The diverse, innovative faculty and students at HCP engage in research covering a wide variety of subjects in health care. Below is a list of the seven specialty areas that broadly encompass HCP research; it is not all-inclusive but is meant to provide an overview of interests and accomplishments. For more details or for information on a particular subject or faculty member, go to the Publications section of the website and search by faculty member, or type in keywords in the Search field at the top right-hand side of the website.
Aging, Disability, and End of Life
Research in this area covers several domains including long term care, hospice care and end-of-life care. Recently we have begun work on disability policy, with studies specifically examining health care received by those with disabilities. Much of this work is done in collaboration with the National Bureau of Economic Research. We are also studying the implications of different models of coverage for dually eligible beneficiaries who receive their health care via Medicare and their long-term care services via Medicaid. Faculty also study the role of Medicare Part D, the Medicare prescription drug benefit, in nursing homes across the country.
Role of the Consumer
Over the last decade, there has been increasing interest in how patients (“consumers”) can play a more active role in their health. The hope is that consumerism will drive improvements in quality and decreases in spending. At HCP we have been studying whether consumers can effectively use price and quality information to select their providers. We are in the midst of numerous studies of “convenience-care” options such as retail clinics and direct-to-consumer telemedicine and their impact on costs, quality, and access in the health care system.
Comparative Effectiveness Research
Comparative effectiveness work has been part of the HCP portfolio since its inception, initially determining how different health care services (e.g., tests or treatments) differ from each other in cost or quality. In more recent years, the definition of this work has extended to site of service, specifically, how the same service delivered at different sites or under different insurance plans contrast in outcomes. Sites can be hospitals or provider groups (e.g., the Veterans Administration) and plans can include various types of insurers. HCP faculty have had extensive and ongoing experience with comparative research involving alternative sites of care.
In the past decade the importance of the field of health economics has been highlighted by financing mechanisms and their impacts are changed by both public and private insurers. For over ten years we have studied payment changes and their effects on traditional Medicare as well as on private Medicare Advantage plans. We study new forms of contracting (e.g., ACOs, capitation, bundling) to ascertain these changes on quality and utilization. Our work embraces not only the general population but also those with mental illnesses, and those who are underserved by traditional mechanisms. HCP's research has been supported for decades by grants from the National Institute of Aging, the National Institutes of Health, and by private foundations, including a major grant from the Laura and John Arnold Foundation.
New Models of Delivery
New models of health care like retail clinics and telemedicine have emerged over the past decade, and only now is research and evaluation of their effectiveness being done. These models have the potential to drastically change and improve the landscape of medical care; they are also controversial, raising concerns like quality of care, disruption to the doctor-patient relationship, and lost opportunities for preventive care. HCP has been on the forefront of evaluating these innovations and their impact on access, costs, and efficacy.
Physician Behavior, Organizational Arrangements and Clinical Practice
Changes in health care costs and growth of cost depend, in part, upon how physicians are organized and paid as well as on external events that might influence their behavior. Current HCP studies generally utilize natural experiments to better understand how physician factors influence care outcomes and health care utilization. Faculty investigate the potential impact of changing reimbursement for primary care services from typical fee-for-service payments to fixed monthly per patient payments and how incentives aimed at individual physicians affect the quality of their care.
This area is critical to all aspects of health policy and includes statistics as well as particular components like risk adjustment that are essential to many areas of economic analyses. For more than 25 years, HCP faculty have been at the forefront of developing and applying statistical methods necessary for answering critical questions in health care policy. This work spans the entire field of health services research and focuses on population-based investigations in observational and experimental data, including both massive data sets and smaller survey-based instruments. Methodology ranges from parametric Bayesian hierarchical models to nonparametric machine-learning-based approaches.
At HCP, faculty members in statistics and biostatistics are fully integrated team members and team leaders, bringing a crucial perspective to the scientific process. This leads to studies designed and analyzed with additional statistical rigor, as well as the positing of novel research questions that otherwise would not have been examined. A deep understanding of health care systems
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. HCP faculty are engaged in the study of Medicare drug payment policy, FDA regulatory design and private insurance purchasing of prescription drugs.