HP provides a cross-cutting policy perspective that bridges Departmental programs, public and private sector activities, and the research community, in order to develop, analyze, coordinate and provide leadership on health policy issues for the Secretary. HP carries out this mission by conducting policy, economic and budget analyses, assisting in the development and review of regulations, assisting in the development and formulation of budgets and legislation, assisting in survey design efforts, as well as conducting and coordinating research, evaluation, and information dissemination on issues relating to health policy.
The Office of Health Policy is organized in four divisions that align with major Department programs :Division of Health Care Financing Policy (HFP)
Division of Public Health Services (PHS)
Division of Health Care Access and Coverage (HAC)
Division of Health Care Quality and Outcomes (HQO)
HEALTH POLICY RESEARCH:
- Reports to Congress
- Affordable Care Act Research & Issue Briefs
- HP Authored or Sponsored Work Published in Journals
OTHER HELPFUL INFORMATION:
- Children's Health Insurance and CHIP
- Consumer Protection and Patient Safety
- Health Information and Statistics
- Health Policy
- Health Promotion and Disease Prevention
- Health Insurance Marketplace
- Healthcare Reform
- Other Research
- Patient-Centered Outcomes Research Trust Fund (PCORTF)
- Public Health
- Healthcare Safety Net
- Substance Abuse and Mental Health
Between 1996 and 2013, there was a 54% decrease in the incidence of diabetes-related end-stage renal disease (ESRD-DM) in American Indian and Alaska Native (AI/ AN) populations. This decline has occurred since the Special Diabetes Program for Indians (SDPI) was established in 1997. We estimate that the decrease in ESRD-DM incidence resulted in 2,200 to 2,600 fewer cases and $436 to $520 million of savings to Medicare over a ten-year period, depending on assumptions of what the incidence rate would have been in the absence of diabetic care improvements.
By statute, the majority of patients with end-stage renal disease (ESRD) are eligible for Medicare, regardless of age. Kidney transplantation is ultimately considered the best treatment for ESRD, but ESRD-related eligibility for Medicare coverage extends for only 36 months post-transplant.
Identifying Safety-Net Resources at Health Centers to Prevent Infectious Disease Transmission Resulting from the Opioid Epidemic
The impact of the opioid epidemic on infectious disease transmission is an important public health issue. The problem came dramatically to light in 2015 when an outbreak of new human immunodeficiency virus (HIV) infections occurred in rural Scott County, Indiana. This qualitative study explores the experiences of community health centers (CHC) in caring for people with opioid use disorder (OUD) and preventing HIV and hepatitis C (HCV) based on semi-structured discussions held with staff in eight CHCs located in the Appalachian region, the West, and the Northeast.
Health centers are experimenting with telehealth for a range of conditions, working with different types of remote providers, and confronting different telehealth policies and implementation barriers, depending on their locations and payer mix. This paper explores the experiences of health centers and state Medicaid programs in seven states.
Report to Congress: Current State of Technology-Enabled Collaborative Learning and Capacity Building Models
This report responds to the December 2016 “Expanding Capacity for Health Outcomes (ECHO) Act,” Public Law 114-270, which requires the Department to report to Congress on a range of issues related to technology-enabled collaborative learning and capacity building models and make recommendations on their use. This report consists of a summary document that includes the Department’s recommendations, a report prepared by RAND, which provides a brief history of such models, describes examples of implementations of such models, reviews the current status of the evidence base for such models as o
The objectives of this research effort were to collect feedback through interviews with physicians in small rural practices on the initial implementation of Medicare’s Quality Payment Program in 2017, a new value-based purchasing program for Medicare physicians. RAND's findings suggest that small rural practices are struggling to participate in the QPP due to program complexity and limited resources in these practices. These findings can help in interpreting the first-year QPP participation and performance results, and inform potential policy changes.
Department of Health and Human Services Secretary Alex Azar and Inspector General Daniel Levinson have issued a proposed rule, “Fraud and Abuse; Removal of Safe Harbor Protection for Rebates Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection for Certain Point-of-Sale Reductions in Price on Prescription Pharmaceuticals and Certain Pharmacy Benefit Manager Service Fees.” The Department’s Medicare Part D analysis in the rule is based on the CMS Office of the Actuary’s work commis
This brief presents information on qualified health plans (QHPs) available in the Exchange for states that use the HealthCare.gov platform, including estimates for issuer participation, health plan options, premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP. National estimates and summary tables are presented in each section of the text.
Types and Costs of Services for Dual Beneficiaries by Medicare Advantage Health Plans: An Environmental Scan
The Centers for Medicare and Medicaid Services (CMS) uses the Star Rating program to measure the quality of Medicare Advantage (MA) plans, publicly report plan performance, and determine quality bonus payments and rebates for MA plans. MA plans that serve a high proportion of beneficiaries who are dually enrolled in both Medicare and Medicaid have lower performance and lower MA Star Ratings, on average, than plans serving a lower proportion of these beneficiaries. However, the reasons for these disparities in performance are not completely understood.
Addressing Social Determinants of Health Needs of Dually Enrolled Beneficiaries in Medicare Advantage Plans: Findings from Interviews and Case Studies
Medicare Advantage (MA) plans that serve relatively higher proportions of dually enrolled beneficiaries have lower ratings in the MA Star Rating program than plans that serve fewer dually enrolled beneficiaries. However, some MA plans that serve a high proportion of dually enrolled beneficiaries are high performers. Their high performance may be the result of successful strategies they have implemented to meet the complex health and social needs of their members.
This report highlights key research questions and identifies opportunities to use existing data sources and implement data-linking strategies that can support the HHS five point strategy to combat the opioid crisis.
Data point: Prescription Pharmaceutical Price Changes since the Release of the President’s Drug Pricing Blueprint
Using manufacturer-reported prescription pharmaceutical prices, we observe that the number of price increases has been reduced considerably since the release of the President’s Drug Pricing Blueprint, compared to the same time period in the year prior. Since the Blueprint’s release, there are 60% fewer brand name product price increases in 2018 compared to the same period in 2017, and 54% more brand and generic product price decreases combined.
The OS PCORTF Annual Report provides project descriptions for each of the OS-PCORTF portfolio’s 21 projects that were active in calendar year 2017.
Data Point: Savings Available Under Full Generic Substitution of Multiple Source Brand Drugs in Medicare Part D
ASPE analyzed Part D prescription drug event data from 2016 to estimate spending on brand drugs with generic therapeutic equivalents.
This report summarizes strategies Indian Health Service (IHS) clinics have used to implement the Patient-Centered Medical Home (PCMH) model of care, challenges they faced during implementation, and lessons learned that might benefit IHS clinics that have not yet received PCMH recognition. Common strategies to address challenges include use of telemedicine and partnerships with academic medical centers, and engaging tribal leaders and publicizing PCMH-related changes to the community to secure buy-in on major changes.
This report summarizes findings from a small qualitative study of six health centers that are pursuing a diverse range of approaches to facilitating specialty care for patients.
This study expands upon the analysis of the National Health Service Corps (NHSC) begun in “Provider Retention in High Need Areas and continued in “The National Health Service Corps: An Extended Analysis” by using the same techniques used in these earlier studies to examine retention patterns in Indian Health providers.. The study finds about 81% of the IHS program participants serve in the same I/T/U site one year after completion of their service obligation.
To combat the public health crisis associated with the opioid overdose epidemic, HHS will host an Opioid Code-a-Thon on December 6-7, 2017 to develop data driven solutions to combat the opioid epidemic. This Data Brief presents an overview of the data sources that could be leveraged to study the opioid crisis within each of the five HHS strategic areas, highlights some of the key research questions within these areas, and summarizes data linking strategies that can be used to support research on opioids. This brief is based on a forthcoming ASPE report that will provide expanded details a
This ASPE Data Point analyzes premium increases from two data series, comparing premium costs in individual market plans purchased by consumers in 2013 to exchange plans purchased in 2017 in order to better determine how much premiums have increased since the ACA’s key provisions have taken effect.
Report to Congress: Social Risk Factors and Performance Under Medicare's Value-Based Purchasing Programs
This report, mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 or the IMPACT Act (P.L. 113-185), requires the Secretary, acting through the Assistant Secretary for Planning and Evaluation (ASPE), to conduct research on issues related to socioeconomic status (SES) in Medicare’s value-based payment programs. The term social risk factor is being used in lieu of the term SES based on the January 2016 National Academies of Sciences, Engineering, and Medicine’s report which recommended reframing as such.