Rethinking Payment for Prevention in Healthcare

Author: Maria Alva


Prevention plays a crucial and under-appreciated role in our health system. To improve health outcomes and bring down costs, it will be important to establish a better balance between preventive measures and drug treatments. The next administration should provide incentives to healthcare providers that scale up—and reduce costs of delivering—preventive interventions with demonstrated efficacy. Currently, the U.S. Department of Health and Human Services (HHS) sets broad standards regarding managed care contracts. But states have considerable latitude. States can set income eligibility criteria, define services, and set alternative payment methods with Managed Care Organizations (MCOs). And in just the last few decades, Medicaid programs have been almost fully privatized: MCOs now cover over 85% of the Medicaid population. Because of the existing patchwork of insurance programs and state rules, it is important that regulations set minimum national standards to ensure that health care is accessible and affordable for those who need it the most. Particularly important to this effort are non-distortionary prices and reimbursement policies.

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About the Author

Maria Alva is a health economist with over a decade of research experience. Maria is an Assistant Research Professor at the Massive Data Institute at Georgetown University. Before that, she worked as a federal contractor for the IMPAQ International Health Division as a Senior Research Associate and RTI International as a health economist. Maria’s work has involved impact evaluations of programs addressing chronic disease prevention at the state and local levels. Maria started her career at the University of Oxford, where her research focused on economic analyses of the United Kingdom Prospective Diabetes Study—a landmark trial of policies to improve type 2 diabetes management. Maria’s work has had a significant policy impact. For example, spending estimates from the evaluation of the YMCA DPP informed CMS' policy—Medicare included the Diabetes Prevention Program as a covered benefit in 2018. Maria’s work has been published in leading field journals such as Health Affairs, Health Economics, Health Services Research, American Journal of Preventive Medicine, and Diabetic Medicine.