Health Economist Julius Chen Runs the Numbers on Health Care

The U.S. spends more on health care, per person, than any other high-income country, yet our outcomes fail to measure up. We live sicker and die younger than our counterparts around the world. It’s a scenario ripe for innovation, says Julius Chen, PhD, a health care economist who analyzes how marketplace innovations affect population wellbeing. “Everything we do has tradeoffs,” he says. “I’m looking for ways we can improve the quality and value of health care for the large amount of money we’re spending.”

Chen joined Columbia’s Mailman School of Public Health as an assistant professor of Health Policy and Management in 2018. His current projects include collaborations with large employers and health systems to study innovative service delivery and provider payment models, analyses of telehealth initiatives for underserved communities in New York City, and assessments of how nurse practitioner-led teams can facilitate the delivery of dementia care to Medicare beneficiaries. “I think the private and public sectors can learn from each other to improve population health,” says Chen. “That’s why I’m interested in looking at both sides and working with both private and public employers to improve value and control spending.”

Q. Where do you see the greatest opportunities for innovation in health care?

Chen: I’m interested in public policies, technological advances, and what large employers or payers are doing. You see a lot of headlines about innovations by private companies like Walmart and Google. Equally important are the things that public employers are doing to promote patient-centered, affordable care.

Q. Are there state-level examples of this kind of innovation?

Chen: In New Jersey, the Department of the Treasury oversees health insurance plans for public employees. After years of out-of-control spending, they recently passed reforms to their health insurance plans for public school employees in particular. I’m talking with them about evaluating the effect of those reforms, including value-based payments, integrated care delivery, and narrower provider networks. I’m interested in thinking about how reorganizing such benefits can save states money and provide more patient-centered, coordinated care for public employees.

Q. What’s the value for you in examining innovation across many sectors, public and private?

Chen: I hope that there is sharing of best practices and learning across sectors. I want to get the word out about what’s working and how other entities can copy these models and move the needle on improving outcomes.

Q. What trends in health insurance are you tracking at the state level?

Chen: I’m really interested in this idea of government-sponsored plans that compete with private plans and what that does to the market—a public option. While the idea of a federal public option has lost momentum, a lot of states have picked up on the idea. In one form, the state contracts with private insurance companies set very clear regulations for what the plan can look like, and offer it on the health insurance exchange. It’s government regulated and sponsored, but still technically private.

Q. What’s the goal of a public option?

Chen: In theory, a lower-cost public option would induce competition. The hope is that as a person going on the state’s health insurance exchange, you find this public option plan that’s more affordable and provides the benefits you need. And at the state level, sufficient numbers are drawn to that option so that other insurers feel the pressure and lower their premiums in response to the competition.

Q. are states making progress toward implementing a public option?

Chen: Colorado and Nevada are in the planning stages. Washington has already launched their public option, though early implementation has been challenging. There’s been a lot of learning as they go, modifications, and adjustments. Importantly, a common feature of public option proposals is paying providers for services based on what Medicare pays, which tends to be lower than private insurer prices. It’s an interesting idea to benchmark to Medicare rates. One concern from the provider side is that Medicare rates are too low. I’m curious if there’s a way to achieve a sweet spot, paying enough to compensate for costs and incentivize providers to participate in networks while still ultimately controlling spending growth.