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.

Heart Failure Home Management Challenges and Reasons for Readmission: a Qualitative Study to Understand the Patient's Perspective

Aug. 2, 2018

Jonathan Sevilla-Cazes, Faraz S. Ahmad, Kathryn H. Bowles, Anne Jaskowiak, Tom Gallagher, Lee R. Goldberg, Shreya Kangovi,...

ABSTRACT [FROM JOURNAL]

Background: Heart failure patients have high 30-day hospital readmission rates. Interventions designed to prevent readmissions have had mixed success. Understanding heart failure home management through the patient’s experience may reframe the readmission “problem” and, ultimately, inform alternative strategies.

Objective: To understand patient and caregiver challenges to heart failure home management and perceived reasons for readmission.

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Burns Calls BS on CVS-Aetna Merger

Jul. 23, 2018

[Editor's note: on August 1, 2018, California Insurance Commissioner Dave Jones recommended that the United States Department of Justice sue to block the proposed merger.]

The proposed $69 billion merger of CVS and Aetna drew sharp criticism in a June California Insurance Commission hearing, including from LDI Senior Fellow Lawton R.  Burns, PhD, MBA, Professor of Health Care Management in the Wharton School.

Redesigning Provider Payment: Opportunities and Challenges from the Hawaii Experience

Jul. 18, 2018

Kevin G. Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B. Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye...

ABSTRACT [FROM JOURNAL]

Objectives: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system

Study Design: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the

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Physician Perspectives In Year 1 Of MACRA And Its Merit-Based Payment System: A National Survey

Jul. 11, 2018

ABSTRACT [from journal]

We surveyed a national sample of internal medicine physicians in March–May 2017 to explore their beliefs about the newly implemented Merit-based Incentive Payment System (MIPS). Respondents believed that their efforts in the four focus areas identified in the survey would ultimately improve the value of care. When informed that those areas represented the four MIPS domains, the majority remained positive about the likely impact on value. However, expectations varied by physicians’ characteristics and sense of control over the desired outcomes, and many...

SUMR 2018 Attends AHRQ National Research Service Awards Conference

Jul. 2, 2018
The 24nd annual National Research Service Award (NRSA) Conference took place in tandem with the 2018 AcademyHealth Annual Research Meeting at the Sheraton Seattle Hotel and the adjacent Washington State Convention Center. NRSA is part of the Agency for Healthcare Research and Quality (AHRQ) program that provides training, grants and other supports to undergraduate, predoctoral and postdoctoral trainees and fellows in the health services research field. This year's event was attended by 23 Summer Undergraduate Minority Research (SUMR) scholars from the University of Pennsylvania program co-...

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Integrated Behavioral Health Care in Family Medicine Residencies: A CERA Survey

Jun. 13, 2018

Christine Jacobs, Jay A. Brieler, Joanne Salas, Renée M. Betancourt, Peter F. Cronholm

ABSTRACT [FROM JOURNAL]

Background and Objectives: Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training.

Methods: Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors...

Incidence Trends and Risk Factor Variation in Severe Intraventricular Hemorrhage across a Population Based Cohort

Jun. 13, 2018

Sara C. Handley, Molly Passarella, Henry C. Lee, Scott A.Lorch

ABSTRACT [FROM JOURNAL]

Objective: To quantify the current burden of severe intraventricular hemorrhage (IVH), describe time trends in severe IVH, identify IVH-associated risk factors, and determine the contribution of mediating factors.

Study design: The 

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Comparison Of Hospitals Participating In Medicare’s Voluntary And Mandatory Orthopedic Bundle Programs

Jun. 6, 2018

Abstract [from journal]

We analyzed data from Medicare and the American Hospital Association Annual Survey to compare characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs. BPCI hospitals had higher mean patient volume and were larger and more teaching intensive than were CJR hospitals, but the two groups had similar risk exposure and baseline episode quality and cost. BPCI hospitals...

The Effect of Workforce Assignment on Performance: Evidence from Home Health Care

Research Brief
May. 22, 2018

In this study of more than 43,000 home health episodes following a hospitalization, handoffs between skilled nursing providers—a marker of discontinuity of care—substantially increased hospital readmissions, and were more detrimental for sicker patients. The estimates imply that a single handoff increases the likelihood of 30-day hospital readmission by 16% and that one in four hospitalizations during home health care could be avoided if handoffs were eliminated.

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