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.

Is American Pet Health Care (Also) Uniquely Inefficient?

Jun. 29, 2017

Liran Einav, Amy Finkelstein, Atul Gupta

In American Economic Review, Liran Einav and colleagues, including Atul Gupta, examine similarities between human and pet health care in the U.S.. The authors note similarities in rapid growth in spending in both industries, with wealthier families spending significantly more on both human and pet health. They also note a rapid increase in employment of health care providers in both industries, an increase in medical technology use, and a similar propensity for high spending at the end of life. While human and pet health care share a number of similarities, they also note...

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

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
MPatelHeadshot
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.

Pages