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.

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.

Visit www.alynachien.org for current projects, job opportunities, and other news!

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.

Education

Undergraduate School

University of Chicago
1989 Chicago IL

Graduate School

University of Chicago Pritzker School of Medicine
2001 Chicago IL

Medical School

University of Chicago
2001 Chicago IL

Internship

University of Chicago
2002 Chicago IL

Residency

Pediatrics University of Chicago
2004 Chicago IL

Fellowship

Robert Wood Johnson Clinical Scholar University of Chicago
2006 Chicago IL

Publications

  1. Insurance gaps at age-19 and age-26 health insurance eligibility thresholds by childhood-onset condition severity, Colorado 2014-2018. Health Serv Res. 2025 Jan 12; e14432. View Abstract
  2. Pediatric Practices' Experiences with Massachusetts' Medicaid Accountable Care Organizations. Acad Pediatr. 2024 Nov 05; 102601. View Abstract
  3. A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018. Hosp Pediatr. 2024 Nov 01; 14(11):899-908. View Abstract
  4. Neurodevelopmental and Mental Health Conditions in Children With Medical Complexity. Pediatrics. 2024 Sep 01; 154(3). View Abstract
  5. Impairment Types and Combinations Among Adolescents and Young Adults with Disabilities: Colorado 2014-2018. Acad Pediatr. 2024 May-Jun; 24(4):587-595. View Abstract
  6. Specialist use among privately insured children with disabilities. Health Serv Res. 2024 08; 59(4):e14199. View Abstract
  7. Value-Based Purchasing Design And Effect: A Systematic Review And Analysis. Health Aff (Millwood). 2023 06; 42(6):813-821. View Abstract
  8. Diabetes-Focused Health Care Utilization Among Adolescents and Young Adults With Type 1 Diabetes. Acad Pediatr. 2024 Jan-Feb; 24(1):59-67. View Abstract
  9. Exploring system features of primary care practices that promote better providers' clinical work satisfaction: A qualitative comparative analysis. Health Care Manage Rev. 2022 Oct-Dec 01; 47(4):360-368. View Abstract
  10. Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial. JAMA. 2022 07 05; 328(1):27-37. View Abstract
  11. Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years. Am J Obstet Gynecol. 2022 07; 227(1):108-111. View Abstract
  12. Difficulty Obtaining Behavioral Health Services for Children: A National Survey of Multiphysician Practices. Ann Fam Med. 2022 Jan-Feb; 20(1):42-50. View Abstract
  13. Increases in Inpatient Psychiatry Beds Operated by Systems, For-Profits, and Chains, 2010-2016. Psychiatr Serv. 2022 05; 73(5):561-564. View Abstract
  14. Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance. JAMA Netw Open. 2021 08 02; 4(8):e2121410. View Abstract
  15. Availability of Pediatric Inpatient Services in the United States. Pediatrics. 2021 07; 148(1). View Abstract
  16. Pediatric Primary Care-Based Social Needs Services and Health Care Utilization. Acad Pediatr. 2021 Nov-Dec; 21(8):1331-1337. View Abstract
  17. Protocol for a randomized controlled trial evaluating the impact of the Nurse-Family Partnership's home visiting program in South Carolina on maternal and child health outcomes. Trials. 2020 Dec 04; 21(1):997. View Abstract
  18. Pediatric Hospital Services Within a One-Hour Drive: A National Study. Pediatrics. 2020 11; 146(5). View Abstract
  19. Working around hierarchy: Resident and medical assistant teaming. Health Care Manage Rev. 2020 Jul/Sep; 45(3):232-244. View Abstract
  20. Did the Rising Tide Float All Boats? J Pediatr. 2020 11; 226:9-10. View Abstract
  21. Women's Coverage, Utilization, Affordability, And Health After The ACA: A Review Of The Literature. Health Aff (Millwood). 2020 03; 39(3):387-394. View Abstract
  22. Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations. Health Serv Res. 2020 04; 55(2):277-287. View Abstract
  23. Physician and facility drivers of spending variation in locoregional prostate cancer. Cancer. 2020 04 15; 126(8):1622-1631. View Abstract
  24. Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates. Inquiry. 2020 Jan-Dec; 57:46958020952911. View Abstract
  25. Adult-Oriented Health Reform and Children's Insurance and Access to Care: Evidence from Massachusetts Health Reform. Matern Child Health J. 2019 Aug; 23(8):1008-1024. View Abstract
  26. Intentional or Not: Teamwork Learning at Primary Care Clinics. Med Sci Educ. 2019 Dec; 29(4):969-975. View Abstract
  27. Mental Illness Among Youth With Chronic Physical Conditions. Pediatrics. 2019 07; 144(1). View Abstract
  28. Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study. J Gen Intern Med. 2019 07; 34(7):1146-1153. View Abstract
  29. Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients. JAMA Intern Med. 2019 01 01; 179(1):54-61. View Abstract
  30. Relationship among team dynamics, care coordination and perception of safety culture in primary care. Fam Pract. 2018 12 12; 35(6):718-723. View Abstract
  31. What drives variation in spending for breast cancer patients within geographic regions? Health Serv Res. 2019 02; 54(1):97-105. View Abstract
  32. Assessment of Hospitalist-Subspecialist Agreement About Who Should Be in Charge and Comparison With Actual Assignment Practices. Hosp Pediatr. 2018 08; 8(8):479-485. View Abstract
  33. Racial disparities in fifth-grade sun protection: Evidence from the Healthy Passages study. Pediatr Dermatol. 2018 Sep; 35(5):588-596. View Abstract
  34. Care Quality and Spending Among Commercially Insured Children With Disabilities. Acad Pediatr. 2019 04; 19(3):291-299. View Abstract
  35. A Cost Analysis of Universal versus Targeted Cholesterol Screening in Pediatrics. J Pediatr. 2018 05; 196:201-207.e2. View Abstract
  36. Establishing Teams: How Does It Change Practice Configuration, Size, and Composition? J Ambul Care Manage. 2018 Apr/Jun; 41(2):146-155. View Abstract
  37. Team-based primary care: The medical assistant perspective. Health Care Manage Rev. 2018 Apr/Jun; 43(2):115-125. View Abstract
  38. Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding. J Gen Intern Med. 2018 04; 33(4):415-422. View Abstract
  39. Feeling inadequate: Residents' stress and learning at primary care clinics in the United States. Med Teach. 2018 09; 40(9):920-927. View Abstract
  40. Socioeconomic Background and Commercial Health Plan Spending. Pediatrics. 2017 Nov; 140(5). View Abstract
  41. Achieving the Promise of Price Transparency. JAMA Intern Med. 2017 07 01; 177(7):946-947. View Abstract
  42. Quality of Primary Care for Children With Disabilities Enrolled in Medicaid. Acad Pediatr. 2017 May - Jun; 17(4):443-449. View Abstract
  43. The Effect of Price Information on the Ordering of Images and Procedures. Pediatrics. 2017 Feb; 139(2). View Abstract
  44. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Manage Rev. 2017 Jan/Mar; 42(1):28-41. View Abstract
  45. A Randomized Trial of Displaying Paid Price Information on Imaging Study and Procedure Ordering Rates. J Gen Intern Med. 2017 Apr; 32(4):434-448. View Abstract
  46. How Primary Care Physicians Integrate Price Information into Clinical Decision-Making. J Gen Intern Med. 2017 01; 32(1):81-87. View Abstract
  47. To Risk Adjust or Not to Risk Adjust: Should That Be the Question? JAMA Pediatr. 2016 Apr; 170(4):319-20. View Abstract
  48. How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract. Acad Pediatr. 2016 Mar; 16(2):200-7. View Abstract
  49. Development of the Children With Disabilities Algorithm. Pediatrics. 2015 Oct; 136(4):e871-8. View Abstract
  50. Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care. Pediatrics. 2015 Aug; 136(2):251-62. View Abstract
  51. The role of states in improving price transparency in health care. JAMA Intern Med. 2015 Jun; 175(6):886-7. View Abstract
  52. Development and validation of the primary care team dynamics survey. Health Serv Res. 2015 Jun; 50(3):897-921. View Abstract
  53. Massachusetts health reform and access for children with special health care needs. Pediatrics. 2014 Aug; 134(2):218-26. View Abstract
  54. Physician financial incentives and care for the underserved in the United States. Am J Manag Care. 2014 Feb; 20(2):121-9. View Abstract
  55. Two-year impact of the alternative quality contract on pediatric health care quality and spending. Pediatrics. 2014 Jan; 133(1):96-104. View Abstract
  56. Medicare's physician value-based payment modifier--will the tectonic shift create waves? N Engl J Med. 2013 Nov 28; 369(22):2076-8. View Abstract
  57. Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. Pediatrics. 2013 Mar; 131(3):e903-11. View Abstract
  58. Disparities in unmet need for care coordination: the national survey of children's health. Pediatrics. 2013 Feb; 131(2):217-24. View Abstract
  59. Waste not, want not: promoting efficient use of health care resources. Ann Intern Med. 2013 Jan 01; 158(1):67-8. View Abstract
  60. Impact of a pay for performance program to improve diabetes care in the safety net. Prev Med. 2012 Nov; 55 Suppl:S80-5. View Abstract
  61. Can pay for performance improve the quality of adolescent substance abuse treatment? Arch Pediatr Adolesc Med. 2012 Oct; 166(10):964-5. View Abstract
  62. Racial/ethnic disparities in health-related quality of life and health in children are largely mediated by family contextual differences. Acad Pediatr. 2012 Nov-Dec; 12(6):532-8. View Abstract
  63. Marital conflict and fifth-graders' risk for injury. Accid Anal Prev. 2012 Jul; 47:30-5. View Abstract
  64. Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures? J Gen Intern Med. 2012 May; 27(5):548-54. View Abstract
  65. The impact of statistical choices on neonatal intensive care unit quality ratings based on nosocomial infection rates. Arch Pediatr Adolesc Med. 2011 May; 165(5):429-34. View Abstract
  66. Positive and negative spillovers of the Health Disparities Collaboratives in federally qualified health centers: staff perceptions. Med Care. 2010 Dec; 48(12):1050-6. View Abstract
  67. Breastfeeding rates differ significantly by method used: a cause for concern for public health measurement. Breastfeed Med. 2011 Feb; 6(1):31-5. View Abstract
  68. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010 Dec; 45(6 Pt 2):1934-47. View Abstract
  69. Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison. Acad Pediatr. 2010 Jul-Aug; 10(4):266-73. View Abstract
  70. African American adolescent males' views on doctors and the health care system. J Natl Med Assoc. 2010 Apr; 102(4):312-20. View Abstract
  71. Hospital executives' perspectives on pay-for-performance and racial/ethnic disparities in care. Med Care Res Rev. 2010 Oct; 67(5):574-89. View Abstract
  72. Qualitative insights into how pediatric pay-for-performance programs are being designed. Acad Pediatr. 2009 May-Jun; 9(3):185-91. View Abstract
  73. Incorporating disparity reduction into pay-for-performance. J Gen Intern Med. 2009 Jan; 24(1):135-6. View Abstract
  74. A pediatric-focused review of the performance incentive literature. Curr Opin Pediatr. 2007 Dec; 19(6):719-25. View Abstract
  75. Pay for performance, public reporting, and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007 Oct; 64(5 Suppl):283S-304S. View Abstract
  76. Pay-for-performance in pediatrics: proceed with caution. Pediatrics. 2007 Jul; 120(1):186-8. View Abstract
  77. Community health center quality improvement: a systematic review and future directions for research. Prog Community Health Partnersh. 2007; 1(1):105-16. View Abstract
  78. What do pediatric primary care providers think are important research questions? A perspective from PROS providers. Ambul Pediatr. 2006 Nov-Dec; 6(6):352-5. View Abstract
  79. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006 Apr; 15(2):79-80. View Abstract

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