrepreneurship; Health Care Industry; Medicare; ACOs; Affordable Care Act (ACA); COVID-19; Health Care and Treatment; Entrepreneurship; Growth and Development Strategy; Product Development; Health Industry; United States
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  • 2020
  • Working Paper

Vertical Integration of Healthcare Providers Increases Self-Referrals and Can Reduce Downstream Competition: The Case of Hospital-Owned Skilled Nursing Facilities
By: David Cutler, Leemore S. Dafny, David Grabowski, Steven S. Lee and Christopher Ody
The landscape of the U.S. healthcare industry is changing dramatically as healthcare providers expand both within and across markets. While federal antitrust agencies have mounted several challenges to same-market combinations, they have not challenged any...  View Details
Keywords: Antitrust; Health Care and Treatment; Vertical Integration; Organizational Structure; Competition; Health Industry; United States
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  • 2020
  • Working Paper

Hospital Allocation and Racial Disparities in Health Care
By: Amitabh Chandra, Pragya Kakani and Adam Sacarny
We develop a simple framework to measure the role of hospital allocation in racial disparities in health care and use it to study Black and white Medicare patients who are treated for heart attacks—a condition where virtually everyone receives care, hospital care is...  View Details
Keywords: Health Care and Treatment; Equality and Inequality; Race; Analysis
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  • September 2, 2020
  • Article

How to Pay for Public Option Without Tax Hike
By: Regina E. Herzlinger and Richard Boxer
A bipartisan combination of the two parties’ most popular initiatives can expand health care coverage, significantly reduce costs, and enable freedom of choice, without raising taxes. Along the way, we can revitalize competition between public and private plans. Our...  View Details
Keywords: Health Insurance; Public Option; Health Care and Treatment; Insurance; Cost Management; United States
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  • January 2, 2020
  • Article

Changes in Quality of Care After Hospital Mergers and Acquisitions
By: Nancy Dean Beaulieu, Leemore S. Dafny, B. E. Landon, Jesse Dalton, Ifedayo Kuye and J. Michael McWilliams
Background: The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects...  View Details
Keywords: Hospitals; Mergers and Acquisitions; Health Care and Treatment; Quality
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  • January 2, 2020
  • Article

Medicare for All or Public Option: Can Either Heal Health Care?
By: Regina E. Herzlinger and James Wallace
The United States has serious health care problems: More than 27 million uninsured people, costs that are growing faster than income, and a staggering $37 trillion of unfunded liabilities in the Medicare program. Perhaps most alarming: The US ranks lowest among...  View Details
Keywords: Healthcare; Public Option; Medicare; Health Care and Treatment; Insurance; Cost Management; Problems and Challenges; United States
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  • Article

A Public Option Can Be a Triple Win for U.S. Healthcare
By: Regina E. Herzlinger and Richard Boxer
The United States needs to control healthcare costs and quality while reaching universal coverage. The strongest choice is a public option that allows people to choose between Medicare and private payers. But a public option needs sustainable financing mechanisms that...  View Details
Keywords: Healthcare; Public Option; Universal Health Coverage; Health Care and Treatment; Cost Management; Quality; United States
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  • Article

Economic Principles for Medicare Reform
By: Amitabh Chandra and Craig Garthwaite
In this article, we develop an economic framework for Medicare reform that highlights trade-offs that reform proposals should grapple with but often ignore. Central to our argument is a tension in administratively set prices, which may improve short-term efficiency but...  View Details
Keywords: Medicare; Value-based Care; Health Care Reform; Markets In Health Care; Health Care and Treatment; Value; Governing Rules, Regulations, and Reforms
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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...  View Details
Keywords: Outcomes Reporting; Outcomes Measurement; Medicare; Medicaid; Health Care and Treatment; Outcome or Result; Measurement and Metrics
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  • October 10, 2019
  • Article

The Case for the Public Option Over Medicare for All
By: Regina E. Herzlinger and Richard Boxer
How can the United States better control its health care costs and quality and still achieve universal coverage? The strongest choice is not Medicare for All, which would eliminate private insurance; it’s the public option, which would allow people to choose from...  View Details
Keywords: Universal Health Coverage; Public Option; Medicare; Health Care and Treatment; Insurance; Cost Management; Quality; United States
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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...  View Details
Keywords: Medicare; Medicaid; Bundled Payments; Health Care and Treatment; Cost Management; Performance Evaluation; Outcome or Result
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  • Article

Europe's Alternative to Medicare for All: Swiss and Dutch Private Insurance Provide Better Coverage Than Canada's Single-Payer System
By: Regina E. Herzlinger and Bacchus Barua
An analysis of Canada’s single-payer healthcare system shows the dangers of the proposed Medicare for All model. In fact, the Canadian healthcare system is costly and drives poor outcomes when compared to objective performance measures. Alternatively, the Swiss and...  View Details
Keywords: Healthcare Systems; Universal Health Coverage; Health Care and Treatment; Insurance; Canada; Switzerland; Netherlands
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  • February 2019
  • Article

Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending
By: David Cutler, Jonathan Skinner, Ariel Dora Stern and David Wennberg
There is considerable controversy about the causes of regional variations in health care expenditures. Using vignettes from patient and physician surveys linked to fee-for-service Medicare expenditures, this study asks whether patient demand-side factors or physician...  View Details
Keywords: Health Care and Treatment; Spending; Geographic Location; Values and Beliefs
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  • Article

Decreases In Readmissions Credited to Medicare's Program to Reduce Hospital Readmissions Have Been Overstated
By: Christopher Ody, Lucy Msall, Leemore S. Dafny, David Grabowski and David Cutler
Medicare’s Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a...  View Details
Keywords: Readmission Rates; Hospitals; Acute Care Hospitals; Medicare; Myocardial Infarction; Heart Failure; Health Care and Treatment
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  • February 2018
  • Case

Health Savings Accounts: Enabling Consumer Participation
By: Regina E. Herzlinger and James Wallace
Health savings accounts (HSAs), a creation of the 2003 Medicare Modernization Act, had become an integral part of the drive toward consumer-driven health care. Coupled with high-deductible health plans, HSAs allowed consumers to directly control a significant part of...  View Details
Keywords: Health Care; Healthcare Costs; Health Insurance; Health Care and Treatment; Cost; Insurance; Innovation and Invention; Health Industry; United States
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