The Dartmouth Atlas of Health Care will begin investigating health system performance for patients under the age of 65 in addition to their previous research on Medicare recipients, according to Dartmouth Medical School professor and co-principal investigator David Goodman.
The Atlas, a collaborative project of Dartmouth professors, researchers and administrators, aims to explore the high degree of geographical variation in health system performance to raise awareness and stimulate policy changes that will improve the quality of care while decreasing costs, DMS professor Elliott Fisher, co-principal investigator of the Atlas, said.
While the Atlas' past work was largely based on "20 years of groundbreaking analyses using national Medicare data sets," the new research will involve the analysis of health care for populations under 65 years of age, which are not covered in Medicare data sets, according to Goodman. In the past, the Atlas has released several reports on the under-65 population, but these studies were limited to specific states, Goodman said.
"It's become increasingly clear that because commercial-payer health care plans have to negotiate their prices with providers, those prices vary pretty dramatically," Fisher said.
The new research will allow the Atlas to determine whether physicians and hospitals are helping to slow or counteract the rising costs of care, he said.
The research will involve three pilot projects, according to Fisher. The first of these will examine geographic variances in the rate of joint arthroplasty and knee arthroscopy procedures by utilizing the data sets obtained through a partnership with Blue Health Intelligence, a subsidiary of the Blue Cross Blue Shield Association, according to a Dartmouth Institute for Health Policy and Clinical Practice press release.
The second initiative, titled the Total Cost of Care Project, will develop measures of health care costs for the commercially-insured, under-65 population and compare the data by geographic region, according to Goodman.
The final project will use a $500,000 grant from the Charles H. Hood Foundation to create a Dartmouth Atlas of Children's Health Care in northern New England, which will examine rates of utilization and spending for medical and surgical pediatric care in Maine, Vermont and New Hampshire, according to the press release. The money will go toward the purchase of data sets from insurance providers, as well as staff and production costs, Goodman said.
The project, as well as future research into commercially-insured health care, is aided by some states' adoption of mandated "all-payer claims databases," which require commercial insurance providers to disclose their health care data sets, Goodman said. All-payer claims databases help to overcome one of the greatest challenges facing the Atlas project convincing businesses and commercial insurance providers to contribute their data sets to the project, Goodman said.
"We currently have an unsustainable health care system," Fisher said. "We believe that the work of the Atlas can contribute meaningfully to improving the quality and moving the cost of care, but we have a lot of work to do to prove that that's likely."
All three projects hope to release preliminary reports within a year, according to Fisher.
The variation in health care costs is caused by cost-shifting a provider raising prices on commercially-insured patients due to the perception that they are being under-reimbursed by Medicare as well as the dominant positions of well-regarded providers in negotiations with commercial insurers, Fisher said.
Goodman said he hopes the expanded Atlas project will encourage transparency among health care providers, prompting them to examine their operations and improve their cost-outcome ratios.
"I'm pretty confident that having an annual report on what happens to health care costs in a given community will give attention to costs and quality and will put additional pressure on hospitals to do the hard work of reducing costs and improving quality," Fisher said.
In addition, the new research should draw attention to new payment models that aim to reduce the cost of health care, such as bundled payments and affordable care organizations, which were created by the Affordable Health Care for America Act of 2009, he said. "The Affordable Care Act is very much concerned with unwarranted variation in health care that is variation that can be explained by differences in health system performance," and thus is closely tied to the mission of the Atlas, Goodman said.
The Atlas is funded by the Robert Wood Johnson Foundation, the California Health Care Foundation, the Wellpoint Foundation and the United Heath Foundation.
