Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending

Healthcare price transparency discussions typically focus on increasing patients' access to information about their out-of-pocket costs, but that focus is too narrow and should include other audiences -- physicians, employers, health plans and policymakers -- each with distinct needs and uses for healthcare price information. Greater price transparency can reduce U.S. healthcare spending.For example, an estimated $100 billion could be saved over the next 10 years if three select interventions were undertaken. However, most of the projected savings come from making price information available to employers and physicians, according to an analysis by researchers at the former Center for Studying Health System Change (HSC). Based on the current availability and modest impact of plan-based transparency tools, requiring all private plans to provide personalized out-of-pocket price data to enrollees would reduce total health spending by an estimated$18 billion over the next decade. While $18 billion is a substantial dollar amount, it is less than a tenth of a percent of the$40 trillionin total projected health spending over the same period. In contrast, using state all-payer claims databases to gather and report hospital-specific prices might reduce spending by an estimated $61 billion over 10 years.The effects of price transparency depend critically on the intended audience, the decision-making context and how prices are presented. And the impact of price transparency can be greatly amplified if target audiences are able and motivated to act on the information. Simply providing prices is insufficient to control spending without other shifts in healthcare financing, including changes in benefit design to make patients more sensitive to price differences among providers and alternative treatments. Other reforms that can amplify the impact of price transparency include shifting from fee-for-service payments that reward providers for volume to payment methods that put providers at risk for spending for episodes of care or defined patient populations. While price transparency alone seems unlikely to transform the healthcare system, it can play a needed role in enabling effective reforms in value-based benefit design and provider payment

Data from a pre-publication independent replication initiative examining ten moral judgement effects

We present the data from a crowdsourced project seeking to replicate findings in independent laboratories before (rather than after) they are published. In this Pre-Publication Independent Replication (PPIR) initiative, 25 research groups attempted to replicate 10 moral judgment effects from a single laboratory's research pipeline of unpublished findings. The 10 effects were investigated using online/lab surveys containing psychological manipulations (vignettes) followed by questionnaires. Results revealed a mix of reliable, unreliable, and culturally moderated findings. Unlike any previous replication project, this dataset includes the data from not only the replications but also from the original studies, creating a unique corpus that researchers can use to better understand reproducibility and irreproducibility in science

The pipeline project: Pre-publication independent replications of a single laboratory's research pipeline

This crowdsourced project introduces a collaborative approach to improving the reproducibility of scientific research, in which findings are replicated in qualified independent laboratories before (rather than after) they are published. Our goal is to establish a non-adversarial replication process with highly informative final results. To illustrate the Pre-Publication Independent Replication (PPIR) approach, 25 research groups conducted replications of all ten moral judgment effects which the last author and his collaborators had “in the pipeline” as of August 2014. Six findings replicated according to all replication criteria, one finding replicated but with a significantly smaller effect size than the original, one finding replicated consistently in the original culture but not outside of it, and two findings failed to find support. In total, 40% of the original findings failed at least one major replication criterion. Potential ways to implement and incentivize pre-publication independent replication on a large scale are discussed

Data from a pre-publication independent replication initiative examining ten moral judgement effects

We present the data from a crowdsourced project seeking to replicate findings in independent laboratories before (rather than after) they are published. In this Pre-Publication Independent Replication (PPIR) initiative, 25 research groups attempted to replicate 10 moral judgment effects from a single laboratory's research pipeline of unpublished findings. The 10 effects were investigated using online/lab surveys containing psychological manipulations (vignettes) followed by questionnaires. Results revealed a mix of reliable, unreliable, and culturally moderated findings. Unlike any previous replication project, this dataset includes the data from not only the replications but also from the original studies, creating a unique corpus that researchers can use to better understand reproducibility and irreproducibility in science.Link_to_subscribed_fulltex

The pipeline project: Pre-publication independent replications of a single laboratory's research pipeline

© 2015 The Authors This crowdsourced project introduces a collaborative approach to improving the reproducibility of scientific research, in which findings are replicated in qualified independent laboratories before (rather than after) they are published. Our goal is to establish a non-adversarial replication process with highly informative final results. To illustrate the Pre-Publication Independent Replication (PPIR) approach, 25 research groups conducted replications of all ten moral judgment effects which the last author and his collaborators had âin the pipelineâ as of August 2014. Six findings replicated according to all replication criteria, one finding replicated but with a significantly smaller effect size than the original, one finding replicated consistently in the original culture but not outside of it, and two findings failed to find support. In total, 40% of the original findings failed at least one major replication criterion. Potential ways to implement and incentivize pre-publication independent replication on a large scale are discussed.Link_to_subscribed_fulltex

The Princeton University Preparatory Program and Participants’ Postsecondary Outcomes

This study examines the effectiveness of the Princeton University Preparatory Program (PUPP), a college access program. College access programs have been developed at the federal and university-level to address the weak pipeline of low-income students applying to postsecondary institutions. Few university-sponsored programs have been systematically evaluated. RESEARCH QUESTIONS: The first part of the study examines the association of PUPP and participants’ postsecondary outcomes. To provide a counterfactual, this study compares the outcomes of students who were admitted to the program (2010-12) to those of students who applied but were not admitted for the same years. Using multivariate regression analyses, the section tests the following hypotheses: 1. PUPP participants are more likely than non-participants to attend a 4-year institution vs. a 2-year institution. 2. PUPP participants are more likely than non-participants to attend a selective 4-year institution vs. a non-selective 4-year or 2-year institution. The second part of the study examines whether PUPP mitigates the effect of different school environments on the postsecondary outcomes of only PUPP graduates (2004-12). Using multivariate regression analyses, the section tests the following hypotheses: 3. PUPP participants who attend less well-endowed school districts are no less likely than PUPP participants from more well-endowed schools to attend a 4- year institution vs. a non-selective 4-year or 2-year institution. FINDINGS: The results from the multivariate analyses revealed several key findings: 1. PUPP participation remained significantly and positively associated with higher odds of attending 4-year and selective institutions, controlling for prior academic ability. 2. For PUPP graduates, high school attended remained a significant factor that impacted students’ postsecondary outcomes. CONCLUSIONS: The study recommends that PUPP continues to support students through counseling and academic enrichment. In addition, it recommends that federal programs conduct more research to understand the academic abilities of students served and the effects of programming intensity. These recommendations will serve to strengthen college access programs for the future

Sacramento: Pressures to Control Costs Persist Alongside Growing Capacity and Access Challenges

Since the last round of this study in 2011-2012, the Sacramento economy has largely rallied from its long post-recession slump. While the health care sector has remained mostly stable overall, it has grappled with capacity constraints and access challenges stemming largely from the Affordable Care Act (ACA) insurance coverage expansions. In addition, the competitive standing among the four major hospital systems in this region-- Dignity Health; Kaiser Permanente; Sutter Health; and University of California, David-- has shifted somewhat over the past few years

San Francisco Bay Area: Major Players Drive Regional Network Development

Since the last round of this regional study four years ago, the Bay Area's economy has continued to thrive, although there remain stark economic contrasts between the haves and have-nots. The analysis of the Bay Area health care marketplace reveals these developments:In a region historically characterized by many segmented submarkets, major providers are expanding in efforts to manage care efficiently, serve more patients, and compete with Kaiser Permanente.The number of independent hospitals is shrinking as financial problems mount. Though none of the region's remaining private safety-net hospitals appear threatened by imminent closure, several face an uncertain future.Independent practice associations are seeking to diversify, raise capital, and keep private practice viable, especially for primary care physicians.The region's safety net is strong, but is facing serious capacity and access challenges resulting from the ACA Medi-Cal expansion. They are particularly hampered by their limited ability to recruit and retain clinicians

Tarsier Goggles: a virtual reality tool for experiencing the optics of a dark-adapted primate visual system

Abstract Charles Darwin viewed eyes as the epitome of evolution by natural selection, describing them as organs of extreme perfection and complication. The visual system is therefore fertile ground for teaching fundamental concepts in optics and biology, subjects with scant representation during the rise and spread of immersive technologies in K-12 education. The visual system is an ideal topic for three-dimensional (3D) virtual reality learning environments (VRLEs), and here we describe a 3D VRLE that simulates the vision of a tarsier, a nocturnal primate that lives in southeast Asia. Tarsiers are an enduring source of fascination for having enormous eyes, both in absolute size and in proportion to the size of the animal. Our motivation for developing a tarsier-inspired VRLE, or Tarsier Goggles, is to demonstrate the optical and selective advantages of hyperenlarged eyes for nocturnal visual predation. In addition to greater visual sensitivity, users also experience reductions in visual acuity and color vision. On a philosophical level, we can never know the visual world of another organism, but advances in 3D VRLEs allow us to try in the service of experiential learning and educational outreach