Randall P. Ellis

Randall P. Ellis, Ph.D., is a professor in the Department of Economics at Boston University, where he has been on the faculty since 1981. He earned his Ph.D. in economics from MIT after attending Yale University and the London School of Economics and Political Science. His research has focused on health economics, spanning both US and international economics topics. In 2024 he received the Victor Fuchs Lifetime Achievement Award in the Field of Health Economics from the American Society of Health Economists.

Dr. Ellis is Past President of the American Society of Health Economists and served as an associate editor of the Journal of Health Economics and American Journal of Health Economics. Dr. Ellis was one of three original architects of the Diagnostic Cost Group (DCG) and Hierarchical Condition Category (HCC) models, with funding from the Centers for Medicare & Medicaid Services (CMS), and others. HCC models are used to risk adjust payments to Medicare Advantage (Part C) health plans, Part D prescription drug plans and the ACA (Obamacare) Health Insurance Exchanges. This body of risk adjustment work received the AcademyHealth 2008 Health Services Research Impact Award.

Since 2018 Dr. Ellis lead the creation of an all-new Diagnostic Items (DXI) classification and predictive system that incorporates extensive clinical input, rich disease hierarchies, economic concern about gaming and incentives, and trained machine learning methods to automate the creation of policy relevant payment and performance target formulas that could replace the existing HCC system. He has also collaborated with Dr. Arlene Ash on the incorporation of Social Determinants of Health variables in Medicaid capitation and primary care payment formulas that have been adapted for use in Massachusetts.

Dr. Ellis has written and coauthored over 140 articles, reports and papers. Many have focused on risk adjustment, but others explore provider response to reimbursement systems; optimal insurance; health plan competition; the economics of mental health; health demand modeling in developing countries; and the cost-effectiveness of cancer screening. His recent research funding has been from the Agency for HealthCare Research and Quality (AHRQ) and the Social Science Research Council (SSRC).