Welcome to the Institute on Healthcare Systems

CHRISTOPHER P. TOMPKINS, PH.D.
Director

The Institute on Healthcare Systems (IHS) is dedicated to bringing greater knowledge to both private and public policy makers by comprehensively examining issues and their context, and using data to inform decision making.

Historically, our strengths have been in the areas of payment and financing. This is grounded in Stuart Altman and Stan Wallack's vast experience in national health policy, and has grown to include cutting edge thinking on value based purchasing, typified by Christopher Tompkins' recent work for CMS in this area. Christine Bishop is a national expert on financing for long term care, although her interests are broad and cover a number of labor issues.  Donald Shepard and Bill Stason have both done pioneering work in cost effectiveness analysis.

IHS staff also covers a range of delivery systems issues, such as Cindy Thomas' work in pharmacy policy and Deborah Gurewich's expertise in community health centers. Walter Leutz brings a distinguished career in re-designing delivery systems to meet the needs of elders, particularly fragile elders based in the community.

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 case methodologies and has applied this approach across a number of topical areas. Grant Ritter, Tim Martin, John Chapman and Beth Mohr provide expertise in statistics and analysis using large claims data sets.    

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.

Spotlight

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

Dr. Stuart Altman to Chair the Board of Health Policy Commission in Massachusetts

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Recent Publication

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.

Bundled Payments White Paper

• Thomas CP, Kim M, McDonald A, Kreiner P, Kelleher SJ, Blackman MB, Kaufman PN, Carrow GM.  Prescribers' expectations and barriers to electronic prescribing of controlled substances. Journal of  American Medical Informatics Association published online September 21, 2011  doi:10.1136/amiajnl-2011-000209.full.html   Project funded by the Agency for Healthcare Research and Quality (AHRQ)