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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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Han L, Lan K, Kou D, Meng Z, Feng J, Maitland E, Nicholas S, Wang J. Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula. HEALTH ECONOMICS REVIEW 2024; 14:37. [PMID: 38836982 PMCID: PMC11154974 DOI: 10.1186/s13561-024-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. METHOD We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. RESULTS EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. CONCLUSIONS EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.
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Affiliation(s)
- Lu Han
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Kuixu Lan
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dejian Kou
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Zehua Meng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Jin Feng
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, England, United Kingdom
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, NSW, Australia
| | - Jian Wang
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, Wuhan, China.
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Veazie P, Intrator O, Kinosian B, Phibbs CS. Better performance for right-skewed data using an alternative gamma model. BMC Med Res Methodol 2023; 23:298. [PMID: 38102539 PMCID: PMC10722755 DOI: 10.1186/s12874-023-02113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The Maximum Likelihood Estimator (MLE) for parameters of the gamma distribution is commonly used to estimate models of right-skewed variables such as costs, hospital length of stay, and appointment wait times in Economics and Healthcare research. The common specification for this estimator assumes the variance is proportional to the square of the mean, which underlies estimation and specification tests. We present a specification in which the variance is directly proportional to the mean. METHODS We used simulation experiments to investigate finite sample results, and we used United States Department of Veterans Affairs (VA) healthcare cost data as an empirical example comparing the fit and predictive ability of the models. RESULTS Simulation showed the MLE based on a correctly specified alternative has less parameter bias, lower standard errors, and less skewness in distribution than a misspecified standard model. The application to VA healthcare cost data showed the alternative specification can have better R square, smaller root mean squared error, and smaller mean residuals within deciles of predicted values. CONCLUSIONS The alternative gamma specification can be a useful alternative to the standard specification for estimating models of right-skewed continuous variables.
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Affiliation(s)
- Peter Veazie
- Canandaigua Veterans Affairs Medical Center, 400 Fort Hill Ave., Canandaigua, New York, 14424, USA.
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644, Rochester, NY, 14642, USA.
| | - Orna Intrator
- Canandaigua Veterans Affairs Medical Center, 400 Fort Hill Ave., Canandaigua, New York, 14424, USA
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420644, Rochester, NY, 14642, USA
| | - Bruce Kinosian
- Cpl Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Ave, Philadelphia, PA, 19104, USA
- University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ciaran S Phibbs
- Palo Alto Veterans Affairs Health Care System, 750 Willow Road (MPD 152), Menlo Park, CA, 94025, USA
- Stanford University, 453 Quarry Road, MC 5660, Palo Alto, CA, 94304, USA
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Girdish C, Rossini A, Sutton BS, Parente AK, Howell BL. The Longitudinal Impact Of A Multistate Commercial Accountable Care Program On Cost, Use, And Quality. Health Aff (Millwood) 2022; 41:1795-1803. [PMID: 36469827 DOI: 10.1377/hlthaff.2022.00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The prevalence of accountable care organizations (ACOs) has grown significantly across Medicare and commercial payers in the past decade, but there are limited insights regarding the effect of ACOs on costs in the commercial population. We used longitudinal administrative claims data over the course of nineteen calendar quarters from 2016 to 2021 to assess the ongoing incremental impact of Elevance Health's commercial ACO program on cost and use across fifteen US states. We also analyzed the program's impact on spending subcategories (inpatient, outpatient, professional, and pharmacy) and measured differences in quality performance. The program was associated with incremental savings during this period. Incremental savings were greater in the fully insured population relative to the administrative services only population and were due to outpatient and pharmacy savings. ACO providers had superior quality performance measures relative to contracted providers not participating in ACOs. Payers should be aware of the potential for diminishing marginal returns of ACO contracting on containing health care costs.
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Xie Z, Yadav S, Larson SA, Mainous AG, Hong YR. Associations of patient-centered medical home with quality of care, patient experience, and health expenditures: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2021; 100:e26119. [PMID: 34032757 PMCID: PMC8154504 DOI: 10.1097/md.0000000000026119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
In efforts to improve the delivery of quality primary care, patient-centered medical home (PCMH) model has been promoted. However, evidence on its association with health outcomes has been mixed. The aim of this study was to assess the performance of PCMH model on quality of care, patient experience, health expenditures.This was a cross-sectional study of the 2015-2016 Medical Expenditure Panel Survey-Medical Organization Survey linked data, including 5748 patient-provider pairs. We examined twenty-four quality of care measures (18 high-value and 6 low-value care services), health service utilization, patient experience (patient-provider communication, satisfaction), and health expenditure.Of 5748 patients, representing a weighted population of 56.2 million American adults aged 18 years and older, 44.2% were cared for by PCMH certified providers. 9.3% of those with PCMHs had at least one inpatient stay in the past year, which was comparable to the 11.4% among those with non-PCMHs. Similarly, 17.4% of respondents cared for by PCMH and 18.5% cared for by non-PCMH had at least one ED visit. Overall, we found no significant differences in quality of care measures (neither high-nor low-value of care) between the two groups. The overall satisfaction, the experience of access to care, and communication with providers were also comparable. Patients who were cared for by PCMHs had less total health expenditure (difference $217) and out-of-pocket spending (difference $91) than those cared for by non-PCMHs; however, none of these differences reached the statistical significance (adjusted P > 0.05 for all).This study found no meaningful difference in quality of care, patient experience, health care utilization, or health care expenditures between respondents cared for by PCMH and non-PCMH. Our findings suggest that the PCMH model is not superior in the quality of care delivered to non-PCMH providers.
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Affiliation(s)
- Zhigang Xie
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Sandhya Yadav
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Samantha A. Larson
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Arch G. Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
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Abstract
Accountable care organizations (ACO) emerge each year aiming to improve care
quality while controlling rising health care costs. This cross-sectional study
examined whether ACO arrangements within a Preferred Provider Organization and a
Health Maintenance Organization (HMO) effected patient experience. A modified
Consumer Assessment of Healthcare Providers and Systems ACO survey was used to
assess care domain differences overall and by product. The association between
ACO and non-ACO populations and items in each significant care domain, flu
vaccination, and delayed and emergency department care are explored using
multivariable logistic regression. Accountable care organizations patients were
more likely to report it was easy to get a specialist appointment (adjusted odds
ratio [AOR], 1.54; 95% CI = 1.11-2.13), less likely to report visiting the
emergency department for care (AOR, 0.70; 95% CI = 0.55-0.90) and communicating
with their provider using technology (AOR, 0.79; 95% CI = 0.65-0.96). Reported
experience differed for Access to Specialists between ACO and
non-ACO groups among overall and HMO respondents (79.4% vs 74.7% and 79.9% vs
75.5%, P < .05, respectively). The ACO patient experience
was not substantially better. Strategies incorporating satisfaction and
experience, whether linked to contracts or not, should be encouraged given ACOs
goal to optimize patient care. Survey instruments must be improved to capture
nuances of provider care and patient bond that is vital in ACO integrated
systems.
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Affiliation(s)
- Joanne M Graham
- Health Innovation and Pilot Performance, Health Plan Research and Administration Division, California Public Employees' Retirement System, Sacramento, CA, USA
| | - David W Cowling
- Health Innovation and Pilot Performance, Health Plan Research and Administration Division, California Public Employees' Retirement System, Sacramento, CA, USA
| | - Hui Zhang
- Health Innovation and Pilot Performance, Health Plan Research and Administration Division, California Public Employees' Retirement System, Sacramento, CA, USA
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Briggs ADM, Göpfert A, Thorlby R, Allwood D, Alderwick H. Integrated health and care systems in England: can they help prevent disease? INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectivesOver the past 12 months, there has been increasing policy rhetoric regarding the role of the National Health Service (NHS) in preventing disease and improving population health. In particular, the NHS Long Term Plan sees integrated care systems (ICSs) and sustainability and transformation partnerships (STPs) as routes to improving disease prevention. Here, we place current NHS England integrated care plans in their historical context and review evidence on the relationship between integrated care and prevention. We ask how the NHS Long Term Plan may help prevent disease and explore the role of the 2019 ICS and STP plans in delivering this change.MethodsWe reviewed the evidence underlying the relationship between integrated care and disease prevention, and analysed 2016 STP plans for content relating to disease prevention and population health.ResultsThe evidence of more integrated care leading to better disease prevention is weak. Although nearly all 2016 STP plans included a prevention or population health strategy, fewer than half specified how they will work with local government public health teams, and there was incomplete coverage across plans about how they would meet NHS England prevention priorities. Plans broadly focused on individual-level approaches to disease prevention, with few describing interventions addressing social determinants of health.ConclusionsFor ICSs and STPs to meaningfully prevent disease and improve population health, they need to look beyond their 2016 plans and fill the gaps in the Long Term Plan on social determinants.
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Five-year Impact of a Commercial Accountable Care Organization on Health Care Spending, Utilization, and Quality of Care. Med Care 2020; 57:845-854. [PMID: 31348124 DOI: 10.1097/mlr.0000000000001179] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Accountable Care Organizations (ACOs) have proliferated after the passage of the Affordable Care Act in 2010. Few longitudinal ACO studies with continuous enrollees exist and most are short term. OBJECTIVE The objective of this study was to evaluate the long-term impact of a commercial ACO on health care spending, utilization, and quality outcomes among continuously enrolled members. RESEARCH DESIGN Retrospective cohort study design and propensity-weighted difference-in-differences approach were applied to examine performance changes in 2 ACO cohorts relative to 1 non-ACO cohort during the commercial ACO implementation in 2010-2014. SUBJECTS A total of 40,483 continuously enrolled members of a commercial health maintenance organization from 2008 to 2014. MEASURES Cost, use, and quality metrics for various type of services in outpatient and inpatient settings. RESULTS The ACO cohorts had (1) increased inpatient and outpatient total spending in the first 2 years of ACO operation, but insignificant differential changes for the latter 3 years; (2) decreased outpatient spending in the latter 2 years through reduced primary care visits and lowered spending on specialists, testing, and imaging; (3) no differential changes in inpatient hospital spending, utilization, and quality measures for most of the 5 years; (4) favorable results for several quality measures in preventive and diabetes care domains in at least one of the 5 years. CONCLUSIONS The commercial ACO improved outpatient process quality measures modestly and slowed outpatient spending growth by the fourth year of operation, but had a negligible impact on inpatient hospital cost, use, and quality measures.
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Hong YR, Xie Z, Mainous AG, Huo J. Patient-Centered Medical Home and Up-To-Date on Screening for Breast and Colorectal Cancer. Am J Prev Med 2020; 58:107-116. [PMID: 31862097 DOI: 10.1016/j.amepre.2019.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Effectiveness of the patient-centered medical home model for promoting cancer screening utilization is uncertain, with prior research showing mixed results. Using national patient-provider pair data, this study examined whether having a patient-centered medical home-certified provider influences receipt of recommended screening for breast and colorectal cancer. METHODS A cross-sectional analysis was performed in 2019 on data from the 2015-2016 Medical Organizational Survey and Medicare Expenditure Panel Survey. Participants included U.S. adults aged 50-75 years who met screening guidelines from the U.S. Preventive Services Task Force. Multivariable regression models estimated the up-to-date rates of breast cancer and colorectal cancer screening between the patient-centered medical home and non-patient-centered medical home groups. RESULTS The study sample comprised 4,052 patient-provider pairs, representing a weighted 40.1 million screening-eligible individuals cared for by 2,314 practices. Of those, 1,909 (48.2%) were cared for by patient-centered medical home-certified providers. Unadjusted up-to-date rates were similar between patient-centered medical homes and non-patient-centered medical homes (breast cancer screening, 85.4% vs 83.4%; colorectal cancer screening, 73.3% vs 73.3%). Adjusted analysis indicated no significant differences in rates of breast cancer (p=0.228) or colorectal cancer screening (p=0.878). In subgroup analyses, however, having a patient-centered medical home-certified provider was associated with higher screening rates among individuals aged 50-64 years and those with a private plan for breast cancer and among other racial/ethnic minorities for colorectal cancer. CONCLUSIONS Obtaining care from a patient-centered medical home-certified provider is not associated with increased breast cancer or colorectal cancer screening uptake. Findings of this study suggest that tailoring cancer screening strategies to patient mix may be needed to improve cancer screening utilization in patient-centered medical homes.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida.
| | - Zhigang Xie
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | - Arch G Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida; Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Jinhai Huo
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
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Hong YR, Pavela G, Lee AM, Williamson VG, Cardel MI. Satisfaction with Health Care Among Individuals with Overweight and Obesity: A Nationally Representative Cross-sectional Study. J Gen Intern Med 2019; 34:1397-1399. [PMID: 30887437 PMCID: PMC6667531 DOI: 10.1007/s11606-019-04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 100195, Gainesville, FL, 32610, USA.
| | - Gregory Pavela
- Department of Health Behavior, School of Public Health, University of Alabama, Birmingham, Birmingham, AL, 35294, USA
| | - Alexandra M Lee
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida, Gainesville, FL, 32610, USA
| | - Victoria G Williamson
- Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, 32611, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine University of Florida, Gainesville, FL, 32610, USA
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