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Center for Advancing Health Policy through Research

Research on onepage

Health Care Spending

Health care spending in the United States is a global outlier. Excessive spending drives state and federal budget crises and crowds out other public investments. It leads to premium increases, the erosion of plan benefits, and punishing out-of-pocket spending. Health care quality is inconsistent and not commensurate with spending. Shocking inequalities in access and outcomes are pervasive. While many solutions have been proposed, the path forward remains elusive. Rigorous and innovative research coupled with systematic policy translation is required to drive change.

Recent Health Care Spending news

September 18, 2024 Health Affairs Forefront

The Promise And Pitfalls Of Site-Neutral Payments In Medicare

As Medicare spending continues to rise, reaching 21 percent of total National Health Expenditures, policymakers are exploring site-neutral payment policies to mitigate costs without compromising care quality. This article examines the driving forces behind these policies, the bipartisan support they’ve garnered, and the challenges that lie ahead in implementing effective solutions.
July 11, 2024 Brown University

Price transparency is critical to fix nation’s health care model, Brown scholar tells Congress

Christopher Whaley, testified before Congress, highlighting the urgent need of health care price transparency and its role in combating high healthcare costs in the US and enhancing policy decision-making.
March 18, 2024 Health Affairs Forefront

Congress Has The Opportunity To Deliver Health Care Price Transparency

Congress has a critical opportunity to advance healthcare price transparency, a move that could empower consumers and reduce costs across the system. This article explores the current state of healthcare price transparency and the critical role Congress plays in shaping a system that prioritizes clarity and fairness for all Americans.






Payment Reform

Payment reform is concerned with how healthcare providers, systems, and insurers are reimbursed for the services provided. The primary goal of payment reform models is to achieve quality and efficiency of care and overall better patient and population health outcomes, while controlling healthcare costs. Despite some successes, many reforms have not delivered on their promise while other challenges have emerged. Here at  CAHPR, we are dedicated to generating evidence to guide and inform these payment reforms within the US healthcare landscape.

Recent News

August 12, 2024 Health Affairs Forefront

Are Changes To The Medicare Physician Fee Schedule Driving Value In US Health Care?

The Medicare Physician Fee Schedule is a cornerstone of U.S. healthcare policy, directly influencing how services are priced and covered. This Health Affairs blog delves into a brief analysis of the CY25 Physician Fee Schedule Proposed Changes and what impact it could have moving forward.
July 11, 2024 Brown University

Price transparency is critical to fix nation’s health care model, Brown scholar tells Congress

Christopher Whaley, testified before Congress, highlighting the urgent need of health care price transparency and its role in combating high healthcare costs in the US and enhancing policy decision-making.

Traditional Medicare

The Affordable Care Act created the most significant changes to Medicare since its inception to create new incentives for health care providers to deliver higher quality care at a lower cost. Under the direction of the Centers for Medicare and Medicaid Services (CMS) Innovation Center, these policies continue to evolve, such as through the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. ACO models are by far the most common population-based alternative payment model deployed in Traditional Medicare. Understanding whether these models are successful in reducing spending growth, and how they can be modified to achieve this goal, is central to the future of Traditional Medicare. 

Recent News

August 22, 2024 Harvard Medical School

Hospital-SNF Integration and APM Participation

This article highlights a study published in JAMA Network Open that explores the impact of hospital-SNF (skilled nursing facility) integration on participation in alternative payment models (APMs), particularly focusing on the Bundled Payments for Care Improvement Advanced (BPCI-A) program. The findings reveal that while integration influences APM participation, the effects are complex, pointing to broader implications for healthcare systems.
August 12, 2024 Health Affairs Forefront

Are Changes To The Medicare Physician Fee Schedule Driving Value In US Health Care?

The Medicare Physician Fee Schedule is a cornerstone of U.S. healthcare policy, directly influencing how services are priced and covered. This Health Affairs blog delves into a brief analysis of the CY25 Physician Fee Schedule Proposed Changes and what impact it could have moving forward.
March 20, 2024 Health Affairs Forefront

2025 Medicare Advantage Advance Notice: Small Changes, Missed Opportunities

Under the CMS 2025 Medicare Advantage Advance Notice, CAHPR researchers emphasize the expected revenue increases and minor changes in risk adjustment practices; highlighting the impactful changes on the horizon and the critical reforms that still await attention.

Medicare Advantage

Private plans for Medicare beneficiaries – known as Medicare Advantage (MA) – have grown remarkably, increasing from 24% of beneficiaries in 2010 to 51% in 2023. Under MA, private insurers are paid using risk-adjusted per beneficiary per month rates, an approach that CMS and others believe will encourage efficient resource use and quality. Yet many stakeholders argue that MA plans are overpaid and have questioned the program’s value. In light of unprecedented enrollment growth, understanding how MA can be reformed to deliver on its promise is essential. 

Recent Medicare Advantage News

April 29, 2025 The Boston Globe

Home health care workers are demanding better pay. Cuts to Medicaid could stand in their way.

The article discusses how home health care workers in Rhode Island are fighting for better wages and working conditions through unionization, but their efforts are at risk due to proposed federal Medicaid cuts. David J. Meyers, a health economist at Brown University, warns that such cuts could have a “massive, qualitative impact on people’s lives” and ultimately increase health care spending as unmet needs at home lead to more hospitalizations and emergency visits.
November 22, 2024 Turn on the Lights Podcast

Health system ownership with Hayden Rooke-Ley

Is Medicare Advantage improving healthcare efficiency or creating higher costs that favor insurers? Hayden Rooke-Ley explores its rapid expansion, questions about cost and care quality, and the challenges of implementing effective regulations.
November 11, 2024 The Wall Street Journal

The Sickest Patients Are Fleeing Private Medicare Plans—Costing Taxpayers Billions

An increasing number of Medicare Advantage patients, especially those in their final year of life, are switching to traditional Medicare, leading to a significant cost shift from private insurers to taxpayers.

Markets and Consolidation

A number of trends are changing how physician markets are organized.Over 70% of physicians are now employed by a health care system or corporate entity, including publicly traded and private equity firms. Rural providers have been the focus of consolidation activity, with the impacts on rural markets unclear. And many high performing health systems are entities that integrate insurer and provider functions, in which clinical and financial incentives are linked. Research at CAHPR aims to understand this evolving landscape that has critical implications for competition, choice, access, and the structure of healthcare services. 

Recent Markets and Consolidation News

May 19, 2025 Brown University

Market Power

Professors Erin Fuse Brown and Yashaswini Singh warn that private equity’s focus on short-term returns is reshaping healthcare at the expense of patients and providers. From overburdened hospitals to ethical dilemmas in mental health care, their insights expose how profit-driven ownership can undermine clinical priorities and public trust.
February 22, 2025 MedPage Today

The Danger of Trump's Deregulation Play — Healthcare without guardrails poses risks to patients and providers alike

The Trump administration's push for deregulation threatens to accelerate vertical integration in healthcare. Brown University professor, Dr. Christopher Whaley warns from existing research how this may lead to referrals to more expensive hospitals ultimately leading to higher costs, reduced competition, and financial strain on independent hospitals, particularly in rural areas as the article discusses.
January 28, 2025 Brown University

More primary care physicians are affiliated with hospitals, leading to increased patient costs

The article covers a study published in JAMA Health Forum by Yashaswini Singh and colleagues on the increasing affiliation of primary care physicians with hospitals and private equity firms, leading to higher patient costs without clear improvements in care quality or physician compensation.

State policies

Many US states are enacting their own efforts to enhance the accessibility, quality, fairness, and affordability of health insurance. These policies include but are not limited to surprise billing protections, health insurance exchange oversight, health price transparency tools, policies on competition and consolidation and price limits for medical services. However, the impacts of these policy innovations and the specific design features that drive success or failure are not yet clear. CAHPR researchers are studying the effectiveness of various state policies on prices, spending, utilization, as well as on healthcare labor. These findings have the potential to provide guidance to other states considering similar approaches to regulate healthcare prices.

Recent State Policy News

May 23, 2025 WPRI.COM

Community Focus: Brown University’s Andrew Ryan

This news video features Dr. Andrew Ryan, Director of CAHPR, discussing his study on Rhode Island’s hospital affordability standards, which led to significant hospital price and premium reductions—saving $1,000 per fully insured member by 2022.
May 19, 2025 Rhode Island Current

Hospital price growth cap helped lower insurance premiums, Brown study shows

This article reports on a study by CAHPR researchers that found that Rhode Island’s 2010 hospital price growth cap significantly reduced hospital prices and lowered premiums for fully insured health plans by $1,000 per member annually by 2022. However, the policy had limited impact on the self-insured market due to federal ERISA regulations, and the resulting hospital revenue losses have raised concerns about financial sustainability and care quality.
March 27, 2025 Las Vegas Review Journal

Bill would limit hospital fees in Nevada’s public employee health system

A Nevada bill aims to cap hospital fees for the Public Employees’ Benefits Program to reduce costs, drawing on Oregon's model, which researcher Roslyn Murray of Brown University studied and found led to significant savings without shifting costs to private insurers.
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      • Traditional Medicare
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Research on onepage