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Health Care Payment Approaches

Journal Article
The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity
This retrospective cohort study evaluated the quality and cost implications of receiving primary care from nurse practitioners (NPs) compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service physician rate (pay parity).
May 16, 2023
Journal Article
CalAIM and Specialty Behavioral Health Care: Lessons from Other States on Value-Based Payment
This report examines the experience of state Medicaid agencies with implementation of value-based payment models for behavioral health care and the implications of that experience for future payment reform in California.
May 5, 2023
Commentary
Informing the Debate About Telemedicine Reimbursement: What Do We Need to Know?
At the start of the COVID-19 pandemic, U.S. payers and policymakers broadly expanded payment for telemedicine services and relaxed many regulations. To decide the long-term fate of pandemic-era temporary telemedicine, policymakers should consider the effects of telemedicine on health care spending, patient outcomes, and health equity.
Nov 21, 2022
Journal Article
Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model: Fourth Annual Report
In this model, CMS pays participating organizations for assessing each of their eligible Medicare beneficiary's risk of having a heart attack or stroke over the next 10 years and for reducing CVD risk among high-risk beneficiaries.
Oct 25, 2022
Journal Article
Evaluation of the Million Hearts® Cardiovascular Disease Risk Reduction Model: Third Annual Report
In its first three years, the Million Hearts® Model improved cardiovascular preventive care, but did not yet reduce observed heart attacks and strokes or lower Medicare spending.
Oct 25, 2022
Journal Article
Evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design Model Test: First Two Years of Implementation (2020–2021), and Appendixes
This report presents the RAND Corporation team's findings from its evaluation of Phase II of the Medicare Advantage Value-Based Insurance Design model test, for the years 2020 and 2021.
Oct 19, 2022
Journal Article
Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration
This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.
Sep 20, 2022
Journal Article
Predicting Race And Ethnicity To Ensure Equitable Algorithms For Health Care Decision Making
We describe two applications in which imputation of race and ethnicity can help mitigate potential algorithmic biases: equitable disease screening algorithms using machine learning and equitable pay-for-performance incentives.
Aug 23, 2022
Report
RAND Technical Expert Panel Medicare Advantage (MA) and Part D Contract Star Ratings, February 7, 2022 Meeting
On February 7, 2022, the RAND Corporation convened a Technical Expert Panel web meeting to gather input about the potential development of a measure to capture value-based care arrangements Medicare Advantage organizations have with their contracted providers.
Jun 17, 2022
Journal Article
Content and Actionability of Recommendations to Providers After Shadow Coaching
This study aimed to examine the content of the recommendations given to providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability.
Mar 4, 2022
Report
Carve-In Models for Specialty Behavioral Health Services: Lessons for California
Many states separate, or
Feb 11, 2022
Journal Article
Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems
This study was a cross-sectional mixed-methods analysis of in-depth multimodal data from 31 POs affiliated with 22 purposefully selected health systems in 4 states. Data were analyzed from June 2019 to September 2020.
Feb 8, 2022
Commentary
Rethinking the Impact of Audio-Only Visits on Health Equity
New pandemic-era flexibility that allowed audio-only health visits to be routinely reimbursed as telehealth may be leading to substandard care for those it was meant to serve. It may be time to consider limiting audio-only visits in the pursuit of health equity.
Dec 17, 2021
Commentary
Twelve-Month Continuous Eligibility for Medicaid Adults Can Stabilize Coverage with a Modest Cost Increase
Churning—frequent moving in and out of Medicaid due to income fluctuation—increases insurance coverage gaps, disrupts access to health care, increases unnecessary administrative burden, and leads to suboptimal health outcomes. Federal and state policymakers might consider continuous eligibility to help stabilize Medicaid enrollment.
Dec 8, 2021
Commentary
What Are the Practical Considerations for Outcome-Based Payment in the NHS?
Uncertainty can surround the effectiveness or cost-effectiveness of a new medicine, making it difficult to agree on a medicine's price. One solution to avoid unduly delaying or restricting patients' access is to link the medicine's price to the outcomes it produces in a patient. Despite some barriers, outcome-based payment could offer a “win” for patients, the NHS, and industry.
Dec 2, 2021
Report
Evaluating New York's Medicaid Section 1115 Waiver
New York State’s Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. RAND researchers examined whether two components of the 1115 Demonstration Waiver have helped achieve the program’s goals.
Dec 2, 2021
Journal Article
Making Outcome-Based Payment a Reality in the NHS: Phase 2: Practical Considerations
This study examines implementing an outcome-based payment model in the NHS, the quality and completeness of data on patient outcomes, implications for collecting such data, and establishing steps for the implementation of a pilot OBP scheme.
Dec 1, 2021
Report
Practice Expense Data Collection and Methodology: Phase II Final Report
In this report, the authors address how the Centers for Medicare & Medicaid Services might improve the methodology used in practice expense (PE) rate-setting, update data that inform PE rates, or both.
Nov 1, 2021
Report
Understanding Prescription Drug Supply Chains
The typical stakeholders, relationships, and financial incentives involved in prescription drug supply chains vary depending on the characteristics of a drug and how it reaches patients. Differences in business practices complicate a universal description of drug supply chains.
Oct 27, 2021
Journal Article
Value-Based Payment and Health Care System Preparedness and Resilience
This report explores issues related to VBP and health system preparedness and resiliency to inform discussions about policy options for jointly promoting value, efficiency, and preparedness in the health care system.
Oct 7, 2021

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Researcher Spotlight

Preethi Rao

Health Economist

Preethi Rao (she/her) is a health economist at the RAND Corporation. Her research focuses on topics related to health policy. In particular, she is interested in policy issues related to the Affordable Care Act, prescription drug costs, access to health care, and quality measurement in health…
Melony E. Sorbero

Senior Policy Researcher

Melony Sorbero is a senior policy researcher at the RAND Corporation. A health services researcher with a background in public policy analysis and public health, Sorbero has extensive experience with both quantitative and qualitative research methods and over 15 years of experience conducting…

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