As the U.S. population ages and health care costs continue to rise, policies aimed to control costs have become a major focus of the reform effort. Provider payment reform is at the core of these policies. The overall aim of this research is to understand the implications of provider payment reform on health care costs and physician behavior. The proposed research is largely empirical, but there is an economic theory component. This project will center on an empirical evaluation of a large payment reform policy in a private plan environment.
Cl aims and enrollment data will be used to study the effects of changing a physician group's reimbursement towards prospective payment on costs, utilization, and physician referral behavior. The project will also develop two simple economic models, a normative model of physician optimal referral and a positive model of physician specialization, to complement the empirical work.

Public Health Relevance

As provider payment reform is a central tool for controlling health care costs, understanding how payment reform affects the cost and quality of care is an important objective for policymakers and public health officials. The proposed project provides the public health and health policy communities a rigorous evidence-based evaluation of a large provider payment reform initiative.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Individual Predoctoral NRSA for M.D./Ph.D. Fellowships (ADAMHA) (F30)
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Special Emphasis Panel (ZRG1-F16-B (20))
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Bhattacharyya, Partha
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Harvard University
Schools of Medicine
United States
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Wallace, Jacob; Song, Zirui (2016) Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change At Age Sixty-Five. Health Aff (Millwood) 35:864-72
Song, Zirui; Blumenthal, Daniel M (2016) Expanding Payment Reform in Medicare: The Cardiology Episode-Based Payment Model. JAMA 316:1973-1974
Song, Zirui; Colla, Carrie H (2016) Specialty-Based Global Payment: A New Phase in Payment Reform. JAMA 315:2271-2
Loehrer, Andrew P; Hawkins, Alexander T; Auchincloss, Hugh G et al. (2016) Impact of Expanded Insurance Coverage on Racial Disparities in Vascular Disease: Insights From Massachusetts. Ann Surg 263:705-11
Song, Zirui; Chokshi, Dave A (2015) The role of private payers in payment reform. JAMA 313:25-6
Scott, John W; Salim, Ali; Sommers, Benjamin D et al. (2015) Racial and Regional Disparities in the Effect of the Affordable Care Act's Dependent Coverage Provision on Young Adult Trauma Patients. J Am Coll Surg 221:495-501.e1
Scott, John W; Sommers, Benjamin D; Tsai, Thomas C et al. (2015) Dependent coverage provision led to uneven insurance gains and unchanged mortality rates in young adult trauma patients. Health Aff (Millwood) 34:125-33
Song, Zirui; Chopra, Vineet; McMahon Jr, Laurence F (2015) Addressing the primary care workforce crisis. Am J Manag Care 21:e452-4
Song, Zirui; Wallace, Jacob; Neprash, Hannah T et al. (2015) Medicare Fee Cuts and Cardiologist-Hospital Integration. JAMA Intern Med 175:1229-31
Song, Zirui; Chopra, Vineet; McMahon Jr, Laurence F (2015) Addressing the primary care workforce crisis. Am J Manag Care 21:e452-4

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