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.

Networks, Networks, Networks

Jun. 5, 2015

This is the second post covering the Third Annual Health Insurance Exchanges Conference, hosted by LDI’s HIX working group, which took place in April 2015. The full agenda is here, and the first post, which focused on choice architecture, is here.

Does Philadelphia Have Primary Care Deserts?

May. 19, 2015

Cross-posted with the Field Clinic blog

Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance. That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care. For health care reform to deliver on its promise, people need good access to primary care.

The System is NOT the Solution: Higher Costs in Hospital Systems

May. 4, 2015

In 1997, the consultant Tom Peters proclaimed in his book The Circle of Innovation “the system is the solution”. Fifteen years later, Peters recanted, stating “systems have their place: SECOND place.” What was now more important was leadership and culture.

At the same time (roughly, 1993-2015), hospital executives have been busy building bigger hospital chains that aggregate freestanding facilities and smaller systems. The promise has always been economies of scale and lower-cost operations that justify their growing market power and reduced competition.

Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care

Apr. 1, 2015

Brownsyne Tucker Edmonds, Marjie Mogul, Judy Shea

In Family and Community Health, Judy Shea and colleagues seek to better understand low-income African-American women’s views on prenatal care. The analysis is the result a focus group study using a community-based participatory research framework. Shea and colleagues find that that friends/family and the baby’s health were the top factors that encouraged prenatal care attendance. Barriers to getting prenatal care included insurance, transportation, and ambivalence as to its importance. Facilitators included transportation services, social support, and education about available resources....

Perceptions of High-Risk Patients and Their Providers on the Patient-Centered Medical Home

Apr. 1, 2015

Shreya Kangovi, Katherine Kellom, Christopher Sha, Sarah Johnson, Casey Chanton, Tamala Carter, Judith A. Long, David Grande

In the Journal of Ambulatory Care Management, Shreya Kangovi and colleagues, including Judith Long and David Grande, analyze patient and primary care practice staff perceptions of patient-centered medical homes (PCMH). Through a multi-state qualitative survey, the authors explore areas of agreement and tension between the perceptions of chronically ill, low-income patients and their primary care practice staff on PCMH principles and implementation strategies. PCMH are a team-based delivery model that emphasize continuity of care and health outcomes. Kangovi and colleagues’ conclude some...

Do Integrated Delivery Systems Deliver on Costs and Quality?

Mar. 10, 2015

A new study by LDI Senior Fellow Lawton Burns and colleagues challenges the conventional wisdom about the societal benefits and comparative advantages of integrated delivery networks (IDNs).  A literature review and detailed analysis of financial and quality indicators found “scant evidence” of improved quality, lower cost per case, or greater societal benefit.

Hospital Employment of Supplemental Registered Nurses and Patients’ Satisfaction With Care

Mar. 1, 2015

Karen B. Lasater, Douglas M. Sloane, Linda H. Aiken

In the Journal of Nursing Administration, Linda Aiken and Penn colleagues from the Center for Health Outcomes and Policy Research (CHOPR) examine whether the use of supplemental registered nurses (SRNs), temporary nurses often used by hospitals to alleviate staffing shortages, has an impact on overall patient satisfaction. Using survey data from nurses and patients, they found little evidence that temporary nurses affect patient satisfaction with the hospital or with nursing care in particular. After other hospital and nursing characteristics were controlled, greater use of SRNs was not...

Optimizing the Patient Handoff Between Emergency Medical Services and the Emergency Department

Mar. 1, 2015

Zachary Meisel, Judy A. Shea, Nicholas J. Peacock, Edward T. Dickinson, Breah Paciotti, Roma Bhatia, Egor Buharin, Carolyn C. Cannuscio

In Annals of Internal Medicine, LDI's Zachary Meisel and colleagues examine patient handoffs from emergency medical services (EMS) to hospital emergency departments to learn more about what can be done to improve the structure and process of these high-risk events. The authors conducted focus group interviews with EMS providers around the country to learn more about their perspectives on the professional and interpersonal factors that contribute to the effectiveness of handoffs. EMS providers identified four potential ways of improving the handoff system: communicating directly with the...