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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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Michels SY, Daley MF, Newcomer SR. Completion of multidose vaccine series in early childhood: current challenges and opportunities. Curr Opin Infect Dis 2024; 37:176-184. [PMID: 38427536 PMCID: PMC11210715 DOI: 10.1097/qco.0000000000001007] [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] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Completion of all doses in multidose vaccine series provides optimal protection against preventable infectious diseases. In this review, we describe clinical and public health implications of multidose vaccine series noncompletion, including current challenges to ensuring children receive all recommended vaccinations. We then highlight actionable steps toward achieving early childhood immunization goals. RECENT FINDINGS Although coverage levels are high for most early childhood vaccinations, rates of completion are lower for vaccinations that require multiple doses. Recent research has shown that lower family socioeconomic status, a lack of health insurance coverage, having multiple children in the household, and moving across state lines are associated with children failing to complete multidose vaccine series. These findings provide contextual evidence to support that practical challenges to accessing immunization services are impediments to completion of multidose series. Strategies, including reminder/recall, use of centralized immunization information systems, and clinician prompts, have been shown to increase immunization rates. Re-investing in these effective interventions and modernizing the public health infrastructure can facilitate multidose vaccine series completion. SUMMARY Completion of multidose vaccine series is a challenge for immunization service delivery. Increased efforts are needed to address remaining barriers and improve vaccination coverage in the United States.
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Affiliation(s)
- Sarah Y. Michels
- Center for Population Health Research, University of Montana, Missoula, Montana
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sophia R. Newcomer
- Center for Population Health Research, University of Montana, Missoula, Montana
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
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Wagenschieber E, Blunck D. Impact of reimbursement systems on patient care - a systematic review of systematic reviews. HEALTH ECONOMICS REVIEW 2024; 14:22. [PMID: 38492098 PMCID: PMC10944612 DOI: 10.1186/s13561-024-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 02/07/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND There is not yet sufficient scientific evidence to answer the question of the extent to which different reimbursement systems influence patient care and treatment quality. Due to the asymmetry of information between physicians, health insurers and patients, market-based mechanisms are necessary to ensure the best possible patient care. The aim of this study is to investigate how reimbursement systems influence multiple areas of patient care in form of structure, process and outcome indicators. METHODS For this purpose, a systematic literature review of systematic reviews is conducted in the databases PubMed, Web of Science and the Cochrane Library. The reimbursement systems of salary, bundled payment, fee-for-service and value-based reimbursement are examined. Patient care is divided according to the three dimensions of structure, process, and outcome and evaluated in eight subcategories. RESULTS A total of 34 reviews of 971 underlying primary studies are included in this article. International studies identified the greatest effects in categories resource utilization and quality/health outcomes. Pay-for-performance and bundled payments were the most commonly studied models. Among the systems examined, fee-for-service and value-based reimbursement systems have the most positive impact on patient care. CONCLUSION Patient care can be influenced by the choice of reimbursement system. The factors for successful implementation need to be further explored in future research.
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Affiliation(s)
- Eva Wagenschieber
- Department of Healthcare Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Dominik Blunck
- Department of Healthcare Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nuremberg, Germany.
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Sloan K, Shin M, Palinkas LA, Hudson SV, Crabtree BF, Cantor JC, Tsui J. Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings. Front Public Health 2023; 11:1099552. [PMID: 37213634 PMCID: PMC10192548 DOI: 10.3389/fpubh.2023.1099552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction We explored priorities and perspectives on health policy and payer strategies for improving HPV vaccination rates in safety-net settings in the United States. Methods We conducted qualitative interviews with policy and payer representatives in the greater Los Angeles region and state of New Jersey between December 2020 and January 2022. Practice Change Model domains guided data collection, thematic analysis, and interpretation. Results Five themes emerged from interviews with 11 policy and 8 payer participants, including: (1) payer representatives not prioritizing HPV vaccination specifically in incentive-driven clinic metrics; (2) policy representatives noting region-specific HPV vaccine policy options; (3) inconsistent motivation across policy/payer groups to improve HPV vaccination; (4) targeting of HPV vaccination in quality improvement initiatives suggested across policy/payer groups; and (5) COVID-19 pandemic viewed as both barrier and opportunity for HPV vaccination improvement across policy/payer groups. Discussion Our findings indicate opportunities for incorporating policy and payer perspectives into HPV vaccine improvement processes. We identified a need to translate effective policy and payer strategies, such as pay-for-performance programs, to improve HPV vaccination within safety-net settings. COVID-19 vaccination strategies and community efforts create potential policy windows for expanding HPV vaccine awareness and access.
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Affiliation(s)
- Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michelle Shin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lawrence A. Palinkas
- Department of Children, Youth, and Families, Suzanne Dworak-Peck School of Social Work University of Southern California, Los Angeles, CA, United States
| | - Shawna V. Hudson
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Benjamin F. Crabtree
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Joel C. Cantor
- Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Jennifer Tsui
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Does a pay-for-performance health service model improve overall and rural–urban inequity in vaccination rates? A difference-in-differences analysis from the Gambia. Vaccine X 2022; 12:100206. [PMID: 36051748 PMCID: PMC9424534 DOI: 10.1016/j.jvacx.2022.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/05/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
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Schwalbe N, Hanbali L, Nunes MC, Lehtimaki S. Use of financial incentives to increase adult vaccination coverage: A narrative review of lessons learned from COVID-19 and other adult vaccination efforts. Vaccine X 2022; 12:100225. [PMID: 36217357 PMCID: PMC9535879 DOI: 10.1016/j.jvacx.2022.100225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/29/2022] [Accepted: 09/29/2022] [Indexed: 10/25/2022] Open
Abstract
To encourage COVID-19 vaccination, governments have offered a wide range of incentives to their populations ranging from cash to cows. Often these programs were rolled out at scale before assessing potential effectiveness. To inform future policy, we conducted a narrative review to understand the evidence base informing these programs and the extent to which they are effective. While we found evidence on cash transfers increasing both the coverage and intention to be vaccinated for COVID-19 and other adult vaccines, improvements in coverage were limited. With mixed evidence, lottery programs did not appear to have a consistent meaningful impact on vaccination for COVID-19, and no evidence was identified on the positive effects of other non-cash incentives for COVID-19 or other adult vaccines. We conclude that the impact of cash transfers in incentivizing adult vaccination is marginal and their effectiveness in addressing vaccine hesitancy remains inconclusive.
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Affiliation(s)
- Nina Schwalbe
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Spark Street Advisors, New York, NY, United States,Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, United States,Corresponding author at: 722 W 168th St, New York, NY 10032, USA.
| | | | - Marta C. Nunes
- Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases; and South African Medical Research Council, Vaccines & Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wyplosz B, Fernandes J, Sultan A, Roche N, Roubille F, Loubet P, Fougère B, Moulin B, Duhot D, Vainchtock A, Raguideau F, Lortet-Tieulent J, Blanc E, Moïsi J, Goussiaume G. Pneumococcal and influenza vaccination coverage among at-risk adults: A 5-year French national observational study. Vaccine 2022; 40:4911-4921. [PMID: 35811205 DOI: 10.1016/j.vaccine.2022.06.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. MATERIAL AND METHODS In this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance's (NHI) General scheme's claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. RESULTS AND DISCUSSION In 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36-3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians' visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9per GP,1per specialist over 9 years) despite frequent healthcare visits. CONCLUSION Pneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations.
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Affiliation(s)
- Benjamin Wyplosz
- AP-HP, Bicêtre University Hospital, Service de maladies infectieuses et tropicales, Centre de vaccinations internationales et de l'immunodéprimé, Le Kremlin-Bicêtre, France.
| | - Jérôme Fernandes
- Medical Information Department, Bayonne Hospital, Bayonne, France.
| | - Ariane Sultan
- PhyMedExp, University Montpellier, CNRS, INSERM, Endocrinology-Diabetology-Nutrition Department, University Montpellier, 34295 Montpellier, France.
| | | | | | - Paul Loubet
- Service des Maladies infectieuses et Tropicales, CHU de Nîmes - INSERM U1047 - Université de Montpellier, Nîmes (France).
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Hospital, Tours, France.
| | - Bruno Moulin
- Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France.
| | - Didier Duhot
- Société Française de Médecine Générale, Issy les Moulineaux, France.
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Rand CM, Humiston SG. Provider Focused Interventions to Improve Child and Adolescent Vaccination Rates. Acad Pediatr 2021; 21:S34-S39. [PMID: 33958090 DOI: 10.1016/j.acap.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Cynthia M Rand
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry (CM Rand), Rochester, NY.
| | - Sharon G Humiston
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and Children's Mercy Kansas City (SG Humiston), Mo
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