Institute on Healthcare Systems

Schneider Institutes for Health Policy

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Dr. Christopher Tompkins, IHS Director Welcome to the Institute on Healthcare Systems


The Institute on Healthcare Systems (IHS) is home to many innovations in healthcare research and policy, and is dedicated to providing rigorous technical solutions to policymakers and other stakeholders who are striving to improve quality, efficiency, and value.  We respect the complexity of healthcare, the corresponding need for rigorous and robust approaches to meaningful and stable reform, and the vital strength of empirical illumination and validation.

IHS was built originally on the vast experience in national health policy of our founders, Stuart Altman and Stan Wallack.  Their tradition continues with accomplishments of our director, Christopher Tompkins, including his leadership in developing the shared-savings payment model and related delivery system innovations, hospital value-based purchasing, and  a comprehensive episode-of-care system for Medicare and the public domain.  Similarly, our deputy director, Jennifer Perloff, has led IHS studies in value for capitated delivery systems, and the potential roles of nurse practitioners to implement sustainable delivery system reforms.

Christine Bishop is a national expert on financing of post-acute and long-term care, as well as the economics of healthcare labor markets.  Donald Shepard and colleagues have done pioneering and enduring work in cost-effectiveness analysis, domestically and internationally.  John Chapman, Moaven Razavi and Chris Sistrom are leaders in developing groundbreaking tools and approaches for transforming substantial aspects of healthcare services.

IHS staff also covers a range of delivery systems issues, such as Cindy Thomas' work in prescription drug policy and state health reform. Given the broad range of work done at IHS, our research spans both quantitative and qualitative techniques. Jeff Prottas, for example, is an expert in program implementation and evaluative case studies. Grant Ritter provides expertise in statistics and econometric methods.  Palmira Santos spearheads organizational and delivery system reforms aimed at improving quality for vulnerable populations ranging from neonates to the elderly.  

As health care organizations increasingly enter new reimbursement arrangements like global and episode-based payment, Rob Mechanic has led several new studies evaluating how organizations are adapting to these new payment models.

Policy analysis is an important component of the work at IHS and is led by Rob Mechanic at the Health Industry Forum and Michael Doonan at the Massachusetts Health Policy Forum. 

Chris Tompkins signature


Mechanic, R. (2016). "Medicare Bundled Payment Is Here to Stay." Clinical Orthopaedics and Related Research. 474, pp. 1920-1921
Kaur, R., Perloff, J.N., Tompkins, C., and Bishop, C.E. (2016). "Hospital Post-Acute Care Referral Networks: Is Referrral Concentration Associated With Medicare-Style Bundled Payments?" Health Services Research, Published online Dec. 15, 2016.
Doonan, M., (2016). Book Review on "Obamacre Wars Federalism: State Politics and the Affordable Care Act," Series:  Studies in Government and Public Policy, by Daniel Beland, Philip Rocco and Alex Wadan (University Press of Kansas, 2016). Publius: The Journal of Federalism.                                                                                                                                                                                                                                                                                                                                                                                                                                                         
Stone, R.., Wilhelm, J., Bishop, C.E., Bryant, N.S., Hermer, L., et al. (2016). "Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey." The Gerontologist. Published online April 21, 2016.
Hefele, J.G., Acevedo, A., Nsiah-Jefferson, L., Bishop, C.E., Abbas, Y., Damien, E. and Ramos, C. (2016). "Choosing a Nursing Home: What Do Consumers Want to Know, and Do Preferences Vary Across Race/Ethnicity?" Health Services Research. 51(3), pp 1167-1187.
Mechanic, R. E. 2016. When New Medicare Payment Systems Collide New England Journal of Medicine 374(18): 1706-09.
Graves, J. A., P. Mishra, R. S. Dittus, R. Parikh, J. Perloff, and P. I. Buerhaus. 2016. “Role of Geography and Nurse Practitioner Scope-of-Practice in Efforts to Expand Primary Care System Capacity: Health Reform and the Primary Care Workforce. Med Care 54(1): 81-9.
Doonan, M., and Katz, G. 2016. Choice in the American Health Care System: Changing Dynamics Under the ACA Current Sociology. 63(5), pp. 746-762.
Prottas, J., Flieger, S.P., and Thomas, C.P. 2015. The Vermont Oncology Program: Implementation Report. Report prepared for the Vermont Green Mountain Care Board, September 2015.
Razavi, M., Thomas, C.P. et al. 2015. Vermont Health Care Inpatient and Post-Acute Market Analysis. Report prepared for the Vermont Green Mountain Care Board, August 2015.


May 16, 2016 The State of Senior Living in Waltham, Waltham News Tribune, Senior citizens are a vital part of any community, but do they have the opportunities and support to lead healthy and fulfilling lives in Waltham?That was the question raised by Walter Leutz, a professor at the Heller School for Policy and Management at Brandeis University. Leutz, who teaches classes in social welfare, long-term care and aging at Brandeis, onducted a study on the state of senior citizen living in Waltham. The State of Senior Living
May 2, 2016, Professor Walter Leutz, PhD’81 spent the 2015 calendar year on sabbatical conducting a community-based participatory action research (CBPAR) project focused on healthy aging in Waltham and Greenfield, Mass. CBPAR is a partnership approach to research between community members and researchers in which both parties contribute to the conceptualization, execution, and dissemination of a research study. Leutz recruited, trained, and led 13 older adult co-researchers who volunteered their time to help conduct a qualitative study of five characteristics related to healthy aging: physical infrastructure, services, social participation/civic engagement, safety and healthy behaviors. The study’s results show that both towns exhibit elements of age-friendliness across all five categories, but that more work can be done to promote healthy aging in these communities. Do Waltham & Greenfield, MA Enable Healthy Aging? 
January 2016   Nurse practitioner patients less costly to Medicare than physician patients. First national study contradicts previous research on health care costs. With Medicare enrollment and cost concerns growing, a new study finds that patients with a nurse practitioner as a primary care provider are less costly to Medicare than patients with a physician primary care provider. The study—the first to examine national data—contradicts previous research suggesting that both types of providers generate equal costs or that nurse practitioners actually cost Medicare more.   Read More

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