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
The United States relies on the interactions of private entities – drug manufacturers, health plans and pharmaceutical benefit managers (PBMs) - to achieve value by negotiating prices, operating formularies and implementing other benefit management strategies.
This brief explores lessons about six strategies federal or philanthropic agencies can take to try to enhance local cross-sector collaboration.
Market-based payment policies such as competitive bidding, reference pricing, centers of excellence and tiered provider networks have been implemented both in Medicare and across the private sector, as described in this report required by Executive Order 13890.
This project report provides potential approaches to expand and strengthen the entry-level health care workforce in the United States.
Medicare covers prescription drugs provided during inpatient hospital and skilled nursing facility stays through Part A, retail prescription drugs through Part D, and drugs provided in physicians’ offices and hospital outpatient departments through Part B.
The September 13, 2020 Executive Order on Lowering Drug Prices by Putting America First declared, “It is the policy of the United States that the Medicare program should not pay more for costly Part B or Part D prescription drugs or biological products than the most-favored-nation price.”
Beginning in mid-March 2020, the COVID-19 pandemic has had an unprecedented impact on health care utilization. The impact on patients, their families and the health care system was significant.
This report describes progress HHS has made over the past year to implement the Department’s Advancing American Kidney Health (AAKH) initiative and the Executive Order that accompanied the initiative. The AAKH initiative, which was launched in July 2019, outlined specific action steps to transform kidney care by focusing on three goals: reducing the risk of kidney failure, improving access to and quality of person-centered treatment options, and increasing access to kidney transplants. Related Products:
This report responds to a requirement in Executive Order 13877, "Improving Price and Quality Transparency in American Healthcare to Put Patients First." It describes the phenomenon of a "surprise billing," particularly in the commercial insurance market, the underlying federal and state regulatory frameworks, and recent state actions to address the problem. It also describes federal actions to encourage price transparency for medical services.
ASPE Issue Brief: Medicare Beneficiary Use of Telehealth Visits: Early Data From the Start of the COVID-19 Pandemic
This ASPE issue brief examines changes in Medicare fee-for-service primary care visits and use of telehealth at the start of the COVID-19 public health emergency (PHE). This brief seeks to address the issue of how and whether the Medicare telehealth flexibilities introduced to address the COVID-19 pandemic may have helped maintain access to primary health care during the PHE. Data reflects visits up to early June in 2020.
Parental opioid use disorder (OUD) is a risk factor for the maltreatment of children and placement into foster care. Opioid agonist therapy (OAT) is an evidence-based treatment for OUD using medications such as methadone and buprenorphine. OAT can help parents enter recovery and reduce the risk of maltreatment, and potentially improve child welfare outcomes. Child welfare agencies are increasingly looking to connect parents with treatment. However, there are concerns of inadequate supply of OAT providers.
This brief analyzes information on administrative data resources collected by the Administration for Children and Families (ACF). It explores how the data can be leveraged to improve evidence and research on ACF programs and beneficiaries. Key highlights include:
The Secretary of Health and Human Services (HHS) has been directed to submit a drug pricing report containing information requested by the House Committee on Appropriations. In response, the Assistant Secretary for Planning and Evaluation (ASPE) developed this report containing data and analyses related to prescription drug spending between 2006 and 2017 as well as on prescription drugs benefiting from public funding for biomedical research since 2013
This Report responded to a request from the House and Senate Committees on Appropriations. Published estimates of the cost of new drug development range from $1.2 billion to $2.6 billion and are highly sensitive to assumptions about pre-clinical and clinical development time, cost of capital, the likelihood of reaching approval following the start of clinical testing, and costs of preclinical development and clinical trials conducted among humans, and to the incorporation of recent increases in Orphan drug approvals.
Impact of Participation in Technology-Enabled Collaborative Learning and Capacity Building (ECHO) Models on Provider Retention
This analysis, which used data on participation in Project ECHO provided by New Mexico’s ECHO Institute, explored two retention-related hypotheses: Participation in an ECHO intervention results in increased provider retention at the individual practitioner level; and Sites with an ECHO presence may generate synergies that translate into higher levels of professional satisfaction and achievement even for providers who do not participate in ECHO so that overall provider retention at such sites increases.
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.