Discovering How — and Why — Medical Costs and Outcomes Vary Across Regions

Why do health care quality and cost outcomes vary — in some cases quite widely — from state to state, region to region, and even within the same city? The Network for Regional Healthcare Improvement (NRHI) and four of its members are partnering with the National Bureau of Economic Research, Harvard University, and others in a five- year study that aims to create a national model to help understand the characteristics of delivery systems that contribute to better health care at lower costs.

Measuring the Clinical and Economic Outcomes Associated with Delivery Systems will tap into extensive information — insurance claims, patient-experience data, and other qualitative information — available in four regional health improvement collaboratives (RHICs) to identify which health care delivery systems in a region or state deliver high quality, affordable care and, most importantly, how and why.

The four RHICs participating in this initiative are:

Understanding how and why variations occur locally will in turn help inform research and policy decisions at a national level.

In- and across-state comparisons: The four RHICs are analyzing insurance claims data to calculate a common set of quality and cost measures. The RHICs will calculate results at various levels of geographic and organizational granularity. Throughout the five years of the study, the RHICs will work together to grow their internal quality and cost measure-set and to establish consistency of system and measure definitions.

System characteristics impact: Using information from their provider directories and leveraging their local relationships and knowledge of the marketplace, the RHICs will identify factors that impact cost and quality variations. Factors will include: payment models, formal or informal contracting arrangements, political environment, rural versus urban settings, cultural norms, and system integration and consolidation.

Regional collaboration and alignment: This project is an opportunity to build regional capacity to conduct research across and within states, while accommodating and learning from local variations.

The first area of study will explore quality variations across states and begin to develop hypotheses about why these variations occur. The states will be comparing results on eight quality measures that fall under pediatric, behavioral health and/or preventive care, including Hospital Admissions (18 and older), Adolescent Well-Care Visits, Follow-up Care for Children Prescribed ADHD Medication, and Chlamydia Screening. Results to be released winter 2017.


This project is supported by grant number U19HS024072 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the political views of the Agency for Healthcare Research and Quality.

CONTACT: Dianne Hasselman, Executive Director, Federal and New Programs, NRHI .