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.

Debating Medicaid Rules for Mental Health Care

Aug. 10, 2018

In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities.

Hospitals, Skilled Nursing Facilities, and Bundled Payment

Aug. 10, 2018

The Centers for Medicare and Medicaid Services has rolled out a number of bundled payment programs in the hopes that they will help to control costs and improve coordination and quality of care. A focus of these programs is the care delivered by skilled nursing facilities (SNFs) – a post-acute care setting that currently accounts for a significant portion of cost variation and spending in Medicare.

Differential Pricing of Pharmaceuticals: Theory, Evidence and Emerging Issues

Aug. 9, 2018

Abstract [from journal]

Differential pricing—manufacturers varying prices for on-patent pharmaceuticals across markets—can, in theory, lead to increased patient access and improved research and development (R&D) incentives compared with charging a uniform price across markets. Theoretical models of price discrimination and Ramsey pricing support differentials based inversely on price elasticities, which are plausibly related to average per capita income. However, these models do not address absolute price levels and dynamic efficiency. Value-based differential pricing theory...

Effect of Hospital and Post-Acute Care Provider Participation in Accountable Care Organizations on Patient Outcomes and Medicare Spending

Aug. 9, 2018

Divyansh Agarwal and Rachel M. Werner

Abstract [from journal]

Objective: To test for differences in patient outcomes when hospital and post‐acute care (PAC) providers participate in accountable care organizations (ACOs).

Data/Setting: Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO‐participating hospitals and PAC providers.

Design: We compared changes in outcomes

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Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient's Perspective

Aug. 2, 2018

Jonathan Sevilla-Cazes, Faraz S. Ahmad, Kathryn H. Bowles, Anne Jaskowiak, Tom Gallagher, Lee R. Goldberg, Shreya Kangovi,...

ABSTRACT [FROM JOURNAL]

Background: Heart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient’s experience may reframe the readmission “problem” and, ultimately, inform alternative strategies.

Objective: To understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission.

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Burns Calls BS on CVS-Aetna Merger

Jul. 23, 2018

[Editor's note: on August 1, 2018, California Insurance Commissioner Dave Jones recommended that the United States Department of Justice sue to block the proposed merger.]

The proposed $69 billion merger of CVS and Aetna drew sharp criticism in a June California Insurance Commission hearing, including from LDI Senior Fellow Lawton R.  Burns, PhD, MBA, Professor of Health Care Management in the Wharton School.

Redesigning Provider Payment: Opportunities and Challenges from the Hawaii Experience

Jul. 18, 2018

Kevin G. Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B. Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye...

ABSTRACT [FROM JOURNAL]

Objectives: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

Study Design: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the

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Physician Perspectives In Year 1 Of MACRA And Its Merit-Based Payment System: A National Survey

Jul. 11, 2018

ABSTRACT [from journal]

We surveyed a national sample of internal medicine physicians in March–May 2017 to explore their beliefs about the newly implemented Merit-based Incentive Payment System (MIPS). Respondents believed that their efforts in the four focus areas identified in the survey would ultimately improve the value of care. When informed that those areas represented the four MIPS domains, the majority remained positive about the likely impact on value. However, expectations varied by physicians’ characteristics and sense of control over the desired outcomes, and many...

SUMR 2018 Attends AHRQ National Research Service Awards Conference

Jul. 2, 2018
The 24nd annual National Research Service Award (NRSA) Conference took place in tandem with the 2018 AcademyHealth Annual Research Meeting at the Sheraton Seattle Hotel and the adjacent Washington State Convention Center. NRSA is part of the Agency for Healthcare Research and Quality (AHRQ) program that provides training, grants and other supports to undergraduate, predoctoral and postdoctoral trainees and fellows in the health services research field. This year's event was attended by 23 Summer Undergraduate Minority Research (SUMR) scholars from the University of Pennsylvania program co-...

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

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