Insurance Benefit Design:

A major focus of my work has been evaluating the impact of health policies and/or insurance benefit design on the cost and quality of care. Using quasi-experimental techniques, I have found that Medicare payment reform for hospital-acquired conditions reduces the incidence of these conditions; Medicare’s switch to value-based purchasing for this condition had the desired effect. I conducted the first risk-adjusted analysis of use of hospice among Medicare Advantage versus Fee-for-Service beneficiaries and found opposite directions of effect regarding hospice length of stay compared to the existing literature, which did not risk adjust. Indeed, removing this risk adjustment resulted in the same direction of effect as seen in other unadjusted estimates, underscoring the need to risk-adjust when comparing these two Medicare benefit designs. I have conducted multiple investigations into the quality and cost of care provided by Medicare versus the Veterans Heath Administration (VA) for veterans with cancer who are dually-enrolled in both programs. My research finds VA generally outperforms Medicare with respect to quality, but that both have increasing costs for cancer decedents at the end-of-life. I have also examined differences in insurance benefit design and take up of telehealth during the COVID-19 pandemic and find that it is the managed care/fee-for-service distinction, rather than the commercial/Medicaid distinction that drives variations in uptake of care. Recently, I have evaluated the impact of changes to telehealth cost-sharing engendered by the COVID-19 pandemic, conducting the first analysis of the effect of a policy shock on persons insured by high-deductible health plans, a dominant insurance mechanism. I find that persons are highly responsive to declines in cost-sharing, and that the greater the decline in cost sharing, the greater the uptake of telehealth services.