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
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 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 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 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.
This issue brief presents analysis of Qualified Health Plan (QHP) data in the individual market Marketplace for states that use the HealthCare.gov Marketplace platform and State-Based Marketplaces where data is available. It examines plan affordability in 2017 after taking into account premium tax credits and also examines the plan choices that new and returning consumers will have for 2017. This brief shows that the Affordable Care Act is continuing to promote affordability and choice in the Marketplace for plan year 2017.
In this Issue Brief, we examine spending growth through 2014, the first year the Affordable Care Act’s coverage provisions were in effect, and 2015, where possible. We provide detailed cost growth trends for Medicare and the private insurance market. We also estimate the effect of recently introduced specialty drugs on current and future spending growth.
The dataset provides the total number of Qualified Health Plan selections by ZIP Code and county for the 38 states that use the HealthCare.gov platform, including the Federally-facilitated Marketplaces, State Partnership Marketplaces, and supported State-based Marketplaces, during the Marketplace’s third Open Enrollment Period (based on data for the period November 1, 2015 – February 1, 2016).