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Researcher | Research Overview

Lab Web Site: Alyna Chien

Alyna T. Chien, MD, MS is an expert on the use of incentives to improve healthcare quality and spending. She has conducted a variety of studies that examine the effectiveness of payment reforms like pay-for-performance in adult and pediatric settings. She also examines unintended consequences related to incentives, with a particular focus on how incentives shape care delivery for vulnerable populations like the socioeconomically disadvantaged, racial/ethnic minorities, children, and those with disabilities.

Dr. Chien’s current research includes a study on whether revealing price information to physicians changes their ordering behavior and care quality. She is examining whether geocoding methods can improve pediatric risk adjustment models and creating a claims-based algorithm for identifying Children with Disabilities. She is also evaluating Harvard Medical School’s Academic Innovations Collaborative, a QI learning collaborative aimed at redesigning primary care delivery within the Harvard system.

Researcher | Research Background

Dr. Chien is an Assistant Professor of Pediatrics at Harvard Medical School and practicing pediatrician at Boston Children’s Hospital. Before becoming a physician, she spent nearly a decade in community-based direct service. As a physician, she has always cared for vulnerable patient populations, working almost exclusively with patients insured by Medicaid or receiving care in a free or federally qualified health center setting. Dr. Chien serves on prominent national committees including the PCORI Advisory Panel on Disparities and the AAP Committee on Pediatric Research. She is an alumna of The University of Chicago’s Pritzker School of Medicine and The Robert Wood Johnson Clinical Scholars Program.

Selected Publications

  1. Chien AT, Davis AM, Chin MH, Casalino LP. Pay-for-performance, public reporting and racial disparities in health care. Med Care Res Rev. 2007;64(5 Suppl):283S-304S.
  2. Chien AT, Conti RM, Pollack HA. A pediatric-focused review of the performance incentive literature. Curr Opin Pediatr. 2007;19(6):719-725.
  3. Chien AT, Coleman M, Friedman-Ross LS. Qualitative insights into how pediatric pay-for-performance programs are being designed. Acad Pediatr. 2009;9(3):185-191.
  4. Chien AT, Li Z, Rosenthal MB. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010;45(6 pt 2):1934-1947. PMCID: PMC3029849.
  5. Chien AT, Kirchhoff AC, Schaefer CT, Huang ES, Brown SE, Heuer L, Graber J, Casalino LP, Chin MH. Positive and negative spillovers of the Health Disparities Collaboratives in Federally Qualified Health Centers: staff perceptions. Med Care. 2010;48(12):1050-1056.
  6. Chien AT, Wroblewski K, Damberg C, Williams TR,Yanagihara D, Yakunina Y, Casalino LP. Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures? J Gen Intern Med. 2012;27(5):548-554. PMCID: PMC3326117.
  7. Chien AT, Eastman D, Li Z, Rosenthal MB. Impact of a pay for performance program to improve diabetes care in the safety net. Prev Med. 2012;55 Suppl:S80-S85.
  8. Chien AT, Rosenthal MB. Medicare's physician value-based payment modifier - Will the tectonic shift create waves? N Engl J Med. 2013;369(22):2076-2078.
  9. Chien AT, Song ZS, Chernew ME, Landon BE, McNeil BJ, Schuster MA. Two-year impact of the alternative quality contract on pediatric healthcare quality and spending. Pediatrics. 2014;133(1):96-104.
  10. Chien AT, Chin MH, Alexander GC, Tang H, Peek ME. Physician financial incentives and care for the underserved in the United States. Am J Manag Care. 2014;20(2):121-129.

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Active Projects

2012-2014       Improving Pediatric Risk Adjustment Algorithms

Boston Children’s Hospital Office of Faculty Development
Principal Investigator

Proposes to improve existing pediatric risk adjustment algorithms by increasing the amount of clinical and socio-demographic information these softwares incorporate using existing claims data, Boston Children’s Hospital’s clinical information systems, and publicly available neighborhood information that can be linked to patient addresses.

2013-2015       Using Geocoded Socioeconomic Data to Enhance Pediatric Risk Adjustment Methods

NICHD 1R21HD076442-01
Principal Investigator

This study examines the degree to which incorporating geographically based socioeconomic (SE) information advances our understanding of the risk adjustment methods needed to better match healthcare payments with pediatric patient complexity. The study will facilitate ongoing health system and policy efforts aimed at ensuring that children from low SE background have access to insurance and medical care and narrowing disparities in child health and healthcare.

2013-2015       Understanding the Use and Impact of Price Data in Health Care

Robert Wood Johnson Foundation
Principal Investigator

A mixed method randomized controlled trial to investigate whether providing physicians with real-time information about the price of imaging tests and diagnostic procedures changes test ordering rates, the appropriateness of testing, and physician perspectives on their patient relationships.

Researcher | Publications