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.

How Wide Are Your Physician Networks?

Aug. 24, 2015

In June, we described the first attempt to measure, in a consumer-friendly way, the breadth of physician networks offered by all silver plans on the 2014 health insurance marketplaces. We estimated network size based on the fraction of office-based physicians participating in the network within relevant rating areas in the state. We categorized networks using "T-shirt" sizes:  x-small (less than 10%), small (10%-25%), medium (25%-40%), large (40%-60%), and x-large (more than 60%). We found that nationally, 41% of all networks were either “small” or “x-small”.

Uptake and Impact of a Clinical Diagnostic Decision Support Tool at an Academic Medical Center

Aug. 24, 2015

John S. Barbieri, Benjamin French, Craig A. Umscheid

In Diagnosis, John Barbieri, Benjamin French and Craig Umscheid investigate whether the use of a differential diagnosis (DDX) generator within a health care system leads to an increase in unnecessary testing and specialty consultation. By providing access to a broad differential, DDX generators can potentially help clinicians overcome cognitive biases by directing them to diagnoses they might not have considered otherwise. However, as the tool suggests numerous potential diagnoses, its use could result in an increase in unnecessary testing and specialty consultation, and...

Geographic Barriers to Care: the Final Frontier?

Aug. 13, 2015

Although health reform has reduced many financial barriers to care, it has done little to overcome geographic barriers. Two recent studies by LDI Senior Fellows examine disparities in geographic access to specialty care in the United States, specifically gynecologic cancer care and comprehensive stroke treatment. They assess the potential impact of these disparities on health outcomes, and suggest population-based planning as a way to improve access to specialty care.

“Science has delivered solutions. The question for the world is: When will we put it into practice?”

Aug. 9, 2015

In the mid-eighties, I coordinated a medical genetics clinic at Johns Hopkins Hospital. We shared our outpatient unit, the Moore Clinic, with the AIDS Care Program, which began in 1984. Every week, I would see the devastating and shockingly rapid decline of robust young men—men my age—in the waiting room outside my office. I came to recognize the pattern:  two men would walk in, one weaker, one stronger.

Medicare, Medicaid and the Leonard Davis Institute - Intertwined Legacies

Jul. 24, 2015

Fifty years ago, on July 30, 1965, President Lyndon Johnson signed Medicare and Medicaid into law. Over the next two years, more than 29 million people gained health coverage through these programs. By 1967, as Alice Rivlin recalls, economists were sounding an alarm about rising Medicare costs and reporting to the President that projected growth would be unsustainable.

Sizing Narrow Networks

Jun. 23, 2015

There’s been a lot of talk about "narrow" networks in ACA plans, which trade off limited provider coverage for lower premiums. Using a new integrated dataset of physician networks in plans on the federal and state marketplaces, our latest LDI/RWJF Data Brief describes the breadth of physician networks across all silver plans sold in 2014.

The Skinny on Narrow Networks in Health Insurance Marketplace Plans

Data Brief
Jun. 23, 2015

The Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. 

LDI Poster Spotlight at AcademyHealth

Jun. 16, 2015
The University of Pennsylvania's Leonard Davis Institute of Health Economics (LDI) has more than 300 Senior Fellows and Fellows investigating the medical, economic, social and behavioral issues that influence how health care is financed, managed and delivered across the U.S. The annual AcademyHealth Research Meeting's poster hall provides a convenient way for nearly two dozen of these Penn experts to share their research aimed at improving the country's health care system.

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