About

M. Kate Bundorf is the J. Alexander McMahon Distinguished Professor of Health Policy and Management at the Sanford School of Public Policy. She also serves as a Professor in the Sanford School of Public Policy, the Faculty Director of Research at the same school, and a Professor in Population Health Sciences. Additionally, she is a Core Faculty Member at the Duke-Margolis Institute for Health Policy. Her research includes examining the impact of algorithmic information and recommendations on consumer choice in health insurance plans, contributing to the understanding of decision-making processes in health policy.

Research topics

• Medicine
• Political Science
• Virology
• Business
• Environmental health
• Nursing
• Gerontology

Selected publications

• Geographic Variation in Primary Care Spending Among the Commercially Insured Population

  JAMA Network Open · 2026-03-05

  articleOpen access

  This cross-sectional study examined the level and variation of primary care spending among the commercially insured population across all core-based statistical area in the US.

  PublisherOA PDFDOI

• Price transparency & out-of-pocket payments for medications: Implications of associated delivery fees in the United States

  Health Policy OPEN · 2026-01-26

  articleOpen accessSenior author

  • We examine payments for drugs alone compared to payments for drug and delivery fees required for drug administration. • Price transparency for drugs currently only includes payments for drug alone. • While there are substantial differences in OOP payments for first-line treatments of drugs alone, when including additional payments associated with drug delivery, payments across first-line treatments are more similar. • The amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for drug alone, thus impacting the potential effectiveness of price transparency. Price transparency has been cited as a tool to reduce out-of-pocket (OOP) payments to patients. These tools for prescription drugs often focus on the price to patients for the drug alone. However, costs associated with drug delivery (i.e. infusion center fees, labs, etc) are often unknown and could impact the effectiveness of price transparency tools. Objective: To examine total OOP payments on day of drug receipt (“full day”, i.e. drug + drug administration fees) out-of-pocket (OOP) payments associated with six first-line treatments for metastatic castrate resistant prostate cancer and compare these with payments for drug alone and by insurance type. Using the IBM Marketscan databases, we identify male patients who initiated treatment with one of six focus drugs (docetaxel, abiraterone, enzalutamide, sipuleucel-T, cabazitaxel, and radium-223) used to treat mCRPC from 07/01/2013–06/30/2019. We calculated total OOP payments on day of drug receipt (full day OOP payments) by drug type for six first line treatments. We then used a two-part model to assess the association of first-line therapy with OOP payments for the four most frequently prescribed during the study time period. We find that there is variation in the proportion of payments for drug alone relative to full day payments across first-line treatments. However, regression-adjusted mean full day OOP payments are not statistically different across first-line treatments for mCRPC for the four most frequently prescribed drugs. There are differences in the likelihood that an individual will incur any OOP payment by first-line treatment type and by health plan type. These analyses suggest that when accounting for additional services required on the day of drug receipt, the amount a patient pays to receive a medication for mCRPC can be very different from the OOP payment for the drug alone; these payments also vary by drug and health plan type. Therefore, price transparency for drug alone may not lead to reduced OOP payments for patients.

  PublisherDOI

• Corporate Ownership, Health System Affiliation, and Market Concentration of Home Health Agencies

  JAMA Network Open · 2025-08-21

  articleOpen access

  This cross-sectional study examines how growing health system affiliation and corporate ownership models may potentially contribute to home health agency (HHA) market concentration.

  PublisherOA PDFDOI

• Telehealth Payment Parity and Outpatient Service Utilization: Evidence from Privately Insured Workers

  UNC Libraries · 2025-05-02

  articleOpen access1st authorCorresponding

  Introduction Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Method Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a Difference-in-Difference approach. Results Payment parity was significantly associated with increased telehealth visits and total outpatient visits, but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Conclusion Our findings underscore the important role of the payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.

  PublisherDOI

• Postpartum Medicaid Use in Birthing Parents and Access to Financed Care

  Obstetrical & Gynecological Survey · 2025-12-01

  article

  (Abstracted from JAMA Health Forum 2025;6(6):e251630) Medicaid covers more than 40% of all births in the United States, but pregnancy-related physical and mental health coverage traditionally ends 60 days postpartum. Recognizing the limitations of this policy, the American Rescue Act of 2021 allowed states to extend coverage to 12 months after delivery-a change now adopted by all states except Arkansas.

  PublisherDOI

• Physician Gender and Patient Perceptions of Interpersonal and Technical Skills in Online Reviews

  JAMA Network Open · 2025-02-14 · 10 citations

  articleOpen access

  Importance: Prior studies have revealed gender differences in workplace assessments of physicians, but little is known about differences by physician gender in patients' online written reviews. Objective: To analyze whether patients' perceptions of their physicians' interpersonal manner and technical competence differ by physician gender and practicing specialty and are associated with review star ratings. Design, Setting, and Participants: This cross-sectional study sampled written reviews submitted by patients between October 16, 2015, and May 27, 2020, for physicians across the US from a commercial physician rating and review website. Physicians included primary care physicians (PCPs) listed under family medicine, internal medicine, and pediatrics and surgeons listed under general surgery; orthopedic surgery; and cosmetic, plastic, and reconstructive surgery. Hand-coded reviews were used to fine-tune a natural language processing algorithm to classify all reviews for the presence and valence of patients' comments of physicians' interpersonal manner and technical competence. Statistical analyses were performed from July 2022 to December 2024. Exposure: Female or male physician gender. Main Outcomes and Measures: Outcomes included the presence and valence of interpersonal manner and technical competence comments and receipt of high star ratings. Multilevel logistic regressions analyzed differences by female or male physician gender in interpersonal manner and technical competence comments and whether those comments were associated with review star ratings. Results: The analysis included 345 053 written reviews of 167 150 physicians (mean [SD] age, 55.16 [11.40] years); 60 060 physicians (35.9%) were female, and 36 132 (21.6%) were surgeons. Female physicians overall had higher odds than males of receiving any (odds ratio [OR], 1.19; 95% CI, 1.16-1.22) or negative (OR, 1.22; 95% CI, 1.18-1.26) patient comments for their interpersonal manner. Among PCPs, females had higher odds than males of receiving a negative comment for interpersonal manner (OR, 1.22; 95% CI, 1.18-1.27) and, when receiving that negative comment, had disproportionately lower odds of receiving a high star rating (OR, 0.62; 95% CI, 0.53-0.73). Female physicians overall (OR, 1.09; 95% CI, 1.05-1.13) and female PCPs (OR, 1.08; 95% CI, 1.04-1.13) had higher odds than their male counterparts of receiving a negative comment for their technical competence. When receiving a negative comment for technical competence, both female PCPs (OR, 0.60; 95% CI, 0.50-0.73) and female surgeons (OR, 0.67; 95% CI, 0.50-0.89) had disproportionately lower odds of receiving a high star rating compared with their male counterparts. Female PCPs also had lower odds than male PCPs of receiving a high star rating when receiving a positive comment for technical competence (OR, 0.82; 95% CI, 0.70-0.96). Conclusions and Relevance: In this cross-sectional study of online written reviews, female and male physician gender were differently associated with patients' perceptions of their physicians' interpersonal manner and technical competence. The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.

  PublisherOA PDFDOI

• Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans

  JAMA Network Open · 2025-01-22

  articleOpen access

  Importance: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid. Objective: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid. Design, Setting, and Participants: This cohort study applied a new user, active comparator design to control for selection into MA and inverse probability of treatment weighting to improve the comparability between groups. The cohort included community-living dual-eligible Medicare and Medicaid beneficiaries in North Carolina with 365 days of Medicare FFS enrollment prior to new enrollment in D-SNP (treatment) or other MA plan (active comparator). Linked 100% Medicare and North Carolina Medicaid claims data (2014-2017) provided payments across both payers prior to MA enrollment; after MA enrollment, payments for Medicaid-funded services and supplemental Medicaid payments for Medicare-funded services were observed. Data were analyzed from August 2023 to November 2024. Exposure: New D-SNP enrollment. Main Outcomes and Measures: Outcomes included annualized 1-year Medicaid FFS spending overall and by claim type, including inpatient, outpatient, carrier, home health, personal care services, and behavioral health services. Results: Among 8869 participants in the D-SNP cohort, 4762 (53.7%) were younger than 65 years, 5833 (65.8%), were female, and 975 (11.0%) resided in rural areas. After inverse probability of treatment weighting, characteristics were similar among the comparison MA cohort of 4389 participants (4706 [53.2%] aged <65 years; 5739 [64.9%] female; 971 [11.0%] rural). There were no significant differences in Medicaid FFS spending per person-year (PPY) at baseline or differential change in the year following new enrollment (mean marginal effect, -$387 [95% CI, -$1274 to $501) between groups. There were significant differences between groups in the change in spending on long-term services and supports, with maintained spending on community-based personal care services following new enrollment in D-SNPs compared with reductions for other MA, resulting in a relative increase of $343 (95% CI, $147 to $539). Conclusions and Relevance: This cohort study found that coordination-only D-SNPs was associated with maintained North Carolina Medicaid FFS spending levels for long-term services and supports compared with other MA plans, despite limited integration requirements. However, to reduce or delay nursing home transitions, higher levels of integration may be necessary.

  PublisherOA PDFDOI

• Telehealth payment parity and outpatient service utilization: evidence from privately insured workers

  Health Affairs Scholar · 2025-03-29 · 5 citations

  articleOpen access

  Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a difference-in-difference approach. Payment parity was significantly associated with increased telehealth visits and total outpatient visits but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Our findings underscore the important role of payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.

  PublisherDOI

• The Role of Telehealth Payment Parity on Recommended Care and Emergency Department Service Utilization Among Workers With Chronic Conditions

  Medical Care · 2025-07-07 · 2 citations

  article

  BACKGROUND AND OBJECTIVE: State-level telehealth payment parity, requiring equal payment rates for telehealth and in-person visits, played an important role in ensuring access to telehealth services. The objective of our study is to evaluate how improved access, driven by telehealth payment parity, affected the utilization of disease-specific recommended care management services and emergency department (ED) services among insured patients with chronic conditions. RESEARCH DESIGN: We adopted a 2-way fixed-effect difference-in-differences approach using the Merative Commercial Claims and Encounters database from 2019 to 2021. SUBJECTS: We focused on insured workers aged 19-64 with pre-existing mental health disorders or cardiometabolic risks (CMRs). MEASURES: Outcomes include psychotherapy for mental health disorders, preventive care counseling for CMRs, and ED visits. RESULTS: Telehealth payment parity was associated with a significant increase in the number of psychotherapy visits and tele-psychotherapy by 0.221 visits (95% CI: 0.050-0.391) and 0.411 visits (95% CI: 0.003-0.818) per patient per quarter, respectively. The regulation significantly reduced E.D. visits among individuals with mental health disorders by 0.003 visits (95% CI: -0.007 to 0.000) per quarter, a 25% relative decrease compared with the control at preperiod. However, payment parity was not statistically associated with increasing preventive care visits and lowering ED visits among individuals with CMRs. CONCLUSION: Telehealth payment parity has effectively promoted the adoption of psychotherapy and reduced ED visits among insured workers with mental health disorders. However, it has not significantly improved the uptake of preventive care counseling for individuals with CMRs.

  PublisherDOI

• Postpartum Medicaid Use in Birthing Parents and Access to Financed Care

  JAMA Health Forum · 2025-06-27

  articleOpen access

  Importance: The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown. Objectives: To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days. Design, Setting, and Participants: A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included. Exposure: A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021. Main Outcomes and Measures: Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care. Results: There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits. Conclusions and Relevance: Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.

  PublisherOA PDFDOI

Recent grants

• NIH Grant K02HS011668

  NIH · $383k · 2007

• NIH Grant R03AG023557

  NIH · $40k · 2006

• NIH Grant R01HS018434

  NIH · $1.2M · 2014

• Physician Organization and the Use, Cost and Outcomes of Care

  NIH · $1.2M · 2016–2022

Frequent coauthors

• Laurence C. Baker

  Vencore (United States)

  134 shared

• Daniel P. Kessler

  National Bureau of Economic Research

  115 shared

• Jay Bhattacharya

  Stanford University

  50 shared

• Neeraj Sood

  University of Southern California

  41 shared

• Noemi Pace

  39 shared

• Anne Beeson Royalty

  University of North Carolina at Greensboro

  26 shared

• Maria Polyakova

  Stanford University

  20 shared

• Cristina M Galvin

  Stanford University

  16 shared

Labs

• Sanford School of Public PolicyPI