Stacy Berg Dale

Estimating the Effects of College Characteristics over the Career Using Administrative Earnings Data

We estimate the labor market effect of attending a highly selective college, using the College and Beyond Survey linked to Social Security Administration data. We extend earlier work by estimating effects for students that entered college in 1976 over a longer time horizon (from 1983 through 2007) and for a more recent cohort (1989). For both cohorts, the effects of college characteristics on earnings are sizeable (and similar in magnitude) in standard regression models. In selectionadjusted models, these effects generally fall to close to zero; however, these effects remain large for certain subgroups, such as for black and Hispanic students.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative

BACKGROUND The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. METHODS We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. RESULTS During the first 2 years, initiative practices received a median of

Staffing patterns of primary care practices in the comprehensive primary care initiative.

115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-

Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) Home Telemedicine Demonstration Findings from an independent evaluation

11; 95% confidence interval [CI], -

Costs to Medicare of the IDEATel Home Telemedicine Demonstration: Findings from and Independent Evaluation

23 to

Reducing nursing home use through consumer-directed personal care services.

1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account (

Could There Be a Role for Home Telemedicine in the U.S. Medicare Program

7; 95% CI, -

Effects of Cash and Counseling on Personal Care and Well‐Being

5 to

Estimating the Return to College Selectivity Over the Career Using Administrative Earning Data

19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience--discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health--both of which showed a small improvement in initiative practices relative to comparison practices (P=0.006 and P<0.001, respectively). CONCLUSIONS Midway through this 4-year intervention, practices participating in the initiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services; ClinicalTrials.gov number, NCT02320591.).

How Caregivers and Workers Fared in Cash and Counseling

PURPOSE Despite growing calls for team-based care, the current staff composition of primary care practices is unknown. We describe staffing patterns for primary care practices in the Centers for Medicare and Medicaid Services (CMS) Comprehensive Primary Care (CPC) initiative. METHODS We undertook a descriptive analysis of CPC initiative practices’ baseline staffing using data from initial applications and a practice survey. CMS selected 502 primary care practices (from 987 applicants) in 7 regions based on their health information technology, number of patients covered by participating payers, and other factors; 496 practices were included in this analysis. RESULTS Consistent with the national distribution, most of the CPC initiative practices included in this study were small: 44% reported 2 or fewer full-time equivalent (FTE) physicians; 27% reported more than 4. Nearly all reported administrative staff (98%) and medical assistants (89%). Fifty-three percent reported having nurse practitioners or physician assistants; 47%, licensed practical or vocational nurses; 36%, registered nurses; and 24%, care managers/coordinators—all of these positions are more common in larger practices. Other clinical staff were reported infrequently regardless of practice size. Compared with other CPC initiative practices, designated patient-centered medical homes were more likely to have care managers/coordinators but otherwise had similar staff types. Larger practices had fewer FTE staff per physician. CONCLUSIONS At baseline, most CPC initiative practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. Without such staff and payment for their services, practices are unlikely to deliver comprehensive, coordinated, and accessible care to patients at a sustainable cost.