Working Papers

The Medical Industry Leadership Institute is proud to announce our Working Papers series. Carlson students have written these papers on topics relevant to today's medical industry. The series will represent a small portion of the work done by Carlson students, both past and present. All working papers are posted on our website. We hope that by posting papers we will not only stimulate discussion but also contribute to advancing our knowledge of the medical industry.

All papers have completed a review process prior to being posting, but full responsibility for the content of the paper remains with the author(s). Comments from readers are welcomed and should be sent directly to the author(s). Their views do not necessarily reflect those of the Medical Industry Leadership Institute. All papers are in PDF format.


Using the 2014 health insurance exchange enrollment data and a micro-simulation model funded in part by the U.S. Department of Health and Human Services, we estimate the national and state impact of the ACA on insurance prices and enrollment from 2015-2024.Estimating the trajectory of health plan prices and enrollment is critical to informing ongoing health care policy debate. Decisions regarding the delayed implementation of the qualified health plan requirements, the delayed enforcement of the employer mandate, and the scheduled termination of the temporary reinsurance and risk corridor programs are estimated to have dramatic impact on insurance prices and enrollment by 2017.

The Affordable Care Act changed the landscape of American health care in many significant ways, with much of it receiving high levels of scrutiny. However, the expansion of a little-known federal program for hospitals – a result of Congress’s mission to increase care provided to the uninsured – has largely remained under the radar. It merits attention, however, because this change will cause unanticipated complications for patients and physicians, while likely increasing overall healthcare costs.

  • "A Review of Value-Based Compensation and Its Potential to Impact Healthcare Spend" by Matt Chock, MBA '15

    The trend in U.S. healthcare expenditures has become an important area of focus in recent years for employers and legislators, as its annual outpacing of GDP is placing significant strain on the economy. In order to begin bending the healthcare cost curve, Accountable Care Act (ACA) legislation was passed in 2010 as an attempt to drive greater efficiencies in healthcare through the use of new payment and compensation models. However, those in the healthcare industry that are directly impacted by this legislation are struggling to determine whether the incentive models outlined in the ACA will create the motivation and performance changes that the legislation intends. This paper further discusses the ACA incentive models and how they correlate to learnings from studies on the effect of incentives on motivation and performance, and outcomes from previous healthcare incentive-based demonstration projects.

  • "Working Hard or Hardly Working? The Effects of Pay Structure on Cost of Healthcare Provision"
    by Alex V. Vo, MBA '13

    With the cost of healthcare rising in the United States, policy makers and hospital management are trying to find ways to reduce costs associated with the provision and consumption of healthcare. One way to maintain costs within the hospital is examining physician pay. Financial incentives drive physician behavior and can affect the cost of care provided. Specifically, research has been done on the effects and differences between fee-for-service and the capitation method. The research found that different pay structure has different effects on physician behavior and implications on the cost of care given. However, there is a lack of empirical evidence on physicians with no prior exposure to either compensation method. This thesis intends in investigate how costs are affected by fee-for-service and the capitation method on medical students.

  • " Lean Healthcare: Controlling Cost through Better Care"
    by Frank R. Lowe, MHI ’13, Senior Systems Analyst at Park Nicollet Health Services as part of his capstone project for his Masters of Health Informatics degree.

    W. Edwards Deming said, “It is not enough to do your best; you must know what to do, and then do your best.” All healthcare leaders are looking for solutions to rising healthcare costs, poor quality outcomes and poor patient safety. There is no easy fix; however, a few healthcare organizations with forward thinking leaders chose the very unpopular approach of implementing Lean. These leaders were rewarded by implementing positive transformations to their institutions including marked decreases in costs and increase in quality care for their patients. By dedicating funding and resources to the implementation of Lean, these healthcare institutions have been recognized nationally and internationally for their quality improvements and have become leaders in the field of quality improvement. Discover how healthcare organizations dedicated to Lean have saved millions of dollars while improving quality of care and patient safety.

  • "What is the Regional Impact of the Medicare Fee-For-Service and Medicare Advantage Payment Reductions?"
    by Robert A. Book, Senior Research Director, HSI Network and Michael Ramlet, '09 BSB, Director Health Policy, American Action Forum and MILI Affiliate

    On July 24, 2012, the Congressional Budget Office (CBO) released an updated analysis of the Medicare payment reductions included in the Affordable Care Act (ACA). Notably, this updated CBO estimate represents the first time that the Medicare payment reductions are accounted for in the full 10-year budget window. Totaling an estimated $716 billion between 2013 and 2022, the Medicare payment reductions comprise a majority of the Affordable Care Act's budgetary savings. However, the payment reductions are not uniformly distributed across the U.S. geography. To better understand the regional impact of the Medicare fee-for-service and Medicare Advantage payment reductions, we have revised and updated our earlier MILI working paper to reflect the state and county-level impacts based on the updated CBO estimate.

  • "Does 'Meaningful Use' Lead to Effective EHR in American Healthcare?"
    by Ramakrishna Talasila, MBA'12

    Use of Electronic Health Records (EHR) by American healthcare providers is accelerating, largely due to government regulations and incentives tied to 'Meaningful Use.' While evidence suggests EHRs improve the quality of care, 'Meaningful Use' guidelines have not, thus far, advanced a set of features that will truly realize the full potential of EHRs. In fact, published research suggests that featuring Clinical Decision Support (CDS) in EHRs is critical for the adoption of "evidence-based care" as well as the hoped-for quality and cost improvements, yet it is minimally represented in federal Meaningful Use guidelines. This paper discusses CDS in the context of Meaningful Use, suggesting policy adjustments that can further promote its widespread use in order to achieve the full potential of EHRs.

  • "What Changes will Health Reform Bring to Medicare Advantage Plan Benefits and Enrollment?"
    by Robert A. Book, Senior Research Director, HSI Network and Michael Ramlet, '09 BSB, MILI Affiliate and Director Health Policy, American Action Forum

    The Medicare Advantage (MA) program allows Medicare beneficiaries to choose CMS-approved private insurance as an alternative to "traditional" fee-for-service (FFS) Medicare. The Patient Protection and Affordable Care Act modifies the formula for payments to MA plans, imposing deep cuts to the program. These will result in large reductions in enrollment, reductions in the number of plan choices, and reductions in the level of benefits. We estimate the magnitude of these changes, at both the national and state levels. The impact of these changes is characterized by wide geographic variation, but every state shows a substantial reduction in all three measures.

  • "Show Providers the Money: Revenue Cycle Improvement, the bargaining Chip Needed for Widespread EMR Adoption"
    By Michael Ramlet, '09 BSB

    This paper was Michael's honors theses, completed as part of the summa cum laude requirements. This thesis evaluated the federal health IT incentives in the 2009 economic stimulus bill and the economics of provider electronic medical record adoption.

  • "Insurance Regulation: Is Increased Competition in the Health Insurance Industry Desirable?"
    By Bryce Meyer, '10 JD/MBA

    The Affordable Healthcare for America Act was passed by the United States House of Representatives on November 7, 2009. This Act removes the exemption from antitrust laws for health insurance providers and creates a National Health Insurance Exchange to increase competition and access for consumers to insurance coverage. This paper evaluates whether competition in the health insurance industry will be beneficial to consumers. Subsequent to this paper being written, the United States Senate passed the Patient Protection and Affordable Care Act on December 24, 2009, which will be discussed briefly in the appendix.

  • "Conditions for the Positive Impact of Health IT on Contemporary Health Reform"
    By Brett Pederson, '09 MBA

    This paper discusses the potential benefits of HIT and the environment necessary for those benefits to be reached to full potential. It also touches lightly on policy recommendations to mitigate the inherent risks of HIT implementation.

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