Institute on Healthcare Systems
Schneider Institutes for Health Policy
The Heller School for Social Policy and Management at Brandeis University
CHRISTOPHER P. TOMPKINS, PH.D.
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 currently, 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 and Predipta Seal provide 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. Their supporting team includes Palmira Santos, Darren Zinner and Ellen Grody.
Heller NewsNurse 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. Continue reading....
Timberlake M, Leutz W, Warfield M, Chiri G. “In the Driver’s Seat”: Parent Perceptions of Choice in a Participant-Directed Medicaid Waiver Program for Young Children with Autism. J Autism Dev Disord. 2014;44(4):903-14.
Hacker K, Santos P, Thompson D, Stout S, Bearse A, Mechanic R. Early Experience of a Safety-Net Provider Reorganizing into an Accountable Care Organization. J Health Polit Policy Law. 2014.
Mechanic R. Post-Acute Care — The Next Frontier for Controlling Medicare Spending. New England Journal of Medicine. 2014;370(8):692-4.
Bishop CE. High-Performance Workplace Practices in Nursing Homes: An Economic Perspective. The Gerontologist. 2014;54(Suppl 1):S46-S52. Published online November 14, 2013. (2013).
Bishop CE, Stone R. Implications for Policy: The Nursing Home as Least Restrictive Setting. The Gerontologist. 2014;54(Suppl 1):S98-S103. Published online November 14, 2013. (2013).
Robert Mechanic, M.B.A., and Christopher Tompkins, Ph.D. Lessons Learned Preparing for Medicare Bundled Payments, New England Journal of Medicine 2012; 367:1873-1875, November 15, 2012; DOI: 10.1056/NEJMp1210823
CMS Bundled Payment for Care Improvement Program
Brandeis University has provided analytic support to numerous hospitals applying to participate in the new CMS Bundled Payment for Care Improvement Program. Most of these hospitals have focused on episodes that include both acute and plus post-acute services (Model 2). We prepared this white paper to describe sources of financing risk in the bundled payment program and to assesss potential risk mitigation strategies. Important financial risks include spending for services that are outside the scope of care redesign, systematic changes in patient severity between the baseline period through the duration of the demonstration and random year-to-year variation in providers' average episode costs since many hospitals have relatively modest episode case volumes. We have modeled the impact of exclusions, severity adjustment and stop loss protection on hospital risk. In the coming months CMS will make decisions about program design and begin negotiating with hospitals that it selects to participate in the program. The purpose of this white paper is to inform these discussions by summarizing recent and ongoing work that Brandeis University has undertaken to evaluate ways to mitigate risk without adding additional costs or undesirable incentives into the program. Further technical details about the summary analyses provided in this paper are available from the authors.
For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Health Industry Forum
Tiered and limited network health insurance plans are reemerging as efforts to limit the growth of health spending have intensified. In 2014, these products were 48 percent of the plans offered on the new Health Exchanges and cost 17 percent less, on average, than broad network products. They have also become more prevalent in employer-sponsored programs with 18% of large employers offering a tiered or “high-performance” network in 2014.
The 2014 RCRC Fall Roundtable
Health Industry Forum
This meeting took a deep dive into the progress to date of organizations participating in Medicare’s Pioneer ACO and Medicare Shared Savings Programs. We examined new clinical programs, reviewed key challenges, and discussed potential changes to program rules that could enhance the sustainability of these important new care improvement initiatives.
The Council on Health Economics and Policy
The 21st Princeton Conference was once again held at the Robert Wood Foundation in Princeton, NJ on the topic of The Changing Landscape of Health Care.
The Health Industry Forum
October 29, 2013
Robert Mechanic, Senior Fellow and Executive Director; Palmira Santos, PhD '01, Senior Research Associate; and Darren Zinner, Scientist and Senior Lecturer, and Associate Chair, Health: Science, Society, and Policy Program
Tuesday Talks is a special series of talks by Heller Faculty and Researchers on select Tuesdays throughout the year.
Dr. Stuart Altman to Chair the Board of Health Policy Commission in Massachusetts