Pauly, Mark V

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  • Publication
    Increasing the Value of Health Care: The Role of Nurses
    (2015-10-15) Lindrooth, Richard C; Yakusheva, Olga; Fairman, Julie A; Naylor, Mary D; Pauly, Mark V
    Increasing health care value has become a central objective of payment policies, insurance design and purchasing, and patient and provider decision-making. The word “value” appeared in the title of seven sections of the Affordable Care Act (ACA), and earlier this year CMS set a goal of having 50 percent of reimbursement based on value. This brief reviews nurses’ contribution to value, highlighting evidence published by researchers in the Interdisciplinary Nursing Quality Research Initiative (INQRI), an 8-year program funded by the Robert Wood Johnson Foundation. It also looks at interventions designed to address outcomes targeted by ACA- or Medicare-related payment policies.
  • Publication
    Is There a Future for Employer- Sponsored Health Insurance?
    (2015-03-01) Pauly, Mark V
    Over the next five years, the effects of the ACA on employer-sponsored insurance will be modest. In the longer run, there is greater potential for disruption, depending on how firms respond to the subsidies available on the exchanges for low-wage workers. In all, only about 15% of the workforce likely will be affected. The impacts of the ACA on firms will vary widely based on three main factors: 1) the size of the firm, 2) the average compensation within the firm, and 3) the degree to which wages within the firm are homogenous or heterogeneous. Keeping in mind that employees pay for all their health insurance, group insurance is not intrinsically superior to private exchanges, and cost trumps choice for consumers, firms will choose the option that maximizes benefits to their workers, takes advantage of the best available subsidies while avoiding tax penalties, and results in the lowest administrative costs. Making all low-wage workers eligible for the same subsidies, whether they acquire coverage on the exchanges or in group plans, would be reasonable and involve less distortions.
  • Publication
    The new Medicare Drug Benefit: Much ado About Little?
    (2004-02-18) Pauly, Mark V
    After many years of debate, Congress recently approved a new, voluntary “Medicare Part D” benefit that provides some coverage for prescription drugs. The goal of this coverage is to reduce financial barriers that might prevent beneficiaries from obtaining needed drugs. The degree to which this goal is achieved depends on how well the benefit reaches seniors with previously unmet needs; conversely, it may do little to improve seniors’ health if it replaces existing sources of coverage, or encourages overuse of drugs. This Issue Brief reviews data on current patterns of drug spending among Medicare beneficiaries and summarizes aspects of the new benefit. It explores the likely effect of the coverage on overall use of and spending for prescription drugs and considers whether any additional use is likely to represent needed care that had been forgone because of a cost barrier.
  • Publication
    Accountable Care Organizations: Back to the Future?
    (2012-12-04) Burns, Lawton R; Pauly, Mark V
    Accountable Care Organizations (ACOs) are networks of providers that assume risk for the quality and total cost of the care they deliver. Public policymakers and private insurers hope that ACOs will achieve the elusive “triple aim” of improving quality of care, improving population health, and reducing costs. The model is still evolving, but the premise is that ACOs will accomplish these aims by coordinating care, managing chronic disease, and aligning financial incentives for hospitals and physicians. If this sounds familiar, it may be because the integrated care networks of the 1990s tried some of the same things, and mostly failed in their attempts. This Issue Brief summarizes the similarities and differences between the new ACOs and the integrated delivery networks of the 1990s, and presents the authors’ analysis of the likely success of these new organizations in affecting the costs and quality of health care.
  • Publication
    How Health Affects Small Business in South Africa
    (2007-03-30) Chao, Li-wei; Pauly, Mark V
    Preventable and treatable diseases have taken a devastating human and economic toll on many developing countries. That economic toll is likely to be underestimated because most studies focus on productivity losses in the formal, or largefirm, sector; yet, a large portion of the population of developing countries works in the informal sector in very small businesses, either as an owner-worker or as an employee. It is plausible that ill health might affect small businesses most severely, possibly putting the entire business at risk. This Issue Brief summarizes a three-year study that tracks small businesses in Durban, South Africa, and investigates the connection between the owner’s health and business growth, survival, or closure. The results bolster the economic case for investing resources in the prevention and treatment of disease in developing countries.
  • Publication
    Complementary and Alternative Medicine: Personal Preference or low Cost Option?
    (2005-02-21) Pagán, José A; Pauly, Mark V
    From acupuncture to yoga, Americans’ use of complementary and alternative medicine (CAM) is widespread and growing. The reasons that people give for using CAM are as diverse as the CAM therapies themselves: some perceive that conventional health care is ineffective, while others consider CAM to be more consistent with their own values and beliefs about health. As conventional health care costs rise, it is also possible that some people turn to CAM as a low cost alternative. This Issue Brief summarizes research that evaluates the relationship between CAM use and perceived access to conventional health care.
  • Publication
    From Hospital to Drugstore: Insurance and the Shift to Outpatient Care
    (2001-10-23) Danzon, Patricia. M; Pauly, Mark V
    As policymakers consider whether and how to add prescription drug coverage to Medicare, they need to understand the relationship between insurance coverage and the adoption of new medical technologies, including drugs. Even the direction of these relationships is not always so clear. In this Issue Brief, Drs. Danzon and Pauly examine the shift from inpatient to outpatient care in the last 20 years, and ask two broad questions: to what extent was this shift encouraged by changes in insurance, and to what extent was insurance coverage influenced by this shift?
  • Publication
    How Nursing Affects Medicare’s Outcome-Based Hospital Payments
    (2015-11-12) Yakusheva, Olga; Weiner, Janet; Lindrooth, Richard C; Pauly, Mark V; Spetz, Joanne
    Improving value is one of the central aims of recent and ongoing health care reform. In our last LDI/INQRI Brief, we reviewed the evidence of the role of nurses in increasing the value of health care. In this companion brief, we dig deeper into the three reimbursement strategies that Medicare uses to align hospital financial incentives with quality of care, and we calculate the potential effects of nursing-sensitive quality indicators on hospital payments.
  • Publication
    Primary Care Shortages: More Than a Head Count
    (2014-11-21) Pauly, Mark V; Weiner, Janet; Naylor, Mary D
    The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. This new LDI/ Interdisciplinary Nursing Quality Research Initiative (INQRI) research brief reviews the evidence and how the ACA might affect current and future patterns of delivering primary care.
  • Publication
    Community Benefits: How do For-Profit and Nonprofit Hospitals Measure up?
    (2001-01-23) Nicholson, Sean; Pauly, Mark V
    The rise of the for-profit hospital industry has opened a debate about the level of community benefits provided by non-profit hospitals. Do nonprofits provide enough community benefits to justify the community’s commitment of resources to them, and the tax-exempt status they receive? If nonprofit hospitals convert to for-profit entities, would community benefits be lost in the transaction? This debate has highlighted the need to define and measure community benefits more clearly. In this Issue Brief, the authors develop a new method of identifying activities that qualify as community benefits, and propose a benchmark for the amount of benefit a nonprofit hospital should provide.