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Reindersma T, Fabbricotti I, Ahaus K, Bangma C, Sülz S. Inciting maintenance: Tiered institutional work during value-based payment reform in oncology. Soc Sci Med 2024; 347:116798. [PMID: 38537332 DOI: 10.1016/j.socscimed.2024.116798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned.
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Affiliation(s)
- Thomas Reindersma
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
| | - Isabelle Fabbricotti
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Kees Ahaus
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Chris Bangma
- Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sandra Sülz
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
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2
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Scheefhals ZTM, de Vries EF, Struijs JN, Numans ME, van Exel J. Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study. Soc Sci Med 2024; 340:116413. [PMID: 38000174 DOI: 10.1016/j.socscimed.2023.116413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.
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Affiliation(s)
- Zoë T M Scheefhals
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Eline F de Vries
- Department of Health Economics and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jeroen N Struijs
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands.
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3
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Messerle R, Schreyögg J. Country-level effects of diagnosis-related groups: evidence from Germany's comprehensive reform of hospital payments. Eur J Health Econ 2023:10.1007/s10198-023-01645-z. [PMID: 38051399 DOI: 10.1007/s10198-023-01645-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
Hospitals account for about 40% of all healthcare expenditure in high-income countries and play a central role in healthcare provision. The ways in which they are paid, therefore, has major implications for the care they provide. However, our knowledge about reforms that have been made to the various payment schemes and their country-level effects is surprisingly thin. This study examined the uniquely comprehensive introduction of diagnosis-related groups (DRGs) in Germany, where DRGs function as the sole pricing, billing, and budgeting system for hospitals and almost exclusively determine hospital revenue. The introduction of DRGs, therefore, completely overhauled the previous system based on per diem rates, offering a unique opportunity for analysis. Using aggregate data from the Organisation for Economic Co-operation and Development and recent advances in econometrics, we analyzed how hospital activity and efficiency changed in response to the reform. We found that DRGs in Germany significantly increased hospital activity by around 20%. In contrast to earlier studies, we found that DRGs have not necessarily shortened the average length of stay.
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Affiliation(s)
- Robert Messerle
- Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354, Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354, Hamburg, Germany.
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4
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Li Q, Fan X, Jian W. Impact of Diagnosis-Related-Group (DRG) payment on variation in hospitalization expenditure: evidence from China. BMC Health Serv Res 2023; 23:688. [PMID: 37355657 DOI: 10.1186/s12913-023-09686-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Diagnosis-Related-Group (DRG) payment is considered a crucial means of addressing the rapid increases of medical cost and variation in cost. This paper analyzes the impact of DRG payment on variation in hospitalization expenditure in China. METHOD Patients with chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI) in a Chinese City Z were selected. Patients in the fee-for-service (FFS) payment group and the DRG payment group were used as the control group and intervention group, respectively, and propensity-score-matching (PSM) was conducted. Interquartile distance (IQR), standard deviation (SD) and concentration index were used to analyze variation and trends in terms of hospitalization expenditure across the different groups. RESULTS After DRG payment reform, the SD of hospitalization expenditure in respect of the COPD, AMI and CI patients in City Z decreased by 11,094, 4,833 and 4,987 CNY, respectively. The concentration indices of hospitalization expenditures for three diseases are all below 0 (statistically significant), with the absolute value tending to increase year by year. CONCLUSION DRG payment can be seen to guide medical service providers to provide effective treatment that can improve the consistency of medical care services, bringing the cost of medical care closer to its true clinical value.
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Affiliation(s)
- Qiaosheng Li
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Xiaoqi Fan
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China.
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5
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Chen YJ, Zhang XY, Tang X, Yan JQ, Qian MC, Ying XH. How do inpatients' costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis. BMC Health Serv Res 2023; 23:160. [PMID: 36793088 PMCID: PMC9933283 DOI: 10.1186/s12913-023-09109-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023] Open
Abstract
CONTEXT A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. OBJECTIVE This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age. METHODS An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18-64 years) and an older group (≥ 65 years), further stratified into young-old (65-79 years) and oldest-old (≥ 80 years) groups. RESULTS The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups. CONCLUSION Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.
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Affiliation(s)
- Ya-jing Chen
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China
| | - Xin-yu Zhang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China
| | - Xue Tang
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China
| | - Jia-qi Yan
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China
| | - Meng-cen Qian
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Fudan University, 130 Dongan Road, Shanghai, China
| | - Xiao-hua Ying
- grid.8547.e0000 0001 0125 2443School of Public Health, Fudan University, Shanghai, China ,grid.8547.e0000 0001 0125 2443Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Fudan University, 130 Dongan Road, Shanghai, China
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6
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Whitsel LP, Ajenikoko F, Chase PJ, Johnson J, McSwain B, Phelps M, Radcliffe R, Faghy MA. Public policy for healthy living: How COVID-19 has changed the landscape. Prog Cardiovasc Dis 2023; 76:49-56. [PMID: 36690285 PMCID: PMC9852261 DOI: 10.1016/j.pcad.2023.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a transformational impact on public policy as governments played a leading role, working alongside and coordinating with business/industry, healthcare, public health, education, transportation, researchers, non-governmental organizations, philanthropy, and media/communications. This paper summarizes the impact of the pandemic on different areas of public policy affecting healthy living and cardiovascular health including prevention (i.e., nutrition, physical activity, air quality, tobacco use), risk factors for chronic disease (hypertension, diabetes, obesity, substance abuse), access to health care, care delivery and payment reform, telehealth and digital health, research, and employment policy. The paper underscores where public policy is evolving and where there are needs for future evidence base to inform policy development, and the intersections between the public and private sectors across the policy continuum. There is a continued need for global multi-sector coordination to optimize population health.
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Affiliation(s)
- Laurie P Whitsel
- American Heart Association, Washington, DC 20036, United States of America.
| | - Funke Ajenikoko
- American Heart Association, Washington, DC 20036, United States of America
| | - Paul J Chase
- American Heart Association, Washington, DC 20036, United States of America
| | - Janay Johnson
- American Heart Association, Washington, DC 20036, United States of America
| | - Brooke McSwain
- American Heart Association, Washington, DC 20036, United States of America
| | - Melanie Phelps
- American Heart Association, Washington, DC 20036, United States of America
| | - Reyna Radcliffe
- American Heart Association, Washington, DC 20036, United States of America
| | - Mark A Faghy
- Biomedical Research Theme, School of Human Sciences, University of Derby, Deby, United Kingdom
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7
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Rocque GB, Dionne-Odom JN, Stover AM, Daniel CL, Azuero A, Huang CHS, Ingram SA, Franks JA, Caston NE, Dent DAN, Basch EM, Jackson BE, Howell D, Weiner BJ, Pierce JY. Evaluating the implementation and impact of navigator-supported remote symptom monitoring and management: a protocol for a hybrid type 2 clinical trial. BMC Health Serv Res 2022; 22:538. [PMID: 35459238 PMCID: PMC9027833 DOI: 10.1186/s12913-022-07914-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background Symptoms in patients with advanced cancer are often inadequately captured during encounters with the healthcare team. Emerging evidence demonstrates that weekly electronic home-based patient-reported symptom monitoring with automated alerts to clinicians reduces healthcare utilization, improves health-related quality of life, and lengthens survival. However, oncology practices have lagged in adopting remote symptom monitoring into routine practice, where specific patient populations may have unique barriers. One approach to overcoming barriers is utilizing resources from value-based payment models, such as patient navigators who are ideally positioned to assume a leadership role in remote symptom monitoring implementation. This implementation approach has not been tested in standard of care, and thus optimal implementation strategies are needed for large-scale roll-out. Methods This hybrid type 2 study design evaluates the implementation and effectiveness of remote symptom monitoring for all patients and for diverse populations in two Southern academic medical centers from 2021 to 2026. This study will utilize a pragmatic approach, evaluating real-world data collected during routine care for quantitative implementation and patient outcomes. The Consolidated Framework for Implementation Research (CFIR) will be used to conduct a qualitative evaluation at key time points to assess barriers and facilitators, implementation strategies, fidelity to implementation strategies, and perceived utility of these strategies. We will use a mixed-methods approach for data interpretation to finalize a formal implementation blueprint. Discussion This pragmatic evaluation of real-world implementation of remote symptom monitoring will generate a blueprint for future efforts to scale interventions across health systems with diverse patient populations within value-based healthcare models. Trial registration NCT04809740; date of registration 3/22/2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07914-6.
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Affiliation(s)
- Gabrielle B Rocque
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA. .,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, Birmingham, AL, USA.
| | - J Nicholas Dionne-Odom
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.,University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Angela M Stover
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Casey L Daniel
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Andres Azuero
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Chao-Hui Sylvia Huang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Jeffrey A Franks
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Nicole E Caston
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - D' Ambra N Dent
- Department of Medicine, Division of Hematology and Oncology, University of Alabama at Birmingham, 1824 6th Avenue South, 35924-3300 - WTI 240E, Birmingham, AL, USA
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Bradford E Jackson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
| | - Doris Howell
- Supportive Care, Princess Margaret Cancer Centre Research Institute, Toronto, Ontario, Canada
| | - Bryan J Weiner
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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8
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Waitzberg R, Siegel M, Quentin W, Busse R, Greenberg D. It probably worked: a Bayesian approach to evaluating the introduction of activity-based hospital payment in Israel. Isr J Health Policy Res 2022; 11:8. [PMID: 35168669 PMCID: PMC8845384 DOI: 10.1186/s13584-022-00515-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background In 2013–2014, Israel accelerated adoption of activity-based payments to hospitals. While the effects of such payments on patient length of stay (LoS) have been examined in several countries, there have been few analyses of incentive effects in the Israeli context of capped reimbursements and stretched resources. Methods We examined administrative data from the Israel Ministry of Health for 14 procedures from 2005 to 2016 in all not-for-profit hospitals (97% of the acute care beds). Survival analyses using a Weibull distribution allowed us to examine the non-negative and right-skewed data. We opted for a Bayesian approach to estimate relative change in LoS. Results LoS declined in 7 of 14 procedures analyzed, notably, in 6 out of 7 urological procedures. In these procedures, reduction in LoS ranged between 11% and 20%. The estimation results for the control variables are mixed and do not indicate a clear pattern of association with LoS. Conclusions The decrease in LoS freed resources to treat other patients, which may have resulted in reduced waiting times. It may have been more feasible to reduce LoS for urological procedures since these had relatively long LoS. Policymakers should pay attention to the effects of decreases in LoS on quality of care. Stretched hospital resources, capped reimbursements, retrospective subsidies and underpriced procedures may have limited hospitals' ability to reduce LoS for other procedures where no decrease occurred (e.g., general surgery). Supplementary Information The online version contains supplementary material available at 10.1186/s13584-022-00515-y.
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Affiliation(s)
- Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel. .,Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel. .,Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
| | - Martin Siegel
- Department of Empirical Health Economics, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Wilm Quentin
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.,European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Reinhard Busse
- Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.,European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Dan Greenberg
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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9
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Lai Y, Fu H, Li L, Yip W. Hospital response to a case-based payment scheme under regional global budget: The case of Guangzhou in China. Soc Sci Med 2021; 292:114601. [PMID: 34844079 DOI: 10.1016/j.socscimed.2021.114601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022]
Abstract
Both developed and developing countries have been searching for effective provider payment methods to control health expenditure inflation. In January 2018, Guangzhou city in Southern China initiated an innovative case-based payment method for inpatient care under the framework of the regional global budget, called the Diagnosis-Intervention Packet (DIP). Contrary to the usual practice of the case-based payment, the DIP payment scheme includes a price adjustment mechanism through which the actual reimbursement for each case is determined ex post. By employing the difference-in-difference method and data from Beijing and Guangzhou, we evaluate the effects of the DIP payment on medical expenditures and provider behaviors. We find that total health expenditures per case have decreased by 3.5%, which is mainly driven by a substantial decrease in drug expenditures. It suggests that the DIP payment reform achieved a short-term success in slowing down the growth of health expenditures. However, the average point volume per case for local inpatients with social health insurance coverage has increased by more than 3%, primarily due to an increasing likelihood of performing at least one procedure. We also find suggestive evidence of up-coding. All these results suggest that healthcare providers have taken strategic behaviors in response to the DIP payment. These findings hold lessons for the ongoing payment reforms in China and other countries.
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Affiliation(s)
- Yi Lai
- National School of Development, Peking University, Beijing, 100871, China.
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, 100191, China.
| | - Ling Li
- National School of Development, Peking University, Beijing, 100871, China.
| | - Winnie Yip
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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10
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Lindner S, Kaufman MR, Marino M, O'Malley J, Angier H, Cottrell EK, McConnell KJ, DeVoe JE, Heintzman JR. A Medicaid Alternative Payment Model Program In Oregon Led To Reduced Volume Of Imaging Services. Health Aff (Millwood) 2021; 39:1194-1201. [PMID: 32634361 DOI: 10.1377/hlthaff.2019.01656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The patient-centered medical home model aspires to fundamentally restructure care processes, but a volume-based payment system may hinder such transformations. In 2013 Oregon's Medicaid program changed its reimbursement of traditional primary care services for selected community health centers (CHCs) from a per visit to a per patient rate. Using Oregon claims data, we analyzed the price-weighted volume of care for five service areas: traditional primary care services, including imaging, tests, and procedures; other services provided by CHCs that were carved out from the payment reform; emergency department visits; inpatient services; and other services of non-CHC providers. We further subdivided traditional primary care services using Berenson-Eggers Type of Service categories of care. We compared participating and nonparticipating CHCs in Oregon before and after the payment model was implemented. The payment reform was associated with a 42.4 percent relative reduction in price-weighted traditional primary care services, driven fully by decreased use of imaging services. Other outcomes remained unaffected. Oregon's initiative could provide lessons for other states interested in using payment reform to advance the patient-centered medical home model for the Medicaid population.
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Affiliation(s)
- Stephan Lindner
- Stephan Lindner is an assistant professor in the Center for Health Systems Effectiveness and in the Department of Emergency Medicine, both at Oregon Health & Science University, in Portland, Oregon
| | - Menolly R Kaufman
- Menolly R. Kaufman is a research associate in the Center for Health Systems Effectiveness, Oregon Health & Science University
| | - Miguel Marino
- Miguel Marino is an associate professor of biostatistics in the Department of Family Medicine, Oregon Health & Science University, and at the OHSU-Portland State University School of Public Health, in Portland
| | - Jean O'Malley
- Jean O'Malley is a biostatistician in the Research Department at Ochin, Inc., in Portland
| | - Heather Angier
- Heather Angier is an assistant professor in the Department of Family Medicine, Oregon Health & Science University
| | - Erika K Cottrell
- Erika K. Cottrell is an assistant professor in the Department of Family Medicine, Oregon Health & Science University, and an investigator at OCHIN, Inc
| | - K John McConnell
- K. John McConnell is director of the Center for Health Systems Effectiveness and a professor in the Department of Emergency Medicine, both at Oregon Health & Science University
| | - Jennifer E DeVoe
- Jennifer E. DeVoe is professor and chair in the Department of Family Medicine, Oregon Health & Science University
| | - John R Heintzman
- John R. Heintzman is an associate professor in the Department of Family Medicine, Oregon Health & Science University
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11
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Hayen A, van den Berg MJ, Struijs JN, Westert Gert GP. Dutch shared savings program targeted at primary care: Reduced expenditures in its first year. Health Policy 2021; 125:489-494. [PMID: 33589170 DOI: 10.1016/j.healthpol.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/16/2020] [Accepted: 01/26/2021] [Indexed: 11/25/2022]
Abstract
In countries where GPs fulfill a central role in the health care system, like in the Netherlands, the lack of value-based incentives in GP payment systems may have negative consequences for value delivered in other parts of the health care spectrum. We evaluate an experiment in which GPs were allowed to share in savings in total health care expenditures, conditionally on achieving quality targets. At least in theory, these so-called 'shared savings contracts' incentivize GPs to become critical gatekeepers, coordinate the provision of care and substitute for specialist services when appropriate. This study evaluates a Dutch shared savings program targeted at GPs. This study employs a difference-in-differences design using a regional control group of non-participating GPs. We find that program participation led to savings in health care expenditures (-2%), while patient satisfaction was unaffected and while the results for other quality indicators were ambiguous. Additional analyses show that savings have been predominantly realized by lowering the volume of specialist care, and that almost every participating GP displayed cost-saving behavior. This finding suggests that shared savings contracts, even when added as a mere complemented to existing volume-based payment models, already elicit substantive effort to increase the value of health care provided.
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Affiliation(s)
- Arthur Hayen
- Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
| | - Michael Jack van den Berg
- National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands.
| | - Jeroen Nathan Struijs
- National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands.
| | - Gerard Pieter Westert Gert
- Radboud University (Radboud University Medical Center), PO Box 9101, huispost 114, 6500 HB Nijmegen, the Netherlands.
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12
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Dalton MK, Mjåset C, Manful A, Helgeson MD, Wynn-Jones W, Cooper Z, Koehlmoos TP, Weissman JS. Strategies for spinal surgery reimbursement: bundling in the working-age population. BMC Health Serv Res 2021; 21:112. [PMID: 33530994 PMCID: PMC7852105 DOI: 10.1186/s12913-021-06112-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/24/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Bundled payments for spine surgery, which is known for having high overall cost with wide variation, have been previously studied in older adults. However, there has been limited work examining bundled payments in working-age patients. We sought to identify the variation in the cost of spine surgery among working age adults in a large, national insurance claims database. Methods We queried the TRICARE claims database for all patients, aged 18–64, undergoing cervical and non-cervical spinal fusion surgery between 2012 and 2014. We calculated the case mix adjusted, price standardized payments for all aspects of care during the 60-, 90-, and 180-day periods post operation. Variation was assessed by stratifying Hospital Referral Regions into quintiles. Results After adjusting for case mix, there was significant variation in the cost of both cervical ($10,538.23, 60% of first quintile) and non-cervical ($20,155.59, 74%). Relative variation in total cost decreased from 60- to 180-days (63 to 55% and 76 to 69%). Index hospitalization was the primary driver of costs and variation for both cervical (1st-to-5th quintile range: $11,033–$19,960) and non-cervical ($18,565–$36,844) followed by readmissions for cervical ($0–$11,521) and non-cervical ($0–$13,932). Even at the highest quintile, post-acute care remained the lowest contribution to overall cost ($2070 & $2984). Conclusions There is wide variation in the cost of spine surgery across the United States for working age adults, driven largely by index procedure and readmissions costs. Our findings suggest that implementing episodes longer than the current 90-day standard would do little to better control cost variation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06112-0.
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Affiliation(s)
- Michael K Dalton
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA.
| | - Christer Mjåset
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.,Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PO Box 4950, Nydalen, 0424, Oslo, Norway.,Commonwealth Fund Harkness Fellowship, 1 East 75th Street, New York, NY, 10021, USA
| | - Adoma Manful
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA
| | - Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD, 20814, USA
| | - William Wynn-Jones
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA.,Commonwealth Fund Harkness Fellowship, 1 East 75th Street, New York, NY, 10021, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA
| | - Tracey P Koehlmoos
- F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20184, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women's Hospital, 1620 Tremont Street, 1 Brigham Circle, Boston, MA, 02120, USA
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13
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Torres ME, Brolin M, Panas L, Ritter G, Hodgkin D, Lee M, Merrick E, Horgan C, Hopwood JC, Gewirtz A, De Marco N, Lane N. Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study. BMC Health Serv Res 2020; 20:1004. [PMID: 33143701 PMCID: PMC7607694 DOI: 10.1186/s12913-020-05861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service. Methods We analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings. Results Clients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model. Conclusions Addiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05861-8.
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Affiliation(s)
- Maria E Torres
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA. .,Smith College School for Social Work, Lilly Hall, Northampton, MA, 01060, USA.
| | - Mary Brolin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Lee Panas
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Grant Ritter
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Dominic Hodgkin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Margaret Lee
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Elizabeth Merrick
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Constance Horgan
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Jonna C Hopwood
- Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA
| | - Andrea Gewirtz
- Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA
| | - Natasha De Marco
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Nancy Lane
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
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14
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Wang GX, Frank HR, Santanam TS, Zeng E, Vulimiri M, McClellan M, Wong CA. Pediatric accountable health communities: Insights on needed capabilities and potential solutions. Healthc (Amst) 2020; 8:100481. [PMID: 33038579 DOI: 10.1016/j.hjdsi.2020.100481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/25/2020] [Accepted: 09/19/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pediatric accountable health communities (AHCs) are emerging collaborative models that integrate care across health and social service sectors. We aimed to identify needed capabilities and potential solutions for implementing pediatric AHCs. METHODS We conducted a directed content analysis of responses to a Request for Information (RFI) from the Center for Medicare & Medicaid Innovation on the Integrated Care for Kids Model (n = 1550 pages from 202 respondents). We then interviewed pediatric health policy stakeholders (n = 18) to further investigate responses from the RFI. All responses were coded using a consensual qualitative research approach in 2019. RESULTS To facilitate service integration, respondents emphasized the need for cross-sector organizational alignment and data sharing. Recommended solutions included designating "Bridge Organizations" to operationalize service integration across sectors and developing integrated data sharing systems. Respondents called for improved validation and collection methods for data relating to school performance, social drivers of health, family well-being, and patient experience. Recommended solutions included aligning health and education data privacy regulations and utilizing metrics with cross-sector relevance. Respondents identified that mechanisms are needed to blend health and social service funding in alternative payment models (APMs). Recommended solutions included guidance on cross-sector care coordination payments, shared savings arrangements, and capitation to maximize spending flexibility. CONCLUSIONS Pediatric AHCs could provide more integrated, high-value care for children. Respondents highlighted the need for shared infrastructure and cross-sector alignment of measures and financing. IMPLICATIONS Insights and solutions from this study can inform policymakers planning or implementing innovative, child-centered AHC models. LEVEL OF EVIDENCE Level V.
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Abstract
This article explores one of the undeniable driving forces in health care: payment, and the shift toward value-based reimbursement as a lever to better align provider incentives toward appropriate utilization of health care services. The increasing burden of heart failure has made it an attractive target for many payment reform efforts and alternative payment models. As the ultimate goal of "value-based care" interventions is to reduce costs and improve quality outcomes and experience for patients while simultaneously improving the caregiver experience, financial models require a level of clinical translation to yield sustainable care redesign improvements.
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Affiliation(s)
- Jessica Walradt
- Department of Managed Care, Northwestern Memorial HealthCare, 541 North Fairbanks Court, Suite 1500, Chicago, IL 60611, USA
| | - Hannah Alphs Jackson
- Department of Managed Care, Northwestern Memorial HealthCare, 541 North Fairbanks Court, Suite 1500, Chicago, IL 60611, USA; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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de Vries EF, Drewes HW, Struijs JN, Heijink R, Baan CA. Barriers to payment reform: Experiences from nine Dutch population health management sites. Health Policy 2019; 123:1100-7. [PMID: 31578167 DOI: 10.1016/j.healthpol.2019.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 06/06/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022]
Abstract
Population health management (PHM) initiatives aim for better population health, quality of care and reduction of expenditure growth by integrating and optimizing services across domains. Reforms shifting payment of providers from traditional fee-for-service towards value-based payment models may support PHM. We aimed to gain insight into payment reform in nine Dutch PHM sites. Specifically, we investigated 1) the type of payment models implemented, and 2) the experienced barriers towards payment reform. Between October 2016 and February 2017, we conducted 36 (semi-)structured interviews with program managers, hospitals, insurers and primary care representatives of the sites. We addressed the structure of payment models and barriers to payment reform in general. After three years of PHM, we found that four shared savings models for pharmaceutical care and five extensions of existing (bundled) payment models adding providers into the model were implemented. Interviewees stated that reluctance to shift financial accountability to providers was partly due to information asymmetry, a lack of trust and conflicting incentives between providers and insurers, and last but not least a lack of a sense of urgency. Small steps to payment reform have been taken in the Dutch PHM sites, which is in line with other international PHM initiatives. While acknowledging the autonomy of PHM sites, governmental stewardship (e.g. long-term vision, supporting knowledge development) can further stimulate value-based payment reforms.
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17
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Eichmiller F. Third-Party Perspective of Dental Caries Management. Dent Clin North Am 2019; 63:731-736. [PMID: 31470926 DOI: 10.1016/j.cden.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Caries management could provide a unique opportunity to model reform to the dental reimbursement system. To be successful we must first understand the scope and basis of many of the obstacles to reform. Reform must also provide value to all the players involved in benefit determination, provision of care, and payment for care. Value is viewed as outcomes achieved per dollar from the patient's perspective and over a complete cycle of care or management. Reimbursing for value requires measurement of value, and one hypothetical model for caries management is presented based on Michael Porter's hierarchy of outcome measures.
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18
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Liao JM, Martinez JR, Shan EZ, Huang JJ, Dinh CT, Huang EQ, Navathe AS. Medicare's new voluntary bundled payment program: Episode selection and participant characteristics. Healthc (Amst) 2019; 7:26-30. [PMID: 30992188 DOI: 10.1016/j.hjdsi.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA; Value and Systems Science Lab, Seattle, WA 98195, USA; Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA.
| | - Joseph R Martinez
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; The Wharton School at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eric Z Shan
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jack J Huang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Claire T Dinh
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Erin Q Huang
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Amol S Navathe
- Leonard Davis Institute of Health Economics, Philadelphia, PA 19104, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; CMC Philadelphia VA Medical Center, Philadelphia, PA 19104, USA
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19
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Murciano-Goroff YR, McCarthy AM, Bristol MN, Domchek SM, Groeneveld PW, Motanya UN, Armstrong K. Medical oncologists' willingness to participate in bundled payment programs. BMC Health Serv Res 2018; 18:391. [PMID: 29855315 PMCID: PMC5984411 DOI: 10.1186/s12913-018-3202-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 05/13/2018] [Indexed: 12/15/2022] Open
Abstract
Background Bundled payment programs play an increasingly important role in transforming reimbursement for oncologic care. We assessed determinants of oncologists’ willingness to participate in bundled payment programs for breast cancer. We hypothesized that providers would be more likely to participate in bundled payment programs if offered higher levels of reimbursement for each episode of care. Methods Oncologists from Florida, New Jersey, New York, and Pennsylvania were identified in the AMA database or by patients listed in state cancer registries. Providers were randomized to receive one of four versions of a survey describing bundled payment programs offering different levels of compensation for the first year of localized breast cancer treatment ($5000, $10,000, $15,000, or $20,000). Physicians rated their likelihood of participation in a bundled program on a Likert scale. Logistic regression was used to analyze determinants of likelihood of participation in bundling. Results Among 460 respondents, only 17% of oncologists were highly likely to participate in a bundled program paying $5000 for the first year of care, rising to 41% for the $15,000 program, but falling to 34% for the $20,000 program. Likelihood of participation was higher among oncologists who were male, older, and believed that cancer patients should not be offered high-cost drugs with minimal survival benefit. Conclusion Our results suggest that medical oncologists have limited enthusiasm for bundled payments, and higher payments may not overcome resistance to bundling among a substantial proportion of physicians.
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Affiliation(s)
- Yonina R Murciano-Goroff
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA.
| | - Anne Marie McCarthy
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
| | - Mirar N Bristol
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
| | - Susan M Domchek
- University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
| | - Peter W Groeneveld
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - U Nkiru Motanya
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA, 02114, USA
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Palumbo MV, Rambur B, Hart V. Is health care payment reform impacting nurses' work settings, roles, and education preparation? J Prof Nurs 2017; 33:400-404. [PMID: 29157566 DOI: 10.1016/j.profnurs.2016.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
Abstract
This study explores nurses' work settings and educational preparation in the five years before passage of the Affordable Care Act (ACA) and five years after ACA passage, with the aim of identifying areas for nurse educators' attention. The study setting was one small state undergoing rapid transition away from fee-for-service service and thus provided the ideal laboratory to assess the impact of health reform on the nursing workforce. A secondary analysis of data gathered during relicensure compared the nursing workforce at an interval of one decade, with surveys in 2005 (n=4075; 65% response rate) and in 2015 (n=6723; 97% response rate). Findings demonstrated an increase in the proportion of nurses who reported working in ambulatory care and community settings (p=0.001). However, there was no associated decrease in the proportion of nurses who reported working in hospitals. Among respondents who reported employment in the ambulatory care/community settings in 2005, 34.3% had a BSN or higher, a proportion that increased to 41.2% in 2015 (p=0.010); nevertheless, the greatest proportional increase was among AD prepared nurses (34% to 48%). Although new nursing roles emerging as a result of health reform offer baccalaureate nurses the opportunity use the full complement of their knowledge and skills, these data suggest that BS prepared nurses are not fully accessing these opportunities. Implications for nursing education and further research are detailed.
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Affiliation(s)
- Mary Val Palumbo
- University of Vermont, College of Nursing and Health Sciences, 106 Carrigan Drive, Rowell 216, Burlington, VT 05405, United States.
| | - Betty Rambur
- University of Rhode Island, Routhier Endowed Chair for Practice, College of Nursing, 39 Butterfield Road, Kingston, RI, 02881, United States.
| | - Vicki Hart
- University of Vermont, Office of Health Promotion Research, 1 South Prospect Street, Rm 4428, Burlington, VT 05401, United States.
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Clemens J, Gottlieb JD, Molnár TL. Do health insurers innovate? Evidence from the anatomy of physician payments. J Health Econ 2017; 55:153-167. [PMID: 28784289 DOI: 10.1016/j.jhealeco.2017.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 06/07/2023]
Abstract
One of private health insurers' main roles in the United States is to negotiate physician payment rates on their beneficiaries' behalf. We show that these rates are often set in reference to a government benchmark, and ask how often private insurers customize their fee schedules away from this default. We exploit changes in Medicare's payments and dramatic bunching in markups over Medicare's rates to address this question. Although Medicare's rates are influential, 25 percent of physician services in our data, representing 45 percent of covered spending, deviate from the benchmark. Heterogeneity in the pervasiveness and direction of deviations suggests that the private market coordinates around Medicare's pricing for simplicity but abandons it when sufficient value is at stake.
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22
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Cohn DE, Ko E, Meyer LA, Wright JD, Temkin SM, Foote J, Jones NL, Havrilesky LJ. The "value" of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations. Gynecol Oncol 2017; 145:185-191. [PMID: 28258763 DOI: 10.1016/j.ygyno.2017.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 11/19/2022]
Affiliation(s)
- David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH, United States.
| | - Emily Ko
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Pennsylvania Hospital, Philadelphia, PA, United States
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason D Wright
- Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, United States
| | - Sarah M Temkin
- Virginia Commonwealth University, Richmond, VA, United States
| | - Jonathan Foote
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States
| | - Nathaniel L Jones
- Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY, United States
| | - Laura J Havrilesky
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University, Durham, NC, United States
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Ouayogodé MH, Colla CH, Lewis VA. Determinants of success in Shared Savings Programs: An analysis of ACO and market characteristics. Healthc (Amst) 2017; 5:53-61. [PMID: 27687917 PMCID: PMC5368036 DOI: 10.1016/j.hjdsi.2016.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/21/2016] [Accepted: 08/24/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. OBJECTIVE To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. METHODS We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs. We examined the association between ACO financial performance and ACO provider composition, leadership structure, beneficiary characteristics, risk bearing experience, quality and process improvement capabilities, physician performance management, market competition, CMS-assigned financial benchmark, and ACO contract start date. We examined two outcomes from Medicare ACOs' first performance year: savings per Medicare beneficiary and earning shared savings payments (a dichotomous variable). RESULTS When modeling the ACO ability to save and earn shared savings payments, we estimated positive regression coefficients for a greater proportion of primary care providers in the ACO, more practicing physicians on the governing board, physician leadership, active engagement in reducing hospital re-admissions, a greater proportion of disabled Medicare beneficiaries assigned to the ACO, financial incentives offered to physicians, a larger financial benchmark, and greater ACO market penetration. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments. CONCLUSIONS In the first year, performance is quite heterogeneous, yet organizational structure does not consistently predict performance. Organizations with large financial benchmarks at baseline have greater opportunities to achieve savings. Findings on prior risk bearing suggest that ACOs learn over time under risk-bearing contracts. IMPLICATIONS Given the lack of predictive power for organizational characteristics, CMS should continue to encourage diversity in organizational structures for ACO participants, and provide alternative funding and risk bearing mechanisms to continue to allow a diverse group of organizations to participate. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mariétou H Ouayogodé
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Carrie H Colla
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Valerie A Lewis
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Research Building, Level 5, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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24
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Abstract
Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.
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Affiliation(s)
- Samuel H Hubley
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, USA. .,Helen and Arthur E. Johnson Depression Center, 13199 E. Montview Blvd, Suite 330, Aurora, CO, 80045, USA.
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, School of Medicine, University of Colorado Denver, Aurora, CO, USA
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25
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Sood N, Alpert A, Barnes K, Huckfeldt P, Escarce JJ. Effects of payment reform in more versus less competitive markets. J Health Econ 2017; 51:66-83. [PMID: 28073062 PMCID: PMC5551673 DOI: 10.1016/j.jhealeco.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 05/02/2023]
Abstract
Policymakers are increasingly interested in reducing healthcare costs and inefficiencies through innovative payment strategies. These strategies may have heterogeneous impacts across geographic areas, potentially reducing or exacerbating geographic variation in healthcare spending. In this paper, we exploit a major payment reform for home health care to examine whether reductions in reimbursement lead to differential changes in treatment intensity and provider costs depending on the level of competition in a market. Using Medicare claims, we find that while providers in more competitive markets had higher average costs in the pre-reform period, these markets experienced larger proportional reductions in treatment intensity and costs after the reform relative to less competitive markets. This led to a convergence in spending across geographic areas. We find that much of the reduction in provider costs is driven by greater exit of "high-cost" providers in more competitive markets.
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Affiliation(s)
- Neeraj Sood
- University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), 2nd Floor, Los Angeles, CA 90089-3333, United States; National Bureau of Economic Research, 1050 Massachusetts Ave., Cambridge, MA 02138, United States.
| | - Abby Alpert
- The Wharton School, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, 19104, United States.
| | - Kayleigh Barnes
- University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), 2nd Floor, Los Angeles, CA 90089-3333, United States.
| | - Peter Huckfeldt
- University of Minnesota, 420 Delaware Street SE, 15-226 PWB, MMC 729, Minneapolis MN 55455, United States.
| | - José J Escarce
- University of California, Los Angeles, BOX 951736, 911 Broxton Los Angeles, CA 90095-1736, United States.
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26
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Abstract
Healthcare delivery system reform has become a dominant topic of conversation throughout the United States. Driven in part by ever-higher national expenditures on health, an increasing number of payers and provider organizations are working to reduce the costs and improve the quality of healthcare. In this article, we demystify the term "Population Health," review some of the larger payer initiatives currently in effect and discuss specific provider group efforts to improve the quality and cost of healthcare for patients.
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Affiliation(s)
- Timothy A Peterson
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.
| | - Steven J Bernstein
- Department of Internal Medicine, University of Michigan, Center for Clinical Management Research, Ann Arbor, MI; Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - David A Spahlinger
- Department of Internal Medicine, University of Michigan, Center for Clinical Management Research, Ann Arbor, MI
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27
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Abstract
BACKGROUND This article examines uncomfortable realities that the European hospital sector currently faces and the potential impact of wide-spread rationalization policies such as (hospital) payment reform and privatization. METHODS Review of relevant international literature. RESULTS Based on the evidence we present, rationalization policies such as (hospital) payment reform and privatization will probably fall short in delivering better quality of care and lower growth in health expenses. Reasons can be sought in a mix of evidence on the effectiveness of these rationalization policies. Nevertheless, pressures for different business models will gradually continue to increase and it seems safe to assume that more value-added process business and facilitated network models will eventually emerge. CONCLUSIONS The overall argument of this article holds important implications for future research: how can policymakers generate adequate leverage to introduce such changes without destroying necessary hospital capacity and the ability to produce quality healthcare.
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Affiliation(s)
- Patrick Jeurissen
- Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
- Ministry of Health, Welfare, and Sports, The Hague, The Netherlands.
| | | | - Richard B Saltman
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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28
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Kim SJ, Han KT, Kim SJ, Park EC, Park HK. Impact of a diagnosis-related group payment system on cesarean section in Korea. Health Policy 2016; 120:596-603. [PMID: 27173768 DOI: 10.1016/j.healthpol.2016.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 01/17/2023]
Abstract
Cesarean sections (CSs) are the most expensive method of delivery, which may affect the physician's choice of treatment when providing health services to patients. We investigated the effects of the diagnosis-related group (DRG)-based payment system on CSs in Korea. We used National Health Insurance claim data from 2011 to 2014, which included 1,289,989 delivery cases at 674 hospitals. We used a generalized estimating equation model to evaluate the association between the likelihood of cesarean delivery and the length of the DRG adoption period. A total of 477,309 (37.0%) delivery cases were performed by CSs. We found that a longer DRG adoption period was associated with a lower odds ratio of CSs (odds ratio [OR]: 0.997, 95% CI: 0.996-0.998). In addition, a longer DRG adoption period was associated with a lower odds ratio for CSs in hospitals that had voluntarily adopted the DRG system. Similar results were also observed for urban hospitals, primiparas, and those under 28 years old and over 33 years old. Our results suggest that the change in the reimbursement system was associated with a low likelihood of CSs. The impact of DRG adoption on cesarean delivery can also be expected to increase with time, as our finding provides evidence that the reimbursement system is associated with the health provider's decision to provide health services for patients.
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Affiliation(s)
- Seung Ju Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration, Soonchunhyang University, Chungnam, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hye Ki Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
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29
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Abstract
The development of quality measures has gained increasing attention as health care reimbursements transition from fee-for-service to value-based payment models. As behavioral health care moves towards integration of services with primary care, specific measures and payment incentives will be needed to successfully expand access. This study uses a keyword search to identify 730 quality indicators that are relevant to behavioral health and general medical health. Measures identified have been coded and grouped into domains based on a taxonomy developed by the authors. The analysis reveals that quality measures focusing on general medical conditions exceed those focused on behavioral health diagnoses for evidence-based treatments, patient safety, and outcomes. Furthermore, measures predominantly concentrate on care during or following hospitalizations, which represents a minority of behavioral health care and does not characterize the outpatient settings that are the focus of many models of integrated care. The authors offer recommendations for future steps to identify the quality measures that can best evaluate the evolving behavioral health care system.
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Affiliation(s)
- Matthew L Goldman
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Brigitta Spaeth-Rublee
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Abraham D Nowels
- New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | | | - Harold Alan Pincus
- New York State Psychiatric Institute, New York, NY, USA.
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA.
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
- NewYork-Presbyterian Hospital, New York, USA.
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30
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Clough JD, Riley GF, Cohen M, Hanley SM, Sanghavi D, DeWalt DA, Rajkumar R, Conway PH. Patterns of care for clinically distinct segments of high cost Medicare beneficiaries. Healthc (Amst) 2015; 4:160-5. [PMID: 27637821 DOI: 10.1016/j.hjdsi.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Efforts to improve the efficiency of care for the Medicare population commonly target high cost beneficiaries. We describe and evaluate a novel management approach, population segmentation, for identifying and managing high cost beneficiaries. METHODS A retrospective cross-sectional analysis of 6,919,439 Medicare fee-for-service beneficiaries in 2012. We defined and characterized eight distinct clinical population segments, and assessed heterogeneity in managing practitioners. RESULTS The eight segments comprised 9.8% of the population and 47.6% of annual Medicare payments. The eight segments included 61% and 69% of the population in the top decile and top 5% of annual Medicare payments. The positive-predictive values within each segment for meeting thresholds of Medicare payments ranged from 72% to 100%, 30% to 83%, and 14% to 56% for the upper quartile, upper decile, and upper 5% of Medicare payments respectively. Sensitivity and positive-predictive values were substantially improved over predictive algorithms based on historical utilization patterns and comorbidities. The mean [95% confidence interval] number of unique practitioners and practices delivering E&M services ranged from 1.82 [1.79-1.84] to 6.94 [6.91-6.98] and 1.48 [1.46-1.50] to 4.98 [4.95-5.00] respectively. The percentage of cognitive services delivered by primary care practitioners ranged from 23.8% to 67.9% across segments, with significant variability among specialty types. CONCLUSIONS Most high cost Medicare beneficiaries can be identified based on a single clinical reason and are managed by different practitioners. IMPLICATIONS Population segmentation holds potential to improve efficiency in the Medicare population by identifying opportunities to improve care for specific populations and managing clinicians, and forecasting and evaluating the impact of specific interventions.
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Affiliation(s)
- Jeffrey D Clough
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States; Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC, United States.
| | - Gerald F Riley
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Melissa Cohen
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Sheila M Hanley
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Darshak Sanghavi
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Darren A DeWalt
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Rahul Rajkumar
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Patrick H Conway
- Centers for Medicare and Medicaid Services, Baltimore, MD, United States
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31
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George M, Bencic S, Bleiberg S, Alawa N, Sanghavi D. Case study: Delivery and payment reform in congestive heart failure at two large academic centers. Healthc (Amst) 2014; 2:107-12. [PMID: 26250378 DOI: 10.1016/j.hjdsi.2014.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/13/2014] [Indexed: 11/25/2022]
Abstract
To help support implementation of aligning clinical redesign with payment reforms in practices and institutions throughout the country, we present two cases from Duke University Health System ("Duke") and University of Colorado Hospital ("Colorado"). The studies provide practical solutions for not only implementing clinical redesign, but also an understanding of how those clinical innovations can be aligned with alternative payment models. The cases will explore the following questions: What challenges or problems encouraged the organization to redesign CHF care? How did the organization select and then align care innovations with payment reforms, including bundled payments and shared savings? What did the organization identify as key success factors and/or challenges? How did these changes impact the organization׳s clinical outcomes or financial position? Finally, what lessons would the organization share with others attempting to implement similar strategies?
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Affiliation(s)
- Meaghan George
- The Brookings Institution, 1775 Massachusetts Ave NW, Washington, DC 20036, USA
| | - Sara Bencic
- The Brookings Institution, 1775 Massachusetts Ave NW, Washington, DC 20036, USA
| | - Sarah Bleiberg
- The Brookings Institution, 1775 Massachusetts Ave NW, Washington, DC 20036, USA
| | - Nawara Alawa
- The Brookings Institution, 1775 Massachusetts Ave NW, Washington, DC 20036, USA
| | - Darshak Sanghavi
- The Brookings Institution, 1775 Massachusetts Ave NW, Washington, DC 20036, USA.
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32
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Colla CH, Lewis VA, Gottlieb DJ, Fisher ES. Cancer spending and accountable care organizations: Evidence from the Physician Group Practice Demonstration. Healthc (Amst) 2013; 1:100-107. [PMID: 25072017 PMCID: PMC4110916 DOI: 10.1016/j.hjdsi.2013.05.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although accountable care organizations (ACOs) are rapidly being deployed in Medicare, little is known about how the model might affect high-risk, high cost groups such as cancer patients. The Physician Group Practice Demonstration, which ran from 2005 to 2010 in 10 physician groups, provides the best current evidence on the likely effectiveness of accountable care organizations for Medicare beneficiaries. Changes in cancer treatment and spending under this program may be indicative of cancer treatment under ACO payment reform. METHODS Using Medicare fee-for-service claims data, regression analysis was used to estimate changes in payments for cancer patients using a difference-in-difference design comparing pre- (2001-2004) and post-intervention (2005-2009) trends in spending on cancer patients in PGPD participants to local control groups. RESULTS Regression models indicate the Physician Group Practice Demonstration was associated with average Medicare spending reductions per cancer patient of $721 annually across participating sites, an annual 3.9% reduction in payments per patient. Savings derived entirely from reductions in acute care payments for inpatient stays. The Demonstration was also associated with a reduction in mortality among cancer patients. There was no significant change in the proportion of deaths occurring in the hospital. There were significant reductions in hospice use, hospital discharges and ICU days, but no reductions in cancer-specific procedures or chemotherapy. Estimates of all measures varied considerably across participating sites. CONCLUSIONS The Physician Group Practice Demonstration was associated with reductions in admissions for inpatient care among beneficiaries with prevalent cancer, with no adverse effect on mortality. Participants in the Physician Group Practice Demonstration did not change the trajectory of spending for cancer-specific treatments. IMPLICATIONS Inpatient care for beneficiaries with cancer may represent a significant source of potential savings for ACOs, but evidence from the Physician Group Practice Demonstration indicates that no changes were made to cancer treatments such as chemotherapy or surgical procedures.
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Affiliation(s)
- Carrie H. Colla
- The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, USA
- Norris Cotton Cancer Center, Barbara E. Rubin Building, One Medical Center Drive, Lebanon, NH 03756, USA
| | - Valerie A. Lewis
- The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, USA
| | - Daniel J. Gottlieb
- The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, USA
| | - Elliott S. Fisher
- The Dartmouth Institute for Health Policy and Clinical Practice, 35 Centerra Parkway, Lebanon, NH 03766, USA
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