About

Jean M. Abraham is a Professor and Head of Health Policy and Management at the University of Minnesota, affiliated with the Minnesota Population Center. Her research extensively focuses on health insurance markets, health policy, and management, with particular expertise in employer-sponsored health insurance, the Affordable Care Act, and health insurance market dynamics. She has contributed to understanding the long-term decline of the small group health insurance market, drivers of health insurance trends, and the implications for social security and budgetary concerns. Professor Abraham's work also addresses health equity, price transparency in healthcare, and the implementation of health programs such as diabetes self-management. Her research aligns with several United Nations Sustainable Development Goals, including No Poverty, Good Health and Well-being, Decent Work and Economic Growth, Reduced Inequalities, and Responsible Consumption and Production. She has led and collaborated on numerous research projects funded by institutions such as the NIH, Johns Hopkins University, and the Minnesota Department of Health, focusing on health surveys, medical price repositories, and equitable healthcare initiatives. Professor Abraham's scholarly output includes peer-reviewed articles on topics such as hospital responses to federal price transparency regulations, insurer prevalence in administrative services markets, and the effects of minimum wage laws on employer-sponsored insurance provision. She is recognized for her contributions to health policy research and her engagement with public discourse through media commentary and expert interviews.

Research topics

• Oncology
• Medicine
• Internal medicine
• Pathology
• Statistics
• Biology

Selected publications

• Real-World Digitally Based Diabetes Management Program Implementation by a Large Employer

  The American Journal of Managed Care · 2025-03-04

  articleOpen access1st authorCorresponding

  OBJECTIVE: To evaluate the implementation of a digitally based diabetes management program by a large, self-insured employer in Minnesota from May 2021 to April 2022. STUDY DESIGN: Descriptive analysis. METHODS: We described the development, implementation, and effectiveness of a communications strategy to promote program enrollment in the initial year. Using administrative claims data, we analyzed the demographic and clinical attributes associated with an eligible member's enrollment. Finally, we empirically assessed whether expanding the choice of modalities through which enrollees accessed diabetes self-management education and support (DSMES) increased overall utilization and addressed geographic disparities. RESULTS: Although digital health program applications responded to the timing of the communications campaigns, overall program enrollment in absolute terms was low compared with the size of the eligible population. Among those eligible, female and employee subscribers were more likely to enroll. Overall, DSMES use increased slightly during the initial year, but we did not observe significantly higher rates of use among members in rural areas following the digital health program launch. CONCLUSIONS: This study offers new insights to employers and health plans related to supporting digitally based disease management program implementation and enrollee engagement.

  PublisherOA PDFDOI

• BRCA-mutated breast cancer: the unmet need, challenges and therapeutic benefits of genetic testing

  British Journal of Cancer · 2024-08-30 · 57 citations

  reviewOpen access

  Mutations in the BRCA1 and/or BRCA2 genes (BRCAm) increase the risk of developing breast cancer (BC) and are found in ~5% of unselected patients with the disease. BC resulting from a germline BRCAm (gBRCAm) has distinct clinical characteristics along with increased sensitivity to DNA-damaging agents such as poly(ADP-ribose) polymerase (PARP) inhibitors and platinum-based chemotherapies, and potentially decreased sensitivity to cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors. Given the evolving treatment landscape for gBRCAm BC in early and advanced disease settings, timely determination of gBRCAm status is fundamental to facilitate the most effective treatment strategy for patients. However, many patients with gBRCAm are not identified due to suboptimal referral rates and/or a low uptake of genetic testing. We discuss current evidence for a differential response to treatment in patients with gBRCAm in early and advanced BC settings, including outcomes with PARP inhibitors, platinum-based chemotherapies, and CDK4/6 inhibitors, as well as ongoing treatment innovations and the potential of these treatment approaches. Current genetic testing strategies are also examined, including the latest guidelines on who and when to test for gBRCAm, as well as challenges to testing and how these may be overcome.

  PublisherOA PDFDOI

• Prevalence And Profits Of Insurers In The Administrative Services Only Market Serving Self-Insured Employers, 2010–22

  Health Affairs · 2024-12-01 · 2 citations

  article1st authorCorresponding

  For 165 million nonelderly Americans, employers provide health insurance either by purchasing a fully insured plan or through self-insurance. By self-insuring, employers bear the financial risk for enrollees' health care spending and are accountable for plan management, either directly or by contracting with a third-party administrator. Using National Association of Insurance Commissioners data, we demonstrate that insurers are deeply entrenched in the provision of administrative services only (ASO) contracts for self-insured employers. In 2022, insurers administered to nearly four times as many ASO enrollees as they covered in fully insured plans, with fifty-six insurer-based ASO contractors providing services for 118 million enrollees. The largest ASO contractors-CVS Group, Cigna Health Group, and Elevance Health Inc. Group-collectively served more than seventy million ASO enrollees and demonstrated less variable and stronger profitability relative to other ASO contractors. This study expands understanding of this increasingly important market for employer-sponsored insurance.

  PublisherDOI

• Sample size determination for prediction models via learning‐type curves

  Statistics in Medicine · 2024-05-27 · 6 citations

  articleOpen accessSenior author

  This article is concerned with sample size determination methodology for prediction models. We propose to combine the individual calculations via learning-type curves. We suggest two distinct ways of doing so, a deterministic skeleton of a learning curve and a Gaussian process centered upon its deterministic counterpart. We employ several learning algorithms for modeling the primary endpoint and distinct measures for trial efficacy. We find that the performance may vary with the sample size, but borrowing information across sample size universally improves the performance of such calculations. The Gaussian process-based learning curve appears more robust and statistically efficient, while computational efficiency is comparable. We suggest that anchoring against historical evidence when extrapolating sample sizes should be adopted when such data are available. The methods are illustrated on binary and survival endpoints.

  PublisherOA PDFDOI

• A clinical trial exploring a new imaging technique for assessing response to anti-cancer treatments in post-menopausal women with breast cancer

  http://isrctn.com/ · 2024-12-10

  datasetSenior author
  PublisherDOI

• Playing by the Rules? Tracking U.S. Hospitals' Responses to Federal Price Transparency Regulation

  Journal of Healthcare Management · 2024-01-01 · 5 citations

  articleSenior author

  GOAL: As of January 1, 2021, the Centers for Medicare & Medicaid Services requires most U.S. hospitals to publish pricing information on their website to help consumers make decisions regarding services and to transform negotiations with health insurers. For this study, we evaluated changes in hospitals' compliance with the federal price transparency rule after the first year of enactment, during which the Centers for Medicare & Medicaid Services increased the penalty for noncompliance. METHODS: Using a nationally representative random sample of 470 hospitals, we assessed compliance with both parts of the hospital transparency rule (publishing a machine-readable price database and a consumer shopping tool) in the first quarter of 2022 and compared its baseline level in the first quarter of 2021. Using data from the American Hospital Association and Clarivate, we next assessed how compliance varied by hospital factors (ownership, number of beds, system membership, teaching status, type of electronic health record system), market factors (hospital and insurer market concentration), and the estimated change in penalty for noncompliance. PRINCIPAL FINDINGS: By early 2022, 46% of hospitals had posted both machine-readable and consumer-shoppable data, an increase of 24% from the prior year. Almost 9 in 10 hospitals had complied with the consumer-shoppable data requirement by early 2022. Larger hospitals and public hospitals had lower probabilities of baseline compliance with the machine-readable and consumer-shoppable requirements, respectively, although public hospitals were significantly more likely to become compliant with the consumer-shoppable requirement by 2022. Higher hospital market concentration was also associated with higher baseline compliance for both the machine-readable and consumer-shoppable requirements. Furthermore, our analyses found that hospitals with certain electronic health record systems were more likely to comply with the consumer-shoppable requirement in 2021 and became increasingly compliant with the machine-readable requirement in 2022. Finally, we found that hospitals with a larger estimated penalty were more likely to become compliant with the machine-readable requirement. PRACTICAL APPLICATIONS: Longitudinal analyses of compliance with the federal price transparency rule are valuable for monitoring changes in hospitals' behavior and assessing whether compliance changes vary systematically for specific types of hospitals and/or market structures. Our results suggest a trend toward increased hospital compliance between 2021 and 2022. Although hospitals perceive the consumer-shopping tools as being the most impactful, the value of this information depends on whether it is comprehensible and comparable across hospitals. The new price transparency rule has facilitated the creation of new data that have the potential to significantly alter the competitive landscape for hospitals and may require hospital leaders to consider how their organizational strategies change concerning their engagement with payers and patients. Finally, greater price transparency is likely to bolster national policy discussions related to price variation, affordability, and the role of regulation in healthcare markets.

  PublisherDOI

• To be or not to be compliant? Hospitals' initial strategic responses to the federal price transparency rule

  Health Services Research · 2023-11-06 · 5 citations

  articleOpen access

  OBJECTIVE: To understand US hospitals' initial strategic responses to the federal price transparency rule that took effect January 2021. DATA SOURCES AND STUDY SETTING: Primary interview data collected from 12 not-for-profit hospital organizations in six US metropolitan markets. All but one organization were multihospital systems; the 12 organizations represent a total of 81 hospitals. STUDY DESIGN: Exploratory, cross-sectional, qualitative interview study of a convenience sample of hospital organizations across six geographically and compliance diverse markets. DATA COLLECTION/EXTRACTION METHODS: In-depth, semi-structured, qualitative interviews with 16 key informants across sampled organizations between November 2021 and March 2022. Interviews solicited data about internal organizational factors and external market factors affecting strategic responses. Transcribed interviews were de-identified, coded, and analyzed using the constant comparative method. PRINCIPAL FINDINGS: Hospitals' strategic responses were influenced internally by the degree of the regulation's alignment with organizational values and goals, and task complexity vis-a-vis available resources. We found extensive variation in organizational capabilities to comply, and all but one organization relied on consultants and vendors to some degree. Key external factors driving strategic responses were hospitals' variable perceptions about how available price information would affect their competitive position, bottom line, and reputation. Organizations with more confidence in their interpretation of the environment, including how peers or purchasers would behave, and greater clarity in their own organization's position and goals, had more definitive initial strategic responses. In the first year, organizations' strategic responses skewed toward compliance, especially for the rule's consumer shopping requirements. CONCLUSIONS: A deeper understanding of the realities of operationalizing price transparency policy for hospitals is needed to improve its impact.

  PublisherOA PDFDOI

• Do minimum wage laws affect employer-sponsored insurance provision?

  Journal of Health Economics · 2023-10-27 · 8 citations

  articleSenior author
  PublisherDOI

• Was Unstable Medicaid Coverage Among Older Medicare Beneficiaries Associated With Worse Clinical Outcomes? Evidence From the Delivery of Breast Cancer Care

  Medical Care · 2023-07-13 · 3 citations

  article

  BACKGROUND: Medicare and Medicaid dually eligible beneficiaries (duals) could experience Medicaid coverage changes without losing Medicaid. It is unknown whether health care use and clinical outcomes among elderly duals with coverage changes would be like those among duals without coverage changes or duals ever lost Medicaid and whether various types of unstable coverage due to income/asset changes are associated with worse clinical outcomes. OBJECTIVES: Examine the associations of unstable Medicaid coverage with clinical outcomes among older Medicare beneficiaries. RESEARCH DESIGN: Population-based cohort study. SUBJECTS: A total of 131,202 women newly diagnosed with breast cancer at 65 years and older between 2007 and 2015 were identified from the Surveillance, Epidemiology, and End Results-Medicare linked database. MEASURES: We examined 2 types of unstable Medicaid coverage: (1) those who had changes in the types of Medicaid support they received and (2) those who ever lost Medicaid. We examined outcomes that predict better cancer survival and involve the use of inpatient and outpatient services and prescription drugs: early diagnosis, receiving surgery, receiving radiation, hormonal therapy adherence, and discontinuation. We used logistic regressions to estimate the predicted probabilities of outcomes for dual groups. RESULTS: Duals had poorer outcomes than those who were "never dual." Women with the 2 types of unstable Medicaid coverage had similarly worse outcomes than those with stable coverage. Those with stable coverage had similar outcomes regardless of the generosity of Medicaid support. CONCLUSIONS: These patterns are concerning and, in the context of well-defined clinical guidelines for beneficial treatments that extend survival, point to the importance of stable insurance coverage and income.

  PublisherDOI

• To Be or Not to Be Compliant? Hospital Strategic Responses to the Federal Price Transparency Rule

  Academy of Management Proceedings · 2023-07-24 · 1 citations

  article

  The hospital price transparency rule requires hospitals to publicly report prices for a prescribed set of medical services in both machine readable and consumer shoppable formats effective January 1, 2021. Early quantitative analyses consistently have found limited compliance with this regulation, but do not provide insight to why. This study’s objective was to understand hospitals’ strategic responses to this new regulation. We conducted in-depth, semi-structured, qualitative interviews between November 2021 and March 2022 with 12 not-for-profit hospital organizations. The sampled organizations were located in six geographically-diverse and compliance-diverse markets, and 11 were multi-hospital organizations. Drawing on Oliver’s “Typology of Strategic Responses to Institutional Processes” (1991) and broader strategic management theory, the interview protocol was designed to solicit data about internal, organizational factors (e.g. resource constraints) and external, market factors (e.g. market position, peer behavior) affecting their responses. Transcribed interviews were coded and analyzed using the constant comparative method. Among the 12 organizations, we found that strategic responses skewed towards compliance, especially for the consumer shopping requirements. Only 3 organizations demonstrated any elements of an avoid strategy and only one organization had contingency plans to enact a defy strategy contingent upon being fined by the federal government. How hospitals responded (i.e. acquiesce, compromise, avoid, defy, manipulate or some combination) was influenced internally by the degree of the regulation’s alignment with the organization’s values and goals, and task complexity vis-a-vis available resources. We found extensive variation in organizational capabilities to comply, and particularly the reliance of hospital organizations on consultants and vendors to provide key support. The key external factors driving hospital organizations’ strategic responses were hospitals’ variable perceptions related to how making available price information may affect their competitive position, bottom line, and reputation with key stakeholders. Organizations with more confidence in their interpretation of the environment, including how others (peers or purchasers) would behave, as well as greater clarity in understanding their own organization’s position and goals had more definitive, and typically more compliant, strategic responses. This exploratory study provides insights about how hospital organizations are navigating their strategic responses and suggests that a deeper understanding of the realities of operationalizing price transparency for hospital organizations is needed to improve the impact and implementation of price transparency and consumerism policy.

  PublisherDOI

Recent grants

• Initiation and Maintenance of Regular Exercise in an Employer Wellness Program

  NIH · $148k · 2013–2015

Frequent coauthors

• Coleman Drake

  31 shared

• Roger Feldman

  University of Minnesota

  25 shared

• Kosali Simon

  Indiana University Bloomington

  21 shared

• Anne Beeson Royalty

  University of North Carolina at Greensboro

  18 shared

• Bonnie Jerome-DʼEmilia

  Rutgers, The State University of New Jersey

  16 shared

• James W. Begun

  University of Minnesota

  16 shared

• Martin Gaynor

  Carnegie Mellon University

  16 shared

• Daniel W. Sacks

  13 shared

Education

• PhD, Heinz College of Information Systems and Public Policy

  Carnegie Mellon University

  2001

Awards & honors

• Teaching Excellence Award in Health Policy, Association of U…
• Wegmiller Professor of Healthcare Administration, 2016-2022
• Carnegie Mellon University’s Heinz College Alumni Associatio…
• Weckwerth Professor in Healthcare Administration Leadership,…