Research
Current Projects
Evaluation of Avera eCare Initiatives
The RUPRI Center is evaluating a remote healthcare system in the upper Midwest. The eCare projects supported through Avera Health have a common purpose of extending access to urban-based specialty care into rural communities through the local hospital or clinic. The RUPRI Center’s evaluation seeks to determine the impact of e-health services in Avera Health hospitals on the delivery of services, patient satisfaction, provider use, and cost of care. In addition, the evaluation examines the extent to which effectiveness of this innovative care approach can be demonstrated and generalized to other regions of the country.
Funder: The Leona M. & Harry B. Helmsley Charitable Trust
Lead Researcher: Marcia Ward, PhD
Rural Enrollment in Medicare Advantage
Since 2009, the Center has produced a series of reports documenting the modest, continuous growth in enrollment in Medicare Advantage (MA) plans in rural areas of the country. Most of this increase has been concentrated in preferred provider organization (PPO) plans, with a corresponding decline in private fee-for-service (PFFS) plan enrollment. The latest two reports in the series are:
Rural Medicare Advantage Enrollment Update Date: 6/2011
Rural Medicare Advantage: Growth in PPOs Dominates the Rural MA Market in 2011 Date: 3/2011
Funder: ORHP
Lead Researcher: Tim McBride, PhD
Health Insurance Exchanges
In advance of the January 1, 2014 requirement for states to establish Health Benefit Exchanges, the RUPRI Center has been developing models to describe likely Exchange populations. The Federal Employee Health Benefit Plan (FEHBP) covers members of Congress, federal workers and retirees, and their families and has been seen as a model for Exchanges for years. Using FEHBP enrollment data obtained under a Freedom of Information Act petition, the Center is working to develop models that will estimate regional and urban/rural Exchange plans and populations. Early findings - Health Insurance Exchanges: What Lessons Can Be Learned from the Concentration or Competition in Federal Employee Health Benefit Plans? – were presented at the 2011 Annual Congress for the International Health Economics Association.
Funder: ORHP
Lead Researcher: Tim McBride, PhD
Expansion of Health Exchanges
Most states are now developing Health Insurance Exchanges (HIEs), per the provisions of the Patient Protection and Affordable Care Act. Those state-based plans will include elements critical to rural interests, including network adequacy standards, minimum benefit standards, access to information about health plans and consulting services to facilitate choices, and campaigns to encourage enrollment. The RUPRI Center is reviewing all state HIE plans to answer questions about determining minimum standards for network adequacy, access to services for all residents of the state, provisions for extending information about enrollment choices to rural residents, and strategies for maximizing rural enrollment.
Funder: ORHP
Lead Researcher: Keith Mueller, PhD
Impact of Payment Policy on Access to Physician Care in Rural America
The Patient Protection and Affordable Care Act included bonus payments for primary care physicians in shortage areas, based on them billing for CPT codes related to primary care (at least 60%). This policy raises the need to understand the nature of rural primary care practice, which may not result in 60% of billing being through the primary care codes. The role of rural primary care in new systems of integrated care may also be different than an urban model that narrows the range of services completed by primary care physicians. Medicare claims data (Part B) and claims data from Wellmark Blue Cross and Blue Shield of Iowa will be used to develop profiles of the mix of services currently provided by rural primary care physicians. A primary goal of the study is to see if the bonus payments for primary care will reach all of the intended targets.
Funder: ORHP
Lead Researcher: Keith Mueller, PhD
Pharmacy Services in Communities After Losing Local Pharmacy
Since full implementation of the Medicare prescription drug benefit, more than 260 rural communities have lost their only retail pharmacy. This project seeks to develop an understanding of the consequences of the phenomenon in those communities, in particular the impact on access to pharmacy services, not merely access to prescription medications. The project will look at the characteristics of communities that have lost local retail pharmacies, including the structure of the local health care delivery system and will look to see if patterns of drug utilization change after the only local retail pharmacy closes and if utilization of other local health care services change.
A variety of data sources will be used for the project including Census data, data from the Area Resource File, and monthly data from the National Council for Prescription Drug Programs. In addition, Medicare Part D claims data will be obtained and analyzed to establish patterns of utilization in rural places that lost their only pharmacy. Finally, 4 case studies will be conducted in rural places that lost local pharmacy services, followed by a survey of key informants in other places in similar circumstances
Funder: ORHP
Lead Researcher: Keith Mueller, PhD