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Matthews S, Qureshi N, Levin JS, Eberhart NK, Breslau J, McBain RK. Financial Interventions to Improve Screening in Primary Care: A Systematic Review. Am J Prev Med 2024; 67:134-146. [PMID: 38484900 DOI: 10.1016/j.amepre.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Although health screenings offer timely detection of health conditions and enable early intervention, adoption is often poor. How might financial interventions create the necessary incentives and resources to improve screening in primary care settings? This systematic review aimed to answer this question. METHODS Peer-reviewed studies published between 2000 and 2023 were identified and categorized by the level of intervention (practice or individual) and type of intervention, specifically alternative payment models (APMs), fee-for-service (FFS), capitation, and capital investments. Outcomes included frequency of screening, performance/quality of care (e.g., patient satisfaction, health outcomes), and workflow changes (e.g., visit length, staffing). RESULTS Of 51 included studies, a majority focused on practice-level interventions (n=32), used APMs (n=41) that involved payments for achieving key performance indicators (KPIs; n=31) and were of low or very low strength of evidence based on GRADE criteria (n=42). Studies often included screenings for cancer (n=32), diabetes care (n=18), and behavioral health (n=15). KPI payments to both practices and individual providers corresponded with increased screening rates, whereas capitation and provider-level FFS models yielded mixed results. A large majority of studies assessed changes in screening rates (n=48) with less focus on quality of care (n=11) or workflow changes (n=4). DISCUSSION Financial mechanisms can enhance screening rates with evidence strongest for KPI payments to both practices and individual providers. Future research should explore the relationship between financial interventions and quality of care, in terms of both clinical processes and patient outcomes, as well as the role of these interventions in shaping care delivery.
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Affiliation(s)
| | | | | | | | | | - Ryan K McBain
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts; RAND Corporation, Arlington, Virginia
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Kidanemariam M, Pieterse AH, van Staalduinen DJ, Bos WJW, Stiggelbout AM. Does value-based healthcare support patient-centred care? A scoping review of the evidence. BMJ Open 2023; 13:e070193. [PMID: 37429675 DOI: 10.1136/bmjopen-2022-070193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Standardisation of outcome measures is integral to value-based healthcare (VBHC), which may conflict with patient-centred care, focusing on personalisation. OBJECTIVES We aimed to provide an overview of measures used to assess the effect of VBHC implementation and to examine to what extent the evidence indicates that VBHC supports patient-centred care. DESIGN A scoping review guided by the Joanna Briggs Institute methodology. SOURCES OF EVIDENCE We searched the following databases on 18 February 2021: Cochrane Library, EMBASE, MEDLINE and Web of Science. ELIGIBILITY CRITERIA We included empirical papers assessing the effect of the implementation of VBHC, published after introduction of VBHC in 2006. DATA EXTRACTION AND SYNTHESIS Two independent reviewers double-screened papers and data were extracted by one reviewer and checked by the other. We classified the study measures used in included papers into six categories: process indicator, cost measure, clinical outcome, patient-reported outcome, patient-reported experience or clinician-reported experience. We then assessed the patient-centredness of the study measures used. RESULTS We included 39 studies using 94 unique study measures. The most frequently used study measures (n=72) were process indicators, cost measures and clinical outcomes, which rarely were patient-centred. The less frequently used (n=20) patient-reported outcome and experience measures often measured a dimension of patient-centred care. CONCLUSION Our study shows that the evidence on VBHC supporting patient-centred care is limited, exposing a knowledge gap in VBHC research. The most frequently used study measures in VBHC research are not patient-centred. The major focus seems to be on measures of quality of care defined from a provider, institution or payer perspective.
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Affiliation(s)
- Martha Kidanemariam
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arwen H Pieterse
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorine J van Staalduinen
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Institute of Public Administration, Leiden University, The Hague, The Netherlands
| | - Willem Jan W Bos
- Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Anne M Stiggelbout
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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Huang H, Zhu X, Wehby GL. Primary care physicians' participation in the Medicare shared savings program and preventive services delivery: Evidence from the first 7 years. Health Serv Res 2022; 57:1182-1190. [PMID: 35808929 PMCID: PMC9441290 DOI: 10.1111/1475-6773.14030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate whether primary care physicians' participation in the Medicare Shared Savings Program (MSSP) is associated with changes in their preventive services delivery. DATA SOURCES Medicare Provider Utilization and Payment Physician and Other Supplier Public Use File and MSSP Accountable Care Organizations (ACO) Provider-Level Research Identifiable File from 2012 to 2018. STUDY DESIGN The design was a two-way fixed effects model estimating within-provider changes in preventive services delivery over time controlling for provider time-invariant characteristics, national time trends, and characteristics of served patients. The following preventive services were evaluated: influenza vaccination, pneumococcal vaccination, clinical depression screening, colorectal cancer screening, breast cancer screening, Body Mass Index (BMI) screening and follow-up, tobacco use assessment, and annual wellness visits. Both the likelihood of providing services and the volume of services delivered were evaluated. DATA COLLECTION/EXTRACTION METHODS Secondary data linked at the provider level. PRINCIPAL FINDINGS MSSP participation was associated with an increase in the likelihood of providing influenza vaccination (0.7 percentage-points), pneumococcal vaccination (2.0 percentage-points), clinical depression screening (2.1 percentage-points), tobacco use assessment (0.3 percentage-points), and annual wellness visits (4.1 percentage-points). A similar increase was found for the volume of services delivered per 100 patients for several preventive services: influenza vaccination (0.18), pneumococcal vaccination (0.56), clinical depression screening (0.46), and annual wellness visits (1.52). MSSP participation was associated with a decrease in the likelihood (-0.4 percentage-points) and the volume of colorectal cancer screening (-0.03). CONCLUSIONS Primary care physicians' participation in MSSP was associated with an increase in the likelihood and the volume of several preventive services.
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Affiliation(s)
- Huang Huang
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
| | - Xi Zhu
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - George L. Wehby
- Department of Health Management and PolicyUniversity of Iowa College of Public HealthIowa CityIowaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
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Katragadda C, Fung C, Yousefi-Nooraie R, Cupertino P, Joseph J, Kim Y, Li Y. Medicare accountable care organizations: post-acute care use and post-surgical outcomes in urologic cancer surgery. Urology 2022; 167:102-108. [PMID: 35772480 DOI: 10.1016/j.urology.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate association between Medicare accountable care organizations (ACOs) participation of hospitals on post-acute care (PAC) use and spending, and post-surgical outcomes in Medicare beneficiaries undergoing urologic cancer surgeries. Despite increasing prevalence of urologic cancer and surgical care contributing to a large proportion of total health care costs, and recent Medicare payment reforms such as accountable care organizations, the role of ACOs in urologic cancer care has been unexplored. METHODS We conducted a longitudinal analysis of 2011-2017 Medicare claims data to compare post-surgical outcomes between Medicare ACO and non-ACO patients before and after implementation of Medicare shared savings program (MSSP). Our outcomes of interest were Post-acute care (PAC) use (overall, institutional, and home health), Skilled Nursing Facility (SNF) length of stay and Medicare spending for SNF patients, 30-day and 90-day unplanned readmissions and complications after index procedure. RESULTS Study sample included a total of 334,514 Medicare patients undergoing bladder, prostate, kidney cancer surgeries at 524 Medicare ACO and 2066 non-ACO hospitals. For bladder cancer surgery, Medicare ACO participation was associated with significantly reduced overall post-acute care use, but not with changes in readmission or complication rate. For prostate cancer and kidney cancer surgery, we found no significant association between hospital participation in Medicare ACOs and PAC use or post-surgical outcomes. CONCLUSIONS Hospital participation in MSSP ACOs leads to lower post-acute care use without compromising patient outcomes for Medicare beneficiaries undergoing bladder cancer surgery. Future research is needed to understand longer-term impact of ACO participation on urologic cancer surgery outcomes.
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Affiliation(s)
- Chinmayee Katragadda
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
| | - Chunkit Fung
- Division of Hematology, Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY; James P. Wilmot Cancer Institute, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Reza Yousefi-Nooraie
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Paula Cupertino
- James P. Wilmot Cancer Institute, Rochester, NY; Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Jean Joseph
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | | | - Yue Li
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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Haddad DN, Lai P, Luckenbaugh AN, Hawkins AT, Resnick MJ. Optimizing Value for Colorectal Cancer Screening in Medicare Accountable Care Organizations. Gastroenterology 2022; 162:2092-2094.e2. [PMID: 35192843 DOI: 10.1053/j.gastro.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Diane N Haddad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pikki Lai
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander T Hawkins
- Department of Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; Embold Health, Nashville, Tennessee.
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Simon B, Amelung VE. [10 Years Accountable Care Organizations in the USA: Impulses for Health Care Reform in Germany?]. DAS GESUNDHEITSWESEN 2022; 84:e12-e24. [PMID: 35114697 DOI: 10.1055/a-1718-3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
GOAL OF THE STUDY An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany. METHODS In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA. RESULTS In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved. CONCLUSION ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken.
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Affiliation(s)
- Benedikt Simon
- Harkness Fellowship, Commonwealth Fund, New York, United States.,Chief Officer Integrated and Digital Care, Asklepios Kliniken GmbH & Co. KGaA, Hamburg, Germany
| | - Volker Eric Amelung
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
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Golla V, Kaye DR. The Impact of Health Delivery Integration on Cancer Outcomes. Surg Oncol Clin N Am 2021; 31:91-108. [PMID: 34776068 DOI: 10.1016/j.soc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although integrated health care has largely been associated with increases in prices and static or decreased quality across many disease states, it has shown some successes in improving cancer care. However, its impact is largely equivocal, making consensus statements difficult. Critically, integration does not necessarily translate to clinical coordination, which might be the true driver behind the success of integrated health care delivery. Moving forward, it is important to establish payment models that support clinical care coordination. Shifting from a fragmented health system to a coordinated one may improve evidence-based cancer care, outcomes, and value for patients.
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Affiliation(s)
- Vishnukamal Golla
- Duke National Clinician Scholars Program, 200 Morris St, Suite 3400, DUMC Box 104427, Durham, NC 27701, USA; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center; Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center
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Massarweh NN, Kelz RR. From Policy to Patient Care-The Cycle of Health Policy Research. JAMA Surg 2020; 154:793-794. [PMID: 31268506 DOI: 10.1001/jamasurg.2019.1518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nader N Massarweh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rachel R Kelz
- Department of Surgery, Division of Endocrine and Oncologic Surgery, University of Pennsylvania, Philadelphia.,Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia
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Zhao J, Mao Z, Fedewa SA, Nogueira L, Yabroff KR, Jemal A, Han X. The Affordable Care Act and access to care across the cancer control continuum: A review at 10 years. CA Cancer J Clin 2020; 70:165-181. [PMID: 32202312 DOI: 10.3322/caac.21604] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 01/22/2023] Open
Abstract
Lack of health insurance coverage is strongly associated with poor cancer outcomes in the United States. The uninsured are less likely to have access to timely and effective cancer prevention, screening, diagnosis, treatment, survivorship, and end-of-life care than their counterparts with health insurance coverage. On March 23, 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law, representing the largest change to health care delivery in the United States since the introduction of the Medicare and Medicaid programs in 1965. The primary goals of the ACA are to improve health insurance coverage, the quality of care, and patient outcomes, and to maintain or lower costs by catalyzing changes in the health care delivery system. In this review, we describe the main components of the ACA, including health insurance expansions, coverage reforms, and delivery system reforms, provisions within these components, and their relevance to cancer screening and early detection, care, and outcomes. We then highlight selected, well-designed studies examining the effects of the ACA provisions on coverage, access to cancer care, and disparities throughout the cancer control continuum. Finally, we identify research gaps to inform evaluation of current and emerging health policies related to cancer outcomes.
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Affiliation(s)
- Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ziling Mao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Leticia Nogueira
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Laviana AA, Luckenbaugh AN, Resnick MJ. Trends in the Cost of Cancer Care: Beyond Drugs. J Clin Oncol 2020; 38:316-322. [PMID: 31804864 PMCID: PMC6994251 DOI: 10.1200/jco.19.01963] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
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Modi PK, Hollenbeck BK, Borza T. Searching for the value of accountable care organizations in cancer care. Cancer 2018; 124:4287-4289. [PMID: 30419155 DOI: 10.1002/cncr.31698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/15/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Parth K Modi
- Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Division of Urologic Oncology, Department of Urology, Michigan Medicine, Ann Arbor, Michigan
| | - Tudor Borza
- Department of Urology, University of Wisconsin, Madison, Wisconsin
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