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.

Burden Of Parkinson's Disease By Severity: Health Care Costs In The U.S. Medicare Population

Nabila Dahodwala, MD, MS
Oct. 8, 2020

Nabila DahodwalaPengxiang Li, Jordan Jahnke, Vrushabh P. Ladage, Amy R. Pettit, Prasanna L. Kandukuri, Yanjun Bao, Jorge Zamudio, Yash J. Jalundhwala, Jalpa A. Doshi 

Abstract [from journal]

Background: Current understanding of the health care costs of Parkinson's disease (PD) and the incremental burden of advanced disease is incomplete.

Objectives: The aim of this study was to assess the direct economic burden associated with advanced versus mild/moderate PD in a prevalent national sample of elderly U.S. Medicare beneficiaries with a PD diagnosis.

Methods: Analyzing 100% fee-for-service Medicare claims from 2013, we defined advanced PD with a medication-

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The Design Of A Randomized Controlled Trial To Evaluate Multi-dimensional Effects Of A Section 1115 Medicaid Demonstration Waiver With Community Engagement Requirements

Oct. 7, 2020

Kristin A. Linn, Kristen Underhill, Erica L. Dixon, Elizabeth F. Bair, William J. Ferrell, Margrethe E. Montgomery, Kevin G. VolppAtheendar S. Venkataramani

Abstract [from journal]

Section 1115 demonstration waivers provide a mechanism for states to implement changes to their Medicaid programs. While such waivers are mandated to include evaluations of their impact, randomization - the gold standard for assessing causality - has not typically been a consideration. In a critical departure, the Commonwealth of Kentucky opted to pursue a two-arm randomized controlled trial (RCT) for their controversial 2018 Medicaid Demonstration waiver, which included work requirements as a condition for the subset of

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Drug Reimbursement Regulation In 6 Peer Countries

Sep. 28, 2020

Ezekiel J. Emanuel, Cathy Zhang, Aaron Glickman, Emily Gudbranson, Sarah S. P. DiMagno, John W. Urwin

Abstract [from journal]

The US has nearly 4.5% of the world's population but accounts for more than 40% of global drug spending. With the upcoming 2020 election, a top priority of many voters is to better control drug prices and reform the pharmaceutical market. In this Special Communication, the drug price mechanisms and government regulations used in 6 representative peer countries are evaluated: Australia, France, Germany, Norway, Switzerland, and the United Kingdom. Drug price regulation is compared with that currently used in the US

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Differences In Health Care Utilization, Process Of Diabetes Care, Care Satisfaction, And Health Status In Patients With Diabetes In Medicare Advantage Versus Traditional Medicare

Norma Coe, PhD
Sep. 10, 2020

Sungchul Park, Eric B. Larson, Paul Fishman, Lindsay White, Norma B. Coe

Abstract [from journal]

Objective: The objective of this study was to determine differences in health care utilization, process of diabetes care, care satisfaction, and health status for Medicare Advantage (MA) and traditional Medicare (TM) beneficiaries with and without diabetes.

Methods: Using the 2010-2016 Medicare Current Beneficiary Survey, we identified MA and TM beneficiaries with and without diabetes. To address the endogenous plan choice between MA and TM, we used an instrumental variable approach. Using

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Health Care Costs Of Alzheimer's And Related Dementias Within A Medicare Managed Care Provider

Norma Coe, PhD, PARC Co-Director
Sep. 1, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe 

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

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The Psychological Experience Of Obstetric Patients And Health Care Workers After Implementation Of Universal SARS-CoV-2 Testing

Aug. 5, 2020

Whitney R. Bender, Sindhu Srinivas, Paulina Coutifaris, Alexandra Acker, Adi Hirshberg

Abstract [from journal]

Objective: This study was aimed to describe the hospitalization and early postpartum psychological experience for asymptomatic obstetric patients tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) as part of a universal testing program and report the impact of this program on labor and delivery health care workers' job satisfaction and workplace anxiety.

Study design: This is a cohort study of asymptomatic pregnant women who underwent SARS-CoV-2 testing between April 13,

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Receipt Of Home-Based Medical Care Among Older Beneficiaries Enrolled In Fee-For-Service Medicare

Bruce Kinosian, MD
Aug. 3, 2020

Jennifer M. Reckrey, Mia Yang, Bruce Kinosian, Evan Bollens-Lund, Bruce Leff, Christine Ritchie, Katherine Ornstein

Abstract [from journal]

Millions of older Americans are homebound and may benefit from home-based medical care. We characterized the receipt of this care among community-dwelling, fee-for-service Medicare beneficiaries ages sixty-five and older surveyed in the National Health and Aging Trends Study between 2011 and 2017. Five percent of those surveyed received any home-based medical care between 2011 and 2017 (mean follow-up time per person was 3.4 years), and 75 percent of home-based medical care recipients were homebound. Only 11 percent of the total

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A Passive Monitoring Tool Using Hospital Administrative Data Enables Earlier Specific Detection Of Healthcare-Acquired Infections

Jul. 31, 2020

Jeffrey Rewley, Laura Koehly, Christopher Steven Marcum, Felix Reed-Tsochas

Abstract [from journal]

Background: Healthcare-associated infections impose a significant burden on the health care system. Current methods for detecting these infections are constrained by combinations of high cost, long processing times, and imperfect accuracy, reducing their effectiveness.

Methods: We examine whether the quantity of time a patient spends in a ward with other patients clinically-suspected of infection, which we call co-presence, can be used as a tool to predict subsequent healthcare-associated

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Health Care Costs of Alzheimer and Related Dementias Within A Medicare Managed Care Provider

Jul. 23, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient

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Overlap Between Medicare's Comprehensive Care For Joint Replacement Program And Accountable Care Organizations

Jul. 22, 2020

Joshua M. Liao, Eric Z. Shan, Yueming Zhao, Yash Shah, Deborah S. Cousins, Amol S. Navathe

Abstract [from journal]

Background: Overlap between Medicare's Comprehensive Care for Joint Replacement (CJR) model and accountable care organizations (ACOs) may result in positive or negative synergies. In this study, we describe the overlap between the programs at the beneficiary and hospital levels.

Methods: We conducted a retrospective study of patient and hospital characteristics using data from 2016 Medicare claims, the US Census Bureau, the American Hospital Association annual survey, Hospital Compare, and the

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Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. Lee, Ruchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, ...

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

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Stakeholder Perspective On Opioid Stewardship After Prostatectomy: Evaluating Barriers And Facilitators From The Pennsylvania Urology Regional Collaborative

Jul. 22, 2020

Daniel J. LeeRuchika Talwar, James Ding, Thenappan Chandrasekar, Kaynaat Syed, Claudette Fonshell, John Danella, Serge Ginzburg, Thomas Lanchoney, Jeffrey Tomaszewski, Edouard Trabulsi, Adam Reese, Marc Smaldone, Robert Uzzo, Jay D. Raman, Thomas J. Guzzo

Abstract [from journal]

Objective: To evaluate existing practice patterns and potential barriers to implementing opioid stewardship protocols after robot-assisted prostatectomies among providers in the Pennsylvania Urology Regional Collaborative.

Methods: The Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement initiative of 11 academic and community urology practices in Pennsylvania and New Jersey representing 97 urologists. PURC distributed a web-based survey of 24 questions, with

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