JUNE 2009 HOT TOPICS

RAND Resources for Health Care Reform

Driven by concerns about the escalating cost of health care and large numbers of uninsured Americans, Congress is considering a series of sweeping changes to health care policy. These changes have the potential to transform health and health care in the United States in several ways, including expanding insurance programs to cover millions of the currently uninsured; changing how care is paid for and how costs are shared among insurers, patients, and government sources; improving quality of care through a range of methods, including measurement tools, financial incentives for providers, and information technologies; and promoting healthier lifestyle and behavioral choices.

For the past 40 years, RAND Health has conducted research and analysis on topics that are currently at the center of the health care reform debate. RAND Health is a division of the RAND Corporation, a nonprofit research organization providing objective analysis and effective solutions to address public- and private-sector challenges around the world. RAND Health is one of the world's largest private health research groups.

In this and next month's newsletter, we highlight information resources based on RAND research to inform deliberations over health care reform now under way on Capitol Hill. These resources include COMPARE and RAND research profiles, described in more detail below.

COMPARE (Comprehensive Assessment of Reform Efforts). COMPARE is a first-of-its-kind online resource that provides one-stop shopping for objective analysis of health policy issues. COMPARE presents

• facts and figures about the current state of the U.S. health care system, focusing on key dimensions of system performance;
• a description of policy options for changing the health care system;
• an inventory and the status of the most prominent federal, state, and private health care reform proposals; and
• an interactive tool that presents the results of microsimulation analyses of the effects of different health care policy options on multiple dimensions of health system performance, including cost, coverage, and outcomes.

COMPARE is codirected by Elizabeth A. McGlynn, Associate Director of RAND Health, and Jeffrey Wasserman, senior Health Policy Researcher.

Visit COMPARE online

Profiles of Recent RAND Research on Health Reform Topics

Access. RAND's work on access to care has examined the issue across three dimensions: financial access, usually facilitated through health insurance; potential access, usually aided by having a regular health care provider; and realized access, when an individual actually receives needed medical care. Many RAND studies have also examined disparities in access across different population groups and the effect of disparities on health.

RAND Research on Access

Health Insurance Coverage. Increasing the number of people with adequate protection from financial risk due to health care expenses is a cornerstone for most proposed health care reform policies. RAND studies have examined multiple dimensions of coverage, including the cost and potential health effects of new insurance products, such as high-deductible health plans; the challenges faced by small businesses in providing coverage to employees; the groups most at risk for being uninsured; access issues among the uninsured population; state experiments with insuring the uninsured; and coverage for prescription drugs.

RAND Research on Coverage

Disease Management. Disease management is an increasingly popular proactive approach to health care delivery for people with chronic diseases or who are at risk of developing a chronic disease. The approach is intended to save costs and improve health outcomes. RAND work has examined who enrolls in disease-management programs, how disease-management programs affect the health of those enrolled in them, and program costs—both for employers and overall.

RAND Research on Disease Management

Financing Health Care. RAND has been analyzing the financing of health care since 1968. An early landmark study was the RAND Health Insurance Experiment, still the largest health policy study in U.S. history and the only long-term, experimental study of cost sharing and its effect on health care utilization and spending, quality of care, and health. RAND work in this area includes studies on the organization and regulation of health care markets, the effects of population health on public financing, the cost-effective allocation of private and public financing, and distributional issues in health and health care associated with financing.

RAND Research on Financing Health Care

Health Behaviors and Lifestyle Changes. There is widespread consensus that behavioral choices, such as diet and exercise, as well as residential environments can affect health. RAND work on health behavior has focused on obesity and how the environment affects health through access to nutritious food, opportunity for exercise, stressors such as violence and poverty, and exposure to environmental hazards. In addition, RAND has also studied the effect of obesity on health spending, using a micro-simulation model to estimate lifetime cost.

RAND Research on Health Behavior and Lifestyle Change

Health Care Organization and Capacity. RAND work in this area has taken a system perspective, examining how organization affects the health system's ability to provide high-quality care and use resources efficiently and effectively. RAND has conducted hundreds of analyses of how changes in health care markets, delivery systems, and financing mechanisms affect patients, providers, insurers, and medical-product manufacturers. For example, this work has extended into such areas as state health care financing initiatives for the uninsured, the impact of prescription drug benefits on health outcomes and costs, and the effect of managed care on utilization and quality of care.

RAND Research on Health Care Organization and Capacity

Pay for Performance. One strategy for improving quality of care is pay for performance (P4P). P4P programs promote quality improvement by rewarding providers who meet certain quality or efficiency expectations. P4P programs use a variety of performance measures, including clinical processes of care, health outcomes, patient safety, patient experience with receiving care, resource use, and structural indicators such as information technology investment and use. RAND has studied P4P programs in a range of settings. Recent work has focused on helping the Centers for Medicare and Medicaid Services (CMS) design a hospital-based demonstration of P4P programs and evaluating the California Integrated Healthcare Association's (IHA's) statewide P4P program, the largest P4P experiment in the United States.

RAND Research on Pay for Performance

Public Reporting. Another strategy for improving quality of care is to make information about the price and quality of medical care widely available. The assumption is that providing accurate and timely information will enhance consumer decisionmaking and that health care providers who do not get high ratings will be motivated to improve performance. RAND has studied the potential link between public reporting of performance information and improvement in clinical quality of care, patient outcomes, and enhanced patient experience. RAND also played a major role in developing and implementing the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), the most widely used patient experience surveys in the United States.

RAND Research on Public Reporting

Quality. High-quality health care is clinically appropriate and efficient care that promotes health and wellness. RAND has been conducting research on measuring and assessing quality of health care for 40 years. RAND teams developed many of the basic tools and quality measures used in the United States and around the world to assess and improve quality of care, to provide a scientific basis for determining whether medical procedures are used appropriately, and to inform providers and policymakers about whether health care needs are being met. For example, RAND developed the Quality Assessment (QA) Tools, a comprehensive, clinically based system for assessing the quality of care provided to adults and children for a broad range of conditions. In 2005, RAND analysts used these tools to produce the first national report card on quality of care in the United States.

RAND Research on Quality

RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health/.

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