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UMRHRC Projects 2014-2015

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Rural-Urban Differences in Insurer Participation, Premiums, and Health Plan Provider Networks in Federal and State Marketplaces
Many pressing needs exist for timely research to assist policymakers in ensuring that Marketplaces achieve success, particularly in rural communities, which have historically faced limited health insurance choices. Rural areas may be further affected by the construction of rate setting areas which restrict price differences across areas but allow insurers to offer products in subsets of counties within rating areas. Network scope and adequacy are especially important in rural areas with fewer providers and greater distances between providers. The purpose of this project is to: 1) measure the size, scope, and composition of provider networks affiliated with Marketplace plans and how these differ in rural versus urban areas; 2) analyze the relationships between network size and composition, other benefit design attributes, geographic rating area designations, and premiums; 3) examine rural-urban differences in Marketplace-based plan enrollment and how enrollment is affected by plan availability and provider network size and scope.

Impact of the CMS Value-Based Purchasing and Readmission Reduction Programs on Rural Hospitals
The Affordable Care Act authorized CMS to implement two programs focused on realigning hospitals’ financial incentives to provide high quality care: the Value-Based Purchasing (VBP) program and the Hospital Readmissions Reduction Program. A significant number of rural hospitals have received VBP and/or readmission penalties. The purpose of this project is to assess the initial impacts of the CMS Value-Based Purchasing (VBP) and Readmission Reduction Programs on rural PPS hospitals. This project has two parts: a quantitative analysis of VBP bonus and penalty data and readmission penalty data and a qualitative analysis of rural hospital behavior change in response to these programs.

Rural Women Giving Birth in Non-Local Hospitals: Implications for Obstetric Access and Quality
Appropriate referral of high-risk women for a higher level of obstetric and/or neonatal care that is not provided in local hospitals is a crucial element of providing high-quality maternity care. However, out-migration of low-risk women may contribute to the loss of obstetric services in local hospitals by reducing volume to a point where it is not feasible from a financial perspective or advisable from a quality perspective to maintain the service line. The purpose of this project is to: 1) analyze data from nine geographically diverse states on delivery by rural women at non-local hospitals; 2) characterize the roles of medical vs. non-medical factors in delivery at a non-local hospital by identifying lower-risk and higher-risk women using established criteria; and 3) analyze the relationship between delivery at a non-local hospital and obstetric quality measures (e.g., low-risk cesarean rate, labor induction without medical indication, cesarean delivery without medical indication).

Rural Implications of Quality-Based Physician Payment Reform
Physician payment reform efforts, including Medicare initiatives, are developing ways to reimburse physicians that focus on quality and value rather than solely on volume. Research is needed on the implications of these initiatives for rural patients and rural physicians. The purpose of this project is to assess existing evidence about the quality of care provided by rural physicians using currently-available national data, and to determine what additional information will be needed as CMS moves towards inclusion of all physicians in payment reforms based on quality.