2025 Policy Briefs
Health Care Price Transparency: Opportunities for Improving Efficiency and Lowering Costs
The policy brief highlights the challenges of high and opaque healthcare prices in the U.S. and the limited impact of existing transparency efforts on patient costs. It proposes policy solutions such as a national provider ownership database, standardizing price data, strengthening compliance enforcement, and improving employer access to claims data to enhance market competition and cost efficiency - March 2025
Estimating Savings from the Fair Pricing Act and Commercial Site-Neutral Payments in New York State
This policy brief examines New York’s Fair Pricing Act, which proposes site-neutral payment reforms to address price disparities between hospital outpatient departments (HOPDs) and non-hospital settings by capping commercial insurance payments for low-complexity services at 150% of Medicare’s non-hospital rate. The analysis finds that hospitals charge significantly higher prices for these services, and estimates that implementing the policy could have saved New Yorkers $1.14 billion in 2022, reducing both consumer out-of-pocket costs and state budget pressures - February 2025
Related Legislative Briefing: New York State Fair Pricing Act: Findings from Impact Analysis
Estimating the Individual Market Premium Impacts of the Colorado Option
The Colorado Option is a state-implemented public health insurance plan designed to offer more affordable coverage by reducing premiums and fostering competition in the individual market. Analyzing data from 2020 to 2024 with a difference-in-differences approach, this policy brief presents a preliminary assessment comparing premium trends in Colorado to seven other states with reinsurance programs. The findings highlight premium savings achieved, marking a vital step toward making health insurance more accessible and affordable in Colorado, and presents opportunities for future research that considers other market factors - January 2025
2024 Policy Briefs
Estimating the Cost of an Out-of-Pocket Maximum in Traditional Medicare
This policy brief examines the financial impact of establishing an out-of-pocket (OOP) maximum in Traditional Medicare (TM) to increase affordability for beneficiaries without supplemental coverage. By analyzing CMS data, we estimate that setting OOP caps on Part A and B spending could cost the federal government between $8 billion and $41 billion in 2025, depending on the cap level, benefiting 3% to 44% of TM beneficiaries - November 2024
Potential Excess Federal Spending on Dual Medicare Advantage and Veterans Health Administration Enrollees
This policy brief highlights a study by researchers at Providence VA COIN and Brown University School of Public Health, revealing duplicative federal spending for dual MA-VHA enrollees. The brief highlights potential legislative options to curb excess costs such as allowing the VHA to collect reimbursements from MA plans and reducing MA payments for veterans primarily using VHA services - October 2024
Addressing Healthcare Consolidation in the U.S.: Potential Policy Options for a Competitive and Transparent Future
This policy brief dives into the current state of U.S. healthcare consolidation, exploring its various forms—including horizontal, vertical, and cross-market mergers—and the role of private equity. It highlgihts research being done at CAHPR and beyond on the topic and offers critical policy recommendations designed to promote transparency, enhance competition, and address rising costs in the healthcare system. Key proposals include tighter antitrust scrutiny, enhanced ownership transparency, reforms to payment policies, and stronger regulatory frameworks - September 2024
Advancing Telehealth: Potential Policy Solutions to Ensure the Sustainable and Equitable Growth of Telehealth
This policy brief outlines key strategies to ensure telehealth remains vital to healthcare delivery post-pandemic. It highlights the need for permanent policy changes, such as eliminating site-location requirements, supporting telehealth across state lines, and adjusting payment structures to prioritize value over cost savings, while addressing equity concerns to avoid disparities in access and quality of care - September 2024
Evaluating the Impact and Consequences of the ESRD Treatment Choices (ETC) Model
The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model, introduced in July 2019, aims to increase the use of home dialysis and kidney transplants among Medicare beneficiaries. This policy brief evaluates the impact of the ETC Model, focusing on its effectiveness and its consequences for socially disadvantaged communities. Despite the model's intentions, evidence suggests that it has not significantly improved patient outcomes and has disproportionately penalized facilities serving high-risk populations - July 2024
Addressing Site-of-Care Payment Differentials in the United States Health Care System
The disparities in "site-of-care" payments are a significant factor, and contribute to rising expenses and provider consolidations, prompting discussions about implementing site-neutral payments. This brief proposes site-neutral payment policies to address these issues by potentially curbing spending while ensuring care quality, though challenges persist, particularly for rural and underserved hospitals - June 2024
Policy Options to Address the Growth of Private Equity Among U.S. Physician Practices
The issue of private equity (PE) investment in U.S. healthcare, particularly in physician practices, is complex and multifaceted. CAHPR investigators propose several policy options such as enhancing antitrust reviews, closing Medicare payment loopholes, and improving transparency and regulations around PE ownership - March 2024
2023 Policy Briefs
Legislative and Regulatory Strategies for Revitalizing Medicare Advantage
This brief proposes policy options expected to save billions annually while ensuring long-term budget stability across three vital areas: base payment adjustments, refined risk assessments, and adjusting quality bonuses while presenting an array of implementation trade-offs and fiscal considerations - December 2023