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.

Comprehensive Versus Consultative Rehabilitation Services Postacute Stroke: Outcomes Differ

Feb. 24, 2015

Margaret Stineman, Dawei Xie, Jibby Kurichi, Pui Kwong, W. Bruce Vogel, Diane Cowper Ripley, Barbara Bates

In the Journal of Rehabilitation Research & Development, Margaret Stineman and colleagues compare outcomes of postacute stroke patients provided with comprehensive rehabilitation with those provided with consultative rehabilitation services. Of the nearly 3000 patients in the study, 23 percent received comprehensive rehabilitation while the remaining patients received consultative services. The researchers found that those who received comprehensive rehabilitation compared with consultative gained on average 12.8 more points of physical independence on a 78-point scale and...

Healthcare System Supports for Young Adult Patients with Pediatric Onset Chronic Conditions: A Qualitative Study

Jan. 11, 2015

Dava E. Szalda, Manuel E. Jimenez, Jeremiah E. Long, Amelia Ni, Judy A. Shea, Sophia Jan

In the Journal of Pediatric Nursing, Dava Szalda and colleagues examine how adult primary care teams can facilitate the transition and ongoing care of adults with pediatric onset chronic illness. Currently, over 90% of pediatric patients with chronic medical conditions are living into adulthood. For some pediatric onset chronic conditions there are more adults living with an illness than children. This qualitative study explores practice supports and barriers to care for this population, comparing them to other patients with chronic illness in order to identify facilitators that...

Lessons for Providers and Hospitals from Philadelphia’s Obstetric Services Closures and Consolidations, 1997-2012

Jan. 8, 2015

Scott A. Lorch, Ashley E. Martin, Richa Ranade, Sindhu K. Srinivas, and David Grande

In Health Affairs, Scott Lorch and colleagues suggest that the way in which hospitals respond to disruptions caused by the closure of nearby facilities could influence patient outcomes. They look at the example of obstetric services in Philadelphia, where 13 of 19 hospital obstetric units closed between 1997 and 2012. This led to a "severely strained obstetric care system," according to interviews with key informants in hospitals with units still open. The authors conclude that policymakers need to do more to anticipate reductions in supply and monitor patient outcomes.


The Value of Measuring Value

Dec. 20, 2014

(An edited version of this post appeared in

US health care spending has never grown as slowly as it did last year.

Dwight D. Eisenhower was in the Oval Office when the US government began recording health care spending in 1960.  Since that time, growth in health care spending has never been lower than the 3.6% annual rate reported by researchers from the Centers for Medicare and Medicaid Services a few weeks ago in the journal Health Affairs.

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients

Dec. 10, 2014

Mitesh S. Patel, Kevin G. Volpp, Dylan S. Small, Alexander S. Hill, Orit Even-Shoshan, Lisa Rosenbaum, Richard N. Ross, Lisa Bellini, Jingsan Zhu, and Jeffrey H. Silber

In the Journal of the American Medical Association, Mitesh Patel, Kevin Volpp and colleagues evaluate patient outcomes associated with 2011 limits on resident work hours, and find no change in 30-day mortality rates or 30-day all-cause readmission rates. See the LDI blog post on this study.

Primary Care Shortages: More Than a Head Count

Issue Brief
Nov. 21, 2014

The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. 

Primary Care Shortages: More Than Just a Head Count

Nov. 21, 2014

A new LDI/INQRI Research Brief, written by Mark Pauly, PhD, Mary Naylor, RN, PhD, and me, reviews the evidence of an existing or looming primary care shortage in the wake of the ACA. Will the combined effects of an aging population, an increase in coverage and demand for care, and a decrease in the number of physicians going into primary care create widespread gaps in access? Who will treat the newly insured, and will this exacerbate existing workforce shortages?