How RAND Health Care Makes a Difference

RAND Health Care is dedicated to improving the health of all people by improving health care policy and practice in the United States and abroad. The examples below illustrate some of the many ways that RAND has done this by providing health care decisionmakers, practitioners, and communities with objective analysis and actionable solutions. The mix of studies, singular accomplishments, and streams of research exemplify the range, originality, and influence of RAND Health Care’s research and reflect the breadth of our increasingly diversified research agenda.

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Shaping Policy

  • Stethoscope, calculator, pen, and money on top of health insurance claim forms, photo by Valeriya Potapova/Getty Images

    Predicting Outcomes of Health Care Reform Proposals

    RAND developed the COMPARE microsimulation model to estimate the likely impacts of health reform proposals on costs and coverage. The model assessed and helped shape design choices in the Affordable Care Act and has been used to assess a wide range of proposals, including single payer and public option plans.

  • Little girl smiling at doctor listening to her heartbeat with a stethoscope, photo by PeopleImages/Getty Images

    Assessing the Cost and Health Effects of Consumer Cost-Sharing

    Conducted in the 1970s, the RAND Health Insurance Experiment (HIE) is the largest health policy study in U.S. history. It remains the experimental study of how cost-sharing arrangements affect people's use of health services, the quality of care they receive, and their health status.

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    Refining the Medicare Payment System

    Since the inception of Medicare in 1965, RAND has worked to design, evaluate, and monitor the agency’s payment systems. RAND evaluated Medicare’s first prospective payment system for hospital care in the 1980s and subsequently helped refine it. As the agency shifted from volume-based to value-based payment approaches, Medicare turned again to RAND to help design and assess these and other new payment arrangements.

Advancing Practice

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    Inventing Health Care Quality Measurement

    In work spanning five decades, RAND health researchers established the scientific basis for defining and measuring the quality of health care delivery. RAND developed reliable measures of health status, which enables physicians to assess the value of care across multiple dimensions of health. RAND also developed measures for the appropriateness of care that are now the basis for quality measurement around the globe.

  • High angle view of Sulaymaniyah, also called Slemani, a city in the east of the Kurdistan Region, Iraq, not far from the Iran-Iraq border. Photo by Bulgac/Getty Images

    Shaping Medical Institutions Around the World

    RAND’s health policy experts advise medical institutions and national health systems globally. Examples include work in Kurdistan and Qatar. Our experts worked with the Kurdistan Regional Government to redesign system financing and improve quality.

  • Close up of a nurse holding an elderly patient's hands, photo by MartinPrescott/Getty Images

    Determining Palliative Care Needs and Best Practices

    Palliative care programs address patient needs at the end of life. In a groundbreaking study, RAND highlighted the costly and futile care many receive at the end of life, counter to most patients’ wishes. This study and subsequent research contributed to the growing public awareness of the need for expanded palliative care services. Our work helped inform revised national practice guidelines for high-quality palliative care.

Improving Health

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    Improving the Lives of Service Members, Veterans, and Their Families

    RAND researchers have conducted studies to help servicemembers, veterans, and their families cope with the aftermath of deployments. A comprehensive evaluation of mental health treatment offered by the Veterans Health Administration found that quality fell short of the agency’s high standards. These findings were used to improve quality of care. And a RAND study on informal caregivers caring for sick and injured servicemembers and veterans informed policies to address caregiver needs.

  • Teacher sitting on the floor with a group of diverse children, photo by bernardbodo/Getty Images

    Helping Children Cope with Violence and Trauma

    More than half of U.S. children have been exposed to trauma. These children face heightened risks of mental health and behavioral problems as well as school failure. RAND researchers collaborated with the Los Angeles Unified School District and UCLA to develop the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a program delivered in schools. CBITS has been proven to reduce symptoms related to trauma and boost school performance. The program is used in numerous schools in the U.S. and across the globe.

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    Combating the Obesity Epidemic

    More than 150 million Americans are overweight or obese. Obese individuals incur average health care costs one-third higher than persons of normal weight. Cutting the obesity rate in half—to the level in 1978—could save Medicare $1.2 trillion by 2030 by preventing health problems such as diabetes, hypertension, and heart disease. RAND work concluded that obesity is a population-level problem that demands population-focused policies that encourage better eating behaviors and limit the salience, convenience, and ubiquity of low-nutrient food.

Designing Methods and Tools That Work

  • State Policy Evaluation Tool

    COVID-19 Decision Support Tool

    With the spread of the coronavirus disease (COVID-19) in the spring and summer of 2020, state and local policymakers have had to put policies in place quickly, with little evidence to guide them. RAND researchers developed a tool to help state and local officials estimate the effects of distancing and other interventions. The tool combines information from epidemiological and economic models to estimate the effects of social distancing policies on public health and economic outcomes.

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    Understanding Patient Experience with Care

    Patient experience with health care is an important dimension of quality. There is evidence that positive patient experiences with care are associated with better outcomes. RAND researchers pioneered the development of CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey tools to improve understanding of how patients experience care. The tool has been used by the Centers for Medicare & Medicaid Services (CMS), numerous private health plans, and other organizations to support quality improvement.

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    ExpertLens

    ExpertLens is a method developed by RAND to elicit and analyze expert opinion to aid complex decisionmaking. The method is most valuable when surveys, live expert panels, or individual consultations are not feasible. ExpertLens has been used to study a number of issues. For example, it has been used to incorporate patient feedback into clinical guidelines development and to develop consensus about features that should define continuous quality improvement in health care.

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