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.

Financial Incentives for Adherence to Hepatitis C Virus Clinical Care and Treatment: A Randomized Trial of Two Strategies

Jun. 29, 2017

David A. Wohl, Andrew G. Allmon, Donna Evon, Christopher Hurt, Sarah Ailleen Reifeis, Harsha Thirumurthy, Becky Straub, Angela Edwards, Katie R. Mollan

In Open Forum Infectious Diseases, David Wohl and colleagues, including Harsha Thirumurthy, assess the feasibility of two strategies for financially incentivizing adherence to Hepatitis C (HCV) care among patients with substance use disorders. Previous research has shown that, although rates of a sustained response to the virus (SVR) surpass 90%, patients experiencing substance use disorders may struggle to adhere to HCV care. The authors randomly assigned participants to either a fixed or lottery-based monetary incentive for attending clinic appointments, adhering to medications...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

The Economics of Medicaid Reform and Block Grants

Jun. 27, 2017

Paula Chatterjee, Benjamin D. Sommers

In The JAMA Forum, Paula Chatterjee and colleagues explore the rationale for and potential effects of repealing the Affordable Care Act (ACA). The authors argue that Medicaid will be disproportionately affected, as 12 of the 20 million individuals who gained coverage through the ACA are on Medicaid. They assess arguments for Medicaid reform, examine policy implications, and explore potential effects on patients. They examine how these changes would affect current Medicaid payment models, and posit that providers may be more limited in services they can offer to Medicaid recipients...

Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative

Jun. 21, 2017

Victor J. Dzau, Mark B. McClellan, J. Michael McGinnis, Sheila P. Burke, Molly J. Coye, Angela Diaz, Thomas A. Daschle, William H. Frist, Martha Gaines, Margaret A. Hamburg, Jane E. Henney, Shiriki Kumanyika, Michael O. Leavitt, Ruth M. Parker, Lewis G. Sandy, Leonard D....

In a JAMA Special Communication message, Victor Dzau and colleagues, including Shiriki Kumanyika, review the most salient health challenges and opportunities facing the United States, and seek to identify practical priorities and policy initiatives essential to health progress. The authors assess 19 National Academy of Medicine-commissioned white papers, and review publicly available data on health care costs and outcomes. They find that, of the $3.2 trillion spent annually on health care, an estimated 30% is related to waste, inefficiencies, and excessive price. Major health...

The “value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations

Jun. 20, 2017

David E. Cohn, Emily Ko, Larissa A. Meyer, Jason D. Wright, Sarah M. Temkin, Jonathan Foote, Nathaniel L. Jones, Laura J. Havrilesky

In Gynecologic Oncology, David Cohn and colleagues, including Emily Ko, examine trends in gynecologic oncology health care expenditures, and assess how costs may be affected by new models of health care delivery and payment. The authors conduct a review on behalf of the Society of Gynecologic Oncology, and discuss the financial burden of increasing co-payments for cancer patients. They emphasize the need for gynecologic oncology practitioners to prepare for new models of cancer care delivery, such as Oncology Patient-Centered Medical Homes (OCPHM), as well as newer pay for...

Defining Value in Radiation Oncology: Approaches to Weighing Benefits vs. Costs

Jun. 20, 2017

Andre Konski

In Oncology, Andre Konski considers health care payment models and the transition from fee-for-service to value-based payment as it applies to radiation oncology. Konski examines difficulties in determining value, pointing out that both patients and payers could be considered health care ‘customers’ . He assesses how traditional cost-effective analyses may not be suitable for novel radiation oncology therapies, especially as consumers are increasingly conscious of the costs of treatment plans. He argues that radiation oncologists must consider the cost to patients when designing...

How Patients Experience the Trauma Bay

Jun. 16, 2017

After a shooting, a stabbing, a car crash, or a fall, emergency services rush an injured patient to the emergency room. They bypass the waiting room and come directly to a specialized area called the trauma bay, where a team of clinicians performs a fast, intense, full-body exam and initiates treatment for injury. Trauma providers have organized this protocol, known as trauma resuscitation, to identify and treat life-threatening injuries as quickly as possible. Or at least that’s how we see it.

Exit, Voice or Loyalty? An Investigation into Mandated Portability of Front-Loaded Private Health Plans

Jun. 15, 2017

Juan Pablo Atal, Hanming Fang, Martin Karlsson, and Nicholas R. Zieberth

In a National Bureau of Economic Research Working Paper, Juan Pablo Atal and colleagues, including Hanming Fang, study how a mandate designed to increase competition in the German private health care market influences rates of consumers switching insurers or switching plans within an insurer. In the German system, those who opt into private insurance are required to front-load premium costs, so that younger, healthier consumers pay disproportionately into old-age provisions to offset increased costs for older enrollees. Before a 2009 mandate, consumers who switched insurers could...

Effect of a Price Transparency Intervention in the Electronic Health Record on Clinician Ordering of Inpatient Laboratory Tests

Research Brief
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May. 19, 2017

In this randomized clinical trial, clinicians did not change their ordering of inpatient lab tests when Medicare allowable fees were displayed in the electronic health record at the time of order entry.
 

Issues at the Heart of Advancing the De-Adoption of Low-Value Care

Issue Brief
Apr. 18, 2017

A diverse set of national leaders and stakeholders representing industry, think-tanks, provider and patient groups, and academic experts discussed how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable.

Evaluating the Role of Payment Policy in Driving Vertical Integration in the Oncology Market

Apr. 3, 2017

Abby Alpert, Helen Hsi, and Mirelle Jacobson 

In Health Affairs, Abby Alpert and colleagues evaluate the reasons behind the increase in vertical integration in the market for cancer care. Much of the move towards consolidation over the past decade has been vertical - hospitals acquiring physician practices - instead of horizontal - physician practices or hospitals merging with similar entities. The authors' analysis shows that the rate of hospital or health system ownership of practices doubled from about 30...

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

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