BCHT Publications

COVID-19

PUBLICATIONS

Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic, James Robinson, JAMA, January 14, 2021, doi:10.1001/jama.2020.25384

Changes in Health Services Use Among Commercially Insure US Populations During the COVID-19 Pandemic, Christopher M. Whaley, PhD; Megan F. Pera, MS; Jonathan Cantor, PhD; Jennie Chang, BA; Julia Velasco, BS; Heather K. Hagg, PhD;, Neeraj Sood, PhD; Dena M. Bravata, MD,MS, JAMA Network Open. 2020;3(11):e2024984. doi:10.1001/jamanetworkopen.2020.24984

The Covid-19 Pandemic Accelerates the Transition to Virtual Care, James Robinson, PhD, Lina Borgo, MPH, Kevin Fennell, MBA, Tadashi T. Funahashi, MD, NEJM Vol. No. September 10, 2020 DOI: 10.1056/CAT.20.0399

Reference Pricing

Prices paid for the same services vary significantly even within the same market yet, consumers often lack access to information about price and quality when seeking medical care, and providers are not required to justify higher prices with evidence of better quality. Reference pricing can motivate providers to compete based on price as well as quality, and to pursue cost-reducing innovations. The Berkeley Center for Health Technology (BCHT) conducts reference pricing research in order to identify and refine methods to control health care spending while insuring access and quality.

RESEARCH     PRESENTATIONS

 

PUBLICATIONS

Physician and Patient Adjustment to Reference Pricing for Drugs. James C. Robinson, Christopher Whaley, Timothy T. Brown, Sanket S. Dhruva, JAMA Network Open. 2020;3(2):e1920544. doi:10.1001/jamanetworkopen.2019.20544   

Private Sector Strategies to Address High Drug Prices and the Promise of Reference Pricing Programs.
Michael E. Chernew, JAMA Network Open. 2020;3(2):e1920599. doi:10.1001/jamanetworkopen.2019.20599 

Reverse Reference Pricing: Rewarding Patients For Reducing Medicare Costs. Neeraj Sood, Christopher M. Whaley, Health Affairs Blog, DOI: 10.1377/hblog20190604.509495

Consumer Responses to Price Transparency Alone versus Price Transparency Combined with Reference Pricing, Christopher Whaley, Timothy Brown, James Robinson, American Journal of Health Economics 5(2): 227–249

Reference pricing: The case of screening colonoscopies. Marion Aouad, Timothy T. Brown, Christopher M. Whaley, Journal of Health Economics 65 (2019) 246–259

How Can We Increase Patient Shopping for High-Value Providers? Christopher M Whaley, Timothy T Brown, James C Robinson, NIHCM, Issue Brief; in press.

Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization. Christopher M. Whaley, Lan Vu, Neeraj Sood, Michael E. Chernew, Leanne Metcalfe, Ateev Mehrotra,10.1377/hlthaff.2018.05068 , HEALTH AFFAIRS 38, NO. 3 (2019): 440–447.

Firm responses to targeted consumer incentives: Evidence from reference pricing for surgical services. Christopher M Whaley, Timothy T Brown,  Journal of Health Economics 61 (2018) 111–133.

How Do Providers Respond to Reference Pricing? Christopher M Whaley, Timothy T Brown, NIHCM, Issue Brief; 2018.

Pharmaceutical Reference Pricing: Does It Have a Future in the US?, Robinson JC.  Commonwealth Fund, issue brief, September 2018. Issue Brief

Consumer Responses to Price Transparency Alone Versus Price Transparency Combined with Reference Pricing, Whaley C, Brown TT, Robinson JC. , American Journal of Health Economics 2018; in press.

The moral hazard effects of consumer responses to targeted cost-sharing Christopher M. Whaley, Chaoran Guo, Timothy T. Brown, Journal of Health Economics, Volume 56, December 2017, Pages 201-221.

Association of Reference Pricing with Drug Selection and Spending. Robinson JC, Whaley C, Brown TT., New England Journal of Medicine 2017; 377:658-675.

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Pharmaceuticals James C. Robinson, Christopher M. Whaley, and Timothy T. Brown; May 2017, Issue Brief.

Impact of Reference Pricing on Patient Choices, Employer Spending and Consumer Cost Sharing in Health Insurance: Overview James C. Robinson, Christopher M. Whaley, and Timothy T. Brown; February 2017, Issue Brief

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Laboratory Tests James C. Robinson, Christopher M. Whaley, and Timothy T. Brown; February 2017, Issue Brief.

Reference Pricing Changes The ‘Choice Architecture’ Of Health Care For Consumers James C. Robinson, Timothy T. Brown, and Christopher Whaley Health Affairs; 2017; 36(3): 524–530

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Reference Pricing Reduces Employer and Employee Spending for Magnetic Resonance Imaging (MRI) Scans James C. Robinson, Christopher M. Whaley, and Timothy T. Brown; October 2016, Issue Brief

Reference Pricing, Consumer Cost-Sharing, and Insurer Spending for Computed Tomography (CT) Scans James C. Robinson, Christopher M. Whaley, and Timothy T. Brown; November 2016, Issue Brief.

Association of Reference Pricing for Diagnostic Laboratory Testing With Changes in Patient Choices, Prices, and Total Spending for DiagnosticTests James C. Robinson, PhD; Christopher Whaley, BA; Timothy T. Brown, PhD; JAMA Intern Med. doi:10.1001/jamainternmed.2016.2492; online July 25, 2016.

Reference Pricing, Consumer Cost Sharing, and Insurer Spending for Advanced Imaging Tests. Robinson JC, Whaley C, Brown TT; Med Care; 2016

Appropriate Use Of Reference Pricing Can Increase Value. Boynton A, Robinson JC; Health Affairs Blog, July 2015.  

Brown TT, Robinson JC. Reference Pricing with Endogenous or Exogenous Payment Limits: Impacts on Insurer and Consumer Spending. Health Economics. Early View. Article first published online: 22 Apr1l 2015 | DOI: 10.1002/hec.3181.

Consumer Choice Between Hospital-Based and Freestanding Facilities for Arthroscopy. James C. Robinson, PhD; Timothy T. Brown, PhD; Christopher Whaley, PhD; Kevin J. Bozic, MD, MBA; J Bone Joint Surg Am, 2015 Sep 16; 97 (18): 1473 -1481.

Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications. James C. Robinson, PhD ; Timothy T. Brown, PhD ; Christopher Whaley, PhD ; Emily Finlayson, MD, MS; JAMA Intern Med. Published online September 08, 2015. doi:10.1001/jamainternmed.2015.4594

Reference-based Benefit Design Changes Consumers’ Choices and Employers’ Payments for Ambulatory Surgery.Robinson JC, Brown TT, Whaley C; Health Affairs 2015; 34(3):415-22.

Increases in Consumer Cost Sharing Redirect Patient Volumes and Reduce Hospital Prices for Orthopedic Surgery. James Robinson and Timothy Brown; Health Affairs; 2013; 32(8):1392-97.

Consumer Cost Sharing and Use of Biopharmaceuticals for Rheumatoid Arthritis. James Robinson; American Journal of Managed Care; 2013; 19(6): e3205-3213.

Reference Pricing: Stimulating Cost-Conscious Purchasing and Countering Provider Market Power. James Robinson;National Institute for Health Care Management (NIHCM) Foundation: Expert Voices; October, 2013.

Comparison Shopping for Knee SurgeryJames Robinson; Wall Street Journal; October 27, 2013.

How to Turn Employees into Value Shoppers for Health Care. James Robinson; Harvard Business Review; October 21, 2013.

Payers Test Reference Pricing and Centers of Excellence to Steer Patients to Low-Price and High-Quality Providers. James Robinson and Kim MacPherson; Health Affairs; 2012; 31(9): 2028-36.

Aligning Consumer Cost-Sharing with Episode of Care (EOC) Provider Payments. James Robinson and Kim MacPherson; Integrated Healthcare Association White Paper; September 2011.

Redesigning Insurance Benefits and Consumer Cost-Sharing for High-Cost Surgical Services. James Robinson and Kim MacPherson; Integrated Healthcare Association White Paper; September 2011.

Pricing and Access for Pharmaceuticals

The prices for drugs and biologics are interpreted in quite different ways by policymakers and by innovators. For policymakers whose principal concern is patient access and affordability, prices for drugs and biologics are simply too high. And for those whose principal concern is supporting research and innovation for unmet health care needs, prices for drugs and biologics are not high enough or, at least, are in need of additional support to sustain R&D.  Both sides agree that the price of individual products should be better aligned with the value of extended life and reduced suffering they offer to patients, and to society at large by way of increased productivity and reduced downstream expenditures. They also agree that a willingness by pharmaceutical firms to moderate prices should be matched by a willingness of insurers to reduce barriers to patient access, in the form of physician prior authorization and consumer cost sharing requirements.

BCHT is pursuing a range of research projects and professional educational activities related to value-based pricing and patient access, including innovative and value-based pricing, physician payment methods for drug-related services, insurance benefit designs, and the application of reference pricing to drugs.

RESEARCH     PRESENTATIONS

 

PUBLICATIONS

Mending the broken social contract for pharmaceutical pricing and innovation, James C. Robinson, STAT, March 21, 2020

Innovation Prizes To Support Cell And Gene Therapy, James C. Robinson, Health Affairs blog, JULY 2, 2019, DOI: 10.1377/hblog20190626.554362.

Amgen Cuts Repatha’s Price by 60%. Will Value-based Pricing Support Value-based Patient Access?, Robinson JC., Health Affairs Blog, November 28, 2018.

A new era for drug pricing: the ‘accountable choice’. James Robinson, STAT, October 2018.

Value-Based Pricing and Patient Access for Specialty Drugs. James C. Robinson, Scott Howell, Steven D. Pearson, JAMA. 2018; 319(21):2169-2170. doi: 10.1001/jama.2018.5367

Using Data to Lower Costs California’s Reference-Based Payment Experience and Implications for Other States, Christopher M. Whaley, Timothy T. Brown, James C. Robinson, Issue Brief

Orphan Diseases or Population Health? Policy Choices Drive Venture Capital Investments, Misfeldt D, Robinson JC., Health Affairs Blog, July 21, 2107.

Orphan Diseases Or Population Health? Policy Choices Drive Venture Capital Investments. Dayton Misfeldt and James C. Robinson, Health Affairs Blog,(link is external)(link is external) July 21, 2017

The Redesign of Consumer Cost Sharing for Specialty Drugs at the California Health Insurance Exchange Robinson JC, Price A, Goldman Z; Am J Manag Care. 2016;22(4 Suppl):S87-S91.

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Specialty Pharmaceuticals: Policy Initiatives to Improve Assessment, Pricing, Prescription, and Use. James Robinson and Scott Howell; Health Affairs, 2014; 33(10):1745-1750.

Robinson JC, Megerlin F. Le Rapport Prix/Valeur des Médicaments d’Oncologie a L’épreuve des Méthodes de Paiement aux États-UnisTechniques Hospitalieres 2014; Nov-Dec: 27-35.

Association Between Availability of Health Service Prices and Payments for These Services. Christopher Whaley, et al; JAMA, 2014;312(16):1670-1676.

Consumer Cost Sharing and Use of Biopharmaceuticals for Rheumatoid Arthritis. James Robinson; American Journal of Managed Care; 2013; 19(6): e3205-3213.

Waiting for Economic Pressure to Force Our Hand. James Robinson; Managed Care; April 2012.

Applying Value-Based Insurance Design to High-Cost Health Services. James Robinson; Health Affairs; November 2010; 29(11):2009-2016.

Comparative Effectiveness Research: From Clinical Information to Economic Incentives. James Robinson; Health Affairs; 2010; 29(10):1788-1795.

Consumer-Driven Health Care: Promise and Performance. James Robinson and Paul Ginsburg; Health Affairs; March 2009; 28 (supplement 1): w272-w281.

Slouching Toward Value-Based Health Care. James Robinson; Health Affairs; 2008 vol. 27 no. 1 11-12.

The Health Care Rubik's Cube. James Robinson; Health Affairs; May 2008 vol. 27 no. 3619-620.

Cost-Reducing Innovation in Health Care. James C. Robinson and Mark D. Smith; Health Affairs; 2008; 27(5):1353-56.

Financing Innovation

Efforts by public and private insurers to moderate the escalation of specialty drug prices encounter the objection that industry revenues are essential to fund research and development. But industry prices and profits are only one of several mechanisms available for funding pharmaceutical R&D. Others include governmental and philanthropic research grants; commercialization grants for startups; targeted tax incentives; innovation prizes for the achievement of developmental milestones; and special regulatory incentives from the FDA.  This body of research analyzes the alternative mechanisms for funding R&D and explores potential reforms that would reduce the threat to innovation that may occur as a byproduct of downward pressure on drug prices.

 

PUBLICATIONS

Funding of Pharmaceutical Innovation During and After the COVID-19 Pandemic, James Robinson, JAMA, January 14, 2021, doi:10.1001/jama.2020.25384

Mending the broken social contract for pharmaceutical pricing and innovation, James C. Robinson, STAT, March 21, 2020

Innovation Prizes To Support Cell And Gene Therapy, James C. Robinson, Health Affairs blog, JULY 2, 2019, DOI: 10.1377/hblog20190626.554362.

Sustaining Innovation While Ensuring Affordability for Specialty Pharmaceuticals. James C. Robinson,, October 2018. White Paper.

Drug Assessment and Pricing in Germany

As the United States looks for new ideas on pharmaceutical reform, it is instructive to look at drug assessment and pricing in Germany, a prosperous nation that features universal coverage, a private multi-payer health insurance system, a large pharmaceutical industry, and drug prices that are lower and more directly linked to clinical benefit than those in the US. BCHT Director James Robinson has been studying the German system with support of the Commonwealth Fund, combining site visits with econometric analyses of the structure, processes, and outcomes of the German system.

RESEARCH     PRESENTATIONS

 

PUBLICATIONS

Drug Price Moderation in Germany: Lessons for U.S. Reform Efforts, James C. Robinson, Patricia Ex, and Dimitra Panteli,, Commonwealth Fund, Jan.2020, https://doi..org/10.26099/d3g0--mxx46(link is external)(link is external)

Sophisticated Purchasing of Pharmaceuticals Learning From Other Countries, James Robinson, September 28, 2020.doi:10.1001/jama.2020.15072

Moderation in Germany: Lessons for U.S. Reform Efforts, James C. Robinson, Patricia Ex, and Dimitra Panteli, Drug Price Commonwealth Fund, Jan.2020, https://doi..org/10.26099/d3g0--mxx46(link is external)(link is external)

Sophisticated Purchasing of Pharmaceuticals Learning From Other Countries, James Robinson, September 28, 2020.doi:10.1001/jama.2020.15072

Lower Prices and Greater Patient Access — Lessons from Germany’s Drug-Purchasing Structure, James C. Robinson. N Engl J Med 2020; 382:2177-2179, DOI: 10.1056/NEJMp2000341

Increasing Divergence in Drug Prices Between the United States and Germany After Implementation of Comparative Effectiveness Analysis and Collective Price Negotiations, Fabian Berkemeier, Christopher Whaley,  James C. Robinson, J Manag Care Spec Pharm. 2019;25(12):1310-17

Negotiating drug prices without restricting patient access: lessons from Germany,  James C. Robinson, Dimitra Panteli, and Patricia Ex, STAT, June 27, 2019

How Drug Prices Are Negotiated in Germany, James C. Robinson, Patricia Ex, and Dimitra Panteli, June 13, 2019, Commonwealth Fund, blog

Single-Payer Drug Pricing In A Multipayer Health System: Does Germany Offer A Model For The US?  James C. Robinson, Patricia Ex, and Dimitra Panteli, Health Affairs, March 22, 2019, blog 

Reference Pricing in Germany: Implications for U.S. Pharmaceutical Purchasing. Robinson JC, Panteli D, Ex P., Commonwealth Fund, issue brief, February 2019.

Reference Pricing in Germany: Lessons for U.S. Pharmaceutical Purchasing. Robinson JC, Panteli D, Ex P. Commonwealth Fund, issue brief, February 2019. 

Pharmaceutical Reference Pricing: Does It Have a Future in the US?  Robinson JC. Commonwealth Fund, issue brief, September 2018.  

Reference Pricing, Consumer Cost Sharing, and Insurer Spending for Pharmaceuticals.Robinson JC, Whaley CM, Brown TT. Berkeley Center for Health Technology.  Issue Brief.  June 2017.

Association of Reference Pricing with Drug Selection and Spending. Robinson JC, Whaley C, Brown TT.   New England Journal of Medicine 2017; 377:658-675.

Reference Pricing for Joint Replacement

Medical Devices

Implantable medical devices, ranging from artificial knees to cardiac pacemakers to deep brain stimulators, offer substantial benefit to patients and value to society.  This clinical and social value depends, however, on the high quality but affordably priced devices being used on the appropriately selected patient, by an experienced surgeon, and in the least costly site of care.  Over the past ten years BCHT has conducted a series of quantitative and qualitative studies of device assessment, pricing, and utilization, with the results disseminated through peer-reviewed journal articles, Issue Briefs and journalistic reports, and presentations at professional, governmental, and scholarly conferences.  Some of the key findings of the research were brought together in a book, Purchasing Medical Innovation, published by the University of California Press in 2015.

RESEARCH     PRESENTATIONS

 

PUBLICATIONS

Competition among hospitals and between hospitals and ambulatory sites of care

Baltzell J, Robinson JC.  Medical Technology: What Changing Venture Capital Investments Signal.  Health Affairs Blog, January 9, 2017. 

Robinson JC, Fessler R.  “Diversification or Specialization: Lessons from the Redesign of Orthopedic Surgery in Two Hospitals”.  Issue Brief.  University of California, Berkeley Center for Health Technology.  May 2013.

Robinson JC. Case Studies of Orthopedic Surgery Redesign in California: The Virtues of Care Coordination Versus Specialization.  Health Affairs 2013; 32(5):921-28.

 

More sophistical assessment and purchasing of devices

Medical Technology: What Changing Venture Capital Investments Signal. Baltzell J, Robinson JC. Health Affairs Blog, January 9, 2017.

US Hospital Payment Adjustments for Innovative Technology Lag Behind Those In Germany, France, and Japan. Hernandez J, Machacz SF, Robinson JC; Health Affairs 2015; 34(2):261-270.

Purchasing Medical Innovation: The Right Technology, for the Right Patient, at the Right Price.(link is external)(link is external)   Robinson JC; University of California Press, 2015.

Valeur et Paiement des Medicaments Innovants: Cas de l’Oncologie aux Etats-Unis (Value and Payment for Oncology in the United States)(link is external)(link is external)(link is external)(link is external)(link is external)(link is external). Robinson JC.  Annales Pharmaceutiques Francaises 2013; 71(5):285-290. Reprinted in Contrat de Performance et Acces au Marche de l’Innovation Therapeutiqu(link is external)(link is external).  Edited by F. Megerlin.  Issy-les-Moulineaux France: Elsevier Masson.  2014.

Robinson JC, Brown TT.  Quantifying Opportunities for Hospital Cost Control: Medical Device Purchasing and Patient Discharge Planning.  American Journal of Managed Care 2014; 20(9):e418-e424.

 

Alignment of hospitals with physicians through employment and joint ventures

Dolan EL, Robinson JC.  “Physician-Hospital Alignment in the Evaluation, Purchasing, and Use of Implantable Medical Devices.” University of California, Berkeley Center for Health Technology, January 2010.

  

Unjustified variability in price and performance

Reform of Health Care Payment in the United States: What Impact on Relations between Physicians, Hospitals, and Device Manufacturers? James Robinson and Francis Megerlin;  Dec 2012

Variability in Costs Associated with Total Hip and Knee Replacement Implants. James Robinson, Alexis Pozen, Samuel Tseng, and Kevin Bozic; Journal of Bone and Joint Surgery; 2012; 94:1693-98.

Robinson JC, Pozen A, Tseng S, Bozic KJ.  Variability in Costs Associated with Total Hip and Knee Replacement Implants.  Journal of Joint and Bone Surgery 2012; 94:1693-98.

 

Bundled payment for device-intensive procedures

Hernandez J, Machacz SF, Robinson JC.  US Hospital Payment Adjustments for Innovative Technology Lag Behind Those In Germany, France, and Japan.  Health Affairs 2015; 34(2):261-270.

Caillouette J, Robinson JC.  The “Failure” of Bundled Payment: The Importance of Consumer Incentives.  Health Affairs blog August 21, 2014.  

Williams T, Robinson JC.  Bundled Episode-of-Care Payment for Orthopedic Surgery: The Integrated Healthcare Association Initiative.  Issue Brief.  September 2013. 

Bundled Episode-of-Care Payment for Orthopedic Surgery: The Integrated Healthcare Association InitiativeIssue Brief, authored jointly by IHA CEO, Tom Williams, and BCHT Director, James Robinson; September, 2013

Provider Payment and Consumer Benefit Design

Hospitals increasingly are purchasing physician practices and employing individual physicians as part of their strategy to evolve into fully integrated health systems.  This consolidation offers the potential for improvements in care coordination and efficiency, but also the risk of increased pricing power and organizational complexity.  This study uses 2013-14 claims data from Anthem Blue Cross of California, covering all commercially insured enrollees in the firm’s PPO products, to examine the cost of care incurred by patients treated by hospital-affiliated physicians in comparison to costs incurred by patients treated by physicians not employed by hospital-owned medical groups and practices.  The total cost of care per patient is measured using claims for ambulatory, hospital, pharmaceutical, and ancillary clinical services.  This study also examines selected measures of clinical quality, which vary by specialty.  Data were obtained from Anthem. This study is funded by the California Public Employee Retirement System (CalPERS).

RESEARCH     PRESENTATIONS

 

PUBLICATIONS

James C. Robinson, Slouching Towards Disruptive InnovationHealth Affairs Blog, February 2020,10.1377/hblog20200227.395178

Robinson JC, Ex P, Panteli D.  Single-Payer Drug Pricing in a Multi-Payer Health System: Does Germany Offer a Model to the US?  Health Affairs Blog, March 2019

Robinson JC, S Howell, SD Pearson.  Value-based Pricing and Patient Access to Specialty Drugs.  JAMA 2018; 319(21):2169-2170.  

Robinson JC.  Amgen Cuts Repatha’s Price by 60%.  Will Value-based Pricing Support Value-based Patient Access?  Health Affairs Blog, November 28, 2018. healthaffairs.org/do/10.1377/hblog20181127.943927/full/.

Medicare Advantage Reimbursement to Physicians. James Robinson; JAMA Internal Medicine 2017;177(9):1295-1296.  Published online July 10.  doi:10.1001/jamainternmed.2017.2689

Value-Based Physician Payment in Oncology: Public and Private Insurer Initiatives. James Robinson; The Milbank Quarterly, Vol. 95, No. 1, 2017 (pp. 184-203)

Robinson JC, Price A, Goldman Z.  The Redesign of Consumer Cost Sharing for Specialty Drugs at the California Health Insurance Exchange. American Journal of Managed Care 2016; 22(4):Supplement S87-S91