Payment & Delivery

How insurers and providers are organized and paid to deliver care. Research by LDI Senior Fellows examines the shift from fee-for-service payments to newer models of paying for and delivering value, such as Accountable Care Organizations and Patient-Centered Medical Homes.

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

New Study Details Savings from Bundled Payments

Jan. 13, 2017

This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.

And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.

Cost of Joint Replacement Using Bundled Payment Models

Research Brief
Amol Navathe, MD, PhD
Jan. 6, 2017

Evidence on the effects of bundled payment is more important than ever, while hospitals already in Medicare bundled payment programs need guidance in redesigning care. This observational study looks at whether bundled payment for joint replacement affected quality, hospital costs and post-acute care spending in a health system that was an early adopter of the model. Did the bundles save money, and if so, what produced those savings?

Health Systems and Social Determinants

Dec. 1, 2016

The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.

Recurrent Violent Injury: Magnitude, Risk Factors and Opportunities For Intervention From a Statewide Analysis

Research Brief
Oct. 24, 2016

Recurrent injury is a promising target for prevention, as prior injury is a strong predictor of future violent injury and death. But the incidence of recurrent violent injury, on an area-wide level, is unknown, and the risk factors contributing to it are not well understood. 

Emergency Department Length-Of-Stay For Psychiatric Visits Was Significantly Longer Than For Nonpsychiatric Visits, 2002–11

Sep. 22, 2016

Jane M. Zhu, Astha Singhal, Renee Hsia

In Health Affairs, Jane Zhu and colleagues investigate wait times and discharge outcomes among psychiatric patients in the emergency department (ED). This study is a retrospective comparison of more than 230,000 psychiatric and non-psychiatric visits across 350-400 US EDs between 2002 and 2011. They analyzed length-of-stay (a standard measure of ED crowding and access to services) as well as rates of admissions, discharges, and transfers. Length-of-stay was defined as the difference between the time of triage and time of departure from the ED for a given patient. Patients seen in...

Pages