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.

Pennsylvania Launches its Prescription Drug Monitoring Program

Aug. 25, 2016

Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.

Adoption of a portal for the primary care management of pediatric asthma: a mixed method implementation study

Aug. 19, 2016

Alexander G. Fiks ; Nathalie Du Rivage ; Stephanie L. Mayne ; Stacia Finch ; Michelle E. Ross ; Kelli Giacomini ; Andrew Suh ; Banita McCarn ; Elias Brandt ; Dean Karavite ; Elizabeth W. Staton ; Laura P. Shone ; Valerie McGoldrick ; Kathleen Noonan ; Dorothy...

In the Journal of Medical Internet Research, LDI Senior Fellows Alexander Fiks and Kathleen Noonan and colleagues evaluate the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management and the barriers and facilitators of implementation success. Patient portals improve communication between families of children with asthma and their primary care providers as well as outcomes. This mixed-methods multi-site (11 states) study used 10 clinician focus groups, 22 semi-structured parent interviews and surveys that were sent to the parents...

Shared Decision Making and Treatment Decisions for Young Children with Autism Spectrum Disorder

Aug. 19, 2016

Susan E. Levy, Rosemary Frasso, Stephanie Colantonio, Hayley Reed, Gail Stein, Frances K. Barg, David S. Mandell, Alexander G. Fiks

In Academic Pediatrics, Susan Levy and colleagues including Rosemary Frasso, David Mandell and Alexander Fiks, examine the barriers to communication and shared decision-making between pediatricians and parents of young children with autism spectrum disorder (ASD). Lack of shared decision-making and communication about management decisions often results in parents’ perception of unmet needs for coordination of care and referral for specialized care. This authors interviewed 20 pediatricians from 10 primary care practices in urban and suburban areas, and 20 English-speaking parents...

States Worse Than Death Among Hospitalized Patients with Serious Illnesses

Aug. 15, 2016

Emily B. Rubin, Anna E. Buehler, Scott D. Halpern

In JAMA Internal Medicine, Emily Rubin and colleagues, including Scott Halpern, investigate how hospitalized patients with serious illnesses evaluate states of cognitive or functional debility relative to death. The authors conducted structured interviews with 180 patients, 60 years and older, who were hospitalized between July 2015 and March 2016 at an academic medical center in Philadelphia. All patients were asked to evaluate health states with specific physical and cognitive debilities, dependencies on forms of life support and dependencies on others to perform various...

Physicians’ Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities

Research Brief
Aug. 8, 2016

Early evidence suggests that accountable care organizations (ACOs) - networks of doctors and hospitals whose members share responsibility for providing coordinated care to patients - improve health care quality and constrain costs. ACOs are increasingly common in the U.S., both for Medicare and commercially insured patients. However, there are concerns that ACOs may worsen existing disparities in health care quality if disadvantaged patients have less access to physicians who participate in them. Does physicians’ ACO participation relate to the sociodemographic characteristics of their patient population, and if so, why?

A Synchronized Prescription Refill Program Improved Medication Adherence

Aug. 5, 2016

Jalpa A. Doshi, Raymond Lim, Pengxiang Li, Peinie P. Young, Victor F. Lawnicki, Joseph J. State, Andrea B. Troxel, and Kevin G. Volpp

In Health Affairs, Jalpa Doshi and colleagues, including Pengxiang Lee, Andrea Troxel and Kevin Volpp, evaluate whether renewing all medications at the same time from the same pharmacy improves adherence to medication regimens. Synchronizing medication refills is an increasingly popular strategy, but there has been little research regarding its effectiveness. The authors looked at a pilot refill synchronization program implemented by Humana, a large national insurer, and analyzed patients’ adherence before and after participation in the program, compared to a control group. The...

Practice Patterns in Medicaid and Non-Medicaid Asthma Admissions

Aug. 5, 2016

Jeffrey H. SilberPaul R. Rosenbaum, Wei Wang, Shawna Calhoun, James P. Guevara, Joseph J. Zorc, Orit Even-Shoshan

In Pediatrics, Jeffrey Silber and colleagues investigate whether Medicaid and non-Medicaid patients admitted to the hospital for asthma are treated differently in major children’s hospitals. Medicaid provider reimbursement levels can be significantly lower than private insurance reimbursements, making it important to analyze whether this impacts the health care received by Medicaid beneficiaries. The authors used data from 40 children’s hospitals to analyze more than 17,000 matched pairs of Medicaid to non-Medicaid children admitted for asthma in the same hospital over three years...

Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

Research Brief
Jul. 25, 2016

State mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the number of children diagnosed with the disorder. However, diagnosis rates remain much lower than community estimates, suggesting that many commercially insured children with ASD remain undiagnosed or are insured through public plans.

Accounting for Social Risk Factors in Medicare Payment: Third National Report

Jul. 19, 2016

How should social risk factors enter into Medicare’s value-based payments to hospitals? The answer goes beyond an arcane discussion of payment policy; it has a direct impact on hospital bottom lines and the quality of care provided to underserved communities.  A new report from the National Academies of Sciences, Engineering, and Medicine—the third in a series of five—lays out criteria and methods to account for social risk factors in Medicare payment.  

Non-surgical management of ovarian cancer: Prevalence and implications

Jun. 9, 2016

David I. Shalowitz, Andrew J. Epstein, Emily M. Ko, Robert L. Giuntoli

In Gynecologic Oncology, David Shalowitz and colleagues, including Andrew Epstein, analyze the prevalence of non-surgical treatment for ovarian cancer, the reasons behind this in cases where surgery would have been clinically appropriate, and implications for survival rates. The authors find that one in five patients with ovarian cancer do not undergo surgery, which goes against best-practice guidelines. Surgery has been shown to significantly improve survival rates for ovarian cancer compared with non-surgical treatment. The largest determinant of whether a patient had surgical...

Selective Hearing: Physician Ownership and Physicians’ Response to New Evidence

Jun. 4, 2016

David H. Howard, Guy David, and Jason Hockenberry

In the Journal of Economics & Management Strategy, Guy David and colleagues examine whether physicians who own their surgical practices respond to new medical evidence differently from physicians who work in hospital-owned practices. In 2002, a clinical trial demonstrated that knee surgery did not benefit patients with osteoarthritis, which led to an overall decrease in knee surgeries. The authors took advantage of this “information shock” in 2002 to whether assess the impact of physician vs. hospital ownership status on these surgical practice patterns. They identified all...

Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

May. 25, 2016

Craig D Newgard, Zhuo Yang, Daniel Nishijima, K John McConnell, Stacy A Trent, James F Holmes, Mohamud Daya, N Clay Mann, Renee Y Hsia, Tom D Rea, N Ewen Wang, Kristan Staudenmayer, M. Kit Delgado

In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of...

Generic Medication Prescription Rates After Health System–Wide Redesign of Default Options Within the Electronic Health Record

May. 19, 2016

Mitesh Patel, Susan Day, Scott Halpern, William Hanson, Joseph Martinez, Steven Honeywell Jr, Kevin Volpp

In JAMA Internal Medicine, Mitesh Patel and colleagues, including Scott Halpern and Kevin Volpp, evaluate how changing electronic health record (EHR) defaults affects physician prescribing of generic drugs. For the study, the researchers utilized a systemic change to the University of Pennsylvania Health System’s EHR defaults. As part of this change, an opt-out checkbox labeled “dispense as written” was added to the prescription screen, and if left unchecked the generic-equivalent medication was prescribed. The authors find that generic prescribing rates increased significantly...

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