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.

Do Incentive Payments Improve Home-Based Primary Care?

Feb. 4, 2020

After five years, a small experiment to improve care for frail elderly patients receiving primary care at home has delivered some savings to Medicare—although it might be too small to know for sure. Authorized by the Affordable Care Act, the Independence at Home (IAH) Demonstration is part of a broader strategy of testing innovative ways to pay for value in health care—tying additional payment to higher quality care and cutting wasteful spending.

When Should Medicare Mandate Participation In Alternative Payment Models?

Amole Navathe19-head
Feb. 3, 2020

Joshua M. Liao, Mark V. Pauly, Amol S. Navathe

ABSTRACT [from journal]

The Centers for Medicare and Medicaid Services continues to propose and implement alternative payment models (APMs) to shift Medicare payment away from fee-for-service and toward approaches that emphasize health care value. As APMs expand in scope, one critical question is whether they should engage providers on a voluntary or a mandatory basis. Clinicians and


Medicare SNF Payment Policy: What a Difference a Day Makes

Dec. 19, 2019

It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.

Physician Consolidation and the Spread of Accountable Care Organizations

Research Brief
Nov. 4, 2019

Accountable Care Organizations (ACOs) are groups of physicians and hospitals that jointly contract to care for a patient population. ACO contracts incentivize coordination of care across providers. This can lead to greater consolidation of physician practices, which can in turn generate higher costs and lower quality. Given this, the study asks, as ACOs enter health care markets, do physician practices grow larger?

Long-Term Care Financing in the United States

Issue Brief
Oct. 11, 2019

In the United States, people who need long-term care (LTC) face a system with large gaps in care, which they must rely on friends and family to fill. Medicaid finances the majority of paid LTC, but people must exhaust their resources to qualify. Medicare and private health insurance do not cover LTC, and the private market for long-term care insurance is failing. Unpaid family and friends provide most long-term services, but the value of their services is rarely reflected in debates about LTC financing and delivery. Beyond the value of the services, this system has costs to the economy, as spouses and adult children reduce paid work to care for their loved ones. As the population ages and families are less able to shoulder the burden of LTC, the current system may be unable to meet the growing need without an alternative, sustainable financing mechanism.

Consolidation in the Dental Industry: A Closer Look at Dental Payers and Providers

Oct. 3, 2019

Kamyar Nasseh, John R. Bowblis, Marko Vujicic, Sean Shenghsiu Huang 

Abstract [from journal]

We examine the effect of commercial dental insurance concentration on the size of dental practices, the decision of dentists to own a practice, and the choice of dentists to work at a dental management service organization—a type of corporate group practice that has become more prevalent in the United States in recent years. Using 2013–2015 dentist-level data from the American Dental Association, county-level data on firms and employment from the United States Census, and commercial dental insurance market concentration data from FAIR Health®, we find a...