Comparison of low-value care in medicaid vs commercially insured populations

JAMA Internal Medicine

Volumn 176, Issue 7, 2016, Pages 998-1004

  Charlesworth, Christina J ^a   Meath, Thomas H A ^a   Schwartz, Aaron L ^b   McConnell, K John ^a,c  

^a OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

^c OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE RHINOSINUSITIS; ADULT; ARTICLE; COMMERCIALLY INSURED; COMPARATIVE STUDY; COMPUTER ASSISTED TOMOGRAPHY; CONTROLLED STUDY; CROSS-SECTIONAL STUDY; ECHOCARDIOGRAPHY; ELECTROENCEPHALOGRAPHY; EXERCISE TEST; FAINTNESS; FEMALE; HEADACHE; HEALTH STATUS; HUMAN; HYPOTHYROIDISM; KNEE OSTEOARTHRITIS; LOW BACK PAIN; LOW VALUE CARE; LUNG FUNCTION TEST; MAJOR CLINICAL STUDY; MALE; MEDICAID; MEDICAL CARE; MISCELLANEOUS NAMED GROUPS; NEUROIMAGING; OREGON; PLANTAR FASCIITIS; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; THORAX RADIOGRAPHY; CLINICAL PRACTICE; COMMERCIAL PHENOMENA; DEMOGRAPHY; ECONOMICS; HEALTH INSURANCE; INSURANCE; MIDDLE AGED; PRIMARY HEALTH CARE; REIMBURSEMENT; SOCIOECONOMICS; STATISTICS AND NUMERICAL DATA; UNITED STATES;

ADULT; COMMERCE; CROSS-SECTIONAL STUDIES; DEMOGRAPHY; FEMALE; HUMANS; INSURANCE CLAIM REVIEW; INSURANCE, HEALTH; INSURANCE, HEALTH, REIMBURSEMENT; MALE; MEDICAID; MIDDLE AGED; PRACTICE PATTERNS, PHYSICIANS'; PRIMARY HEALTH CARE; SOCIOECONOMIC FACTORS; UNITED STATES;

EID: 84979067071     PISSN: 21686106     EISSN: None     Source Type: Journal    
DOI: 10.1001/jamainternmed.2016.2086     Document Type: Article

References (28)

1. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513-1516.
2. American Board of Internal Medicine Foundation. Choosing Wisely. http://www.choosingwisely.org/. Accessed December 1, 2015.
3. Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low-value care in Medicare. JAMA Intern Med. 2014;174(7):1067-1076.
4. Colla CH, Morden NE, Sequist TD, Schpero WL, Rosenthal MB. Choosing wisely: prevalence and correlates of low-value health care services in the United States. J Gen Intern Med. 2015;30(2):221-228.
5. Schwartz AL, Chernew ME, Landon BE, McWilliams JM. Changes in low-value services in year 1 of the Medicare Pioneer Accountable Care Organization Program. JAMA Intern Med. 2015;175 (11):1815-1825.
6. Kale MS, Bishop TF, Federman AD, Keyhani S. Trends in the overuse of ambulatory health care services in the United States. JAMA Intern Med. 2013;173(2):142-148.
7. Rosenberg A, Agiro A, Gottlieb M, et al. Early trends among seven recommendations from the Choosing Wisely campaign. JAMA Intern Med. 2015; 175(12):1913-1920.
8. Altman D, Frist WH. Medicare and Medicaid at 50 years: perspectives of beneficiaries, health care professionals and institutions, and policy makers. JAMA. 2015;314(4):384-395.
9. National Association of State Budget Officers. State Expenditure Report. Washington, DC: National Association of State Budget Officers; 2014.
10. McConnell KJ. Oregon's Medicaid coordinated care organizations. JAMA. 2016;315(9):869-870.
11. McConnell KJ, Chang AM, Cohen D, et al. Oregon's Medicaid transformation: An innovative approach to holding a health system accountable for spending growth. Health Care: The Journal of Delivery Science and Innovation. 2013;2(3):163-167.
12. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43 (11):1130-1139.
13. Goodman DC, Mick SS, Bott D, et al. Primary care service areas: A new tool for the evaluation of primary care services. Health Serv Res. 2003;38(1, pt 1):287-309.
14. The Dartmouth Institute-Primary Care Service Area (PCSA). http://tdi.dartmouth.edu/research/evaluating/health-system-focus/primary-care-service-area. Accessed December 1, 2015.
15. Oregon Office of Rural Health Service Areas. http://www.ohsu.edu/xd/outreach/oregon-rural-health/data/rural-definitions/service-area.cfm. Accessed December 1, 2015.
16. Chandra A, Finkelstein A, Sacarny A, Syverson C. Healthcare Exceptionalism? Productivity and Allocation in the US Healthcare Sector. http://www.nber.org/papers/w19200. Accessed December 31, 2015.
17. R Core Team. R: A language and environment for statistical computing. https://www.r-project.org/. Accessed December 15, 2016.
18. Kaiser Family Foundation. Health Care Expenditures per Capita by State of Residence. State Health Facts. http://kff.org/other/state-indicator/health-spending-per-capita/. Accessed December 1, 2015.
19. Chernew ME, Sabik LM, Chandra A, Gibson TB, Newhouse JP. Geographic correlation between large-firm commercial spending and Medicare spending. Am J Manag Care. 2010;16(2):131-138.
20. Cutler D, Chandra A, Fisher E, et al. Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending. Washington, DC: National Bureau of Economic Research; 2013.
21. Sirovich B, Gallagher PM, Wennberg DE, Fisher ES. Discretionary decision making by primary care physicians and the cost of U.S. Health care. Health Aff (Millwood). 2008;27(3):813-823.
22. Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Variation in the tendency of primary care physicians to intervene. Arch Intern Med. 2005;165(19): 2252-2256.
23. Baicker K, Chernew ME, Robbins JA. The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization. J Health Econ. 2013;32(6):1289-1300.
24. Chernew M, Decicca P, Town R. Managed care and medical expenditures of Medicare beneficiaries. J Health Econ. 2008;27(6):1451-1461.
25. Callison K. Medicare managed care spillovers and treatment intensity [published onlineMay 11, 2016]. Health Econ. doi:10.1002/hec.3191.
26. McWilliams JM, Landon BE, Chernew ME. Changes in health care spending and quality for Medicare beneficiaries associated with a commercial ACO contract. JAMA. 2013;310(8):829-836.
27. Baicker K, Robbins JA. Medicare payments and system-level health-care use: The spillover effects of Medicare managed care. Am J Health Econ. 2015;1 (4):399-431.
28. Morden NE, Colla CH, Sequist TD, Rosenthal MB. Choosing wisely: The politics and economics of labeling low-value services. N Engl J Med. 2014; 370(7):589-592.