Meredith B. Rosenthal
Professor of Health Economics and Policy
Professor Rosenthal’s research examines the design and impact of
market-based health policy reforms, including the use of provider financial incentives and
mechanisms to alter consumer behavior and the competitive environment for
health care providers.
Ph.D., 1998, Harvard University
A.B., 1990, Brown University
Current Research Projects
Pay for Performance
The adoption of pay for performance to encourage health care providers to improve the quality of care is an important trend in the U.S. and abroad. One of our current projects in this area examines a relatively novel and potentially powerful approach to pay for performance that is patient- rather than population-focused. That is, rewards are calculated for every patient that receives recommended care rather than based on a provider’s performance averaged over a population. The setting for the proposed work is the Hudson Health Plan (HHP), a not-for-profit Medicaid-focused managed care plan. HHP introduced a pediatric immunization bonus program in which providers are eligible for payments of up to $200 per child for complete and timely immunization by the age of 2.
Patient-Centered Medical Homes
There is widespread interest in organizing health care delivery around a defined “medical home” as a means of addressing both the poor quality and high cost of medical care in the United States. By situating accountability for a patient with a physician or clinical team, the medical home model is intended to reduce redundancy, ensure continuity of care, and increase the delivery of high-value preventive care. We have begun to evaluate the implementation and impact of the medical home in a multi-payer pilot, the Rhode Island Chronic Care Sustainability Initiative (CSI). The pilot has been developed in collaboration with a broad group of stakeholders that includes medical group leaders, physician specialty societies, health plans, and purchasers. Our study will examine the adoption of structural changes by participating practices and the impact on cost, quality, and patient experience of care.
At the beginning of the decade, the Institute of Medicine shone an unfavorable spotlight on the health care reimbursement system in the U.S., highlighting its perverse reinforcement of patterns of care that result in high costs and patient harm. The rise of pay for performance was the most immediate response to these concerns. Experimentation with and debate about pay for performance has had an important side effect, however: renewed interest in broader payment reforms. In two recent papers, I have examined emerging provider payment reforms and explored the philosophical and practical differences among them. A related empirical study will examine the implications for payers and providers of adopting an episode-based payment scheme as an alternative to fee-for-service payment.
Dr. Rosenthal’s principal research interests revolve around economic incentives that influence consumer and provider health care decisions. She is currently working on a series of related projects that examine evolving trends in the health insurance market, including the use of pay-for-performance, tiered networks, and consumer-directed health plans.
Most recently, Dr. Rosenthal has been collaborating on a study involving interlocking national surveys of health benefit purchasers and health plans to examine efforts to improve the value of health care, including the use of pay-for-performance, tiered networks, and public reporting of quality information. Results from this study will characterize the current state of value-based purchasing, the interplay between purchaser and health plan activities, and the market, purchaser, and health plan factors associated with the adoption of particular strategies.
Dr. Rosenthal is also working on an evaluation of the uptake and impact of health risk appraisals (HRAs) in a large national health plan.
This study will examine:
- overall rates of HRA completion;
- the impact of a consumer financial incentive on HRA completion;
- the characteristics of consumers who opt to complete an HRA (including a comparison of enrollees in traditional managed care plans to enrollees in consumer-directed health plans); and
- early effects of HRAs on health behavior.
Finally, Dr. Rosenthal has begun to examine the implementation of a set of strategies designed to improve the value of health care spending in a Preferred Provider Organization model plan (“the PPO”, hereafter) that insures low-wage workers in a single metropolitan area. The PPO covers 56,000 primary subscribers and their dependents, a many of whom are members of ethnic and racial minority groups. The specific policies to be evaluated are: network narrowing, pay-for-performance, and financial incentives for patients to adhere to recommended prenatal care.