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payment innovation

Zirui Song, Amol S Navathe, Ezekiel J Emanuel, Kevin G Volpp
The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives...
March 2018: American Journal of Managed Care
Imran Ahmed, Niall Safir Ahmad, Shahnaz Ali, Shair Ali, Anju George, Hiba Saleem Danish, Encarl Uppal, James Soo, Mohammad H Mobasheri, Dominic King, Benita Cox, Ara Darzi
BACKGROUND: Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. OBJECTIVE: The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps...
March 16, 2018: JMIR MHealth and UHealth
Edeltraud J Lenk, William K Redekop, Marianne Luyendijk, Christopher Fitzpatrick, Louis Niessen, Wilma A Stolk, Fabrizio Tediosi, Adriana J Rijnsburger, Roel Bakker, Jan A C Hontelez, Jan H Richardus, Julie Jacobson, Epke A Le Rutte, Sake J de Vlas, Johan L Severens
BACKGROUND: The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). METHODS: A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030...
March 2018: PLoS Neglected Tropical Diseases
Dennis S Freeman, Cathy Hudgins, Joel Hornberger
The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model...
March 5, 2018: Journal of Clinical Psychology in Medical Settings
Burton L Edelstein
Health care costs have traditionally been provider generated whereas payment has been split between public and private sources. There has been little pressure on health care providers to demonstrate value. The quest for value in health care financing is now widely evident as demonstrated by governmental and private sector pursuits of a 3-part aim: better health outcomes at lower cost with improved patient and population experience. Value-based approaches involve payment innovation with its attendant constraints and opportunities for innovation...
April 2018: Dental Clinics of North America
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
Mark McClellan, Mark Japinga
The postelection efforts to repeal, replace, or modify the Affordable Care Act (ACA) suggest that the debate over healthcare coverage will remain contentious, particularly because of the high and rising cost of health care. Feasible, potentially bipartisan approaches to improving access to coverage should emphasize reforming health care to achieve higher quality at a lower cost. In the individual market, where many enrollees face limited options and rising premiums, a combination of high-risk pools, reinsurance, and risk adjustment could improve coverage options while encouraging innovations in care for the highest-risk patients...
January 29, 2018: Annual Review of Medicine
S Jacups, B Rogerson, I Kinchin
OBJECTIVES: Homelessness is not only about lack of secure housing, it is sometimes caused by simple reasons such as lack of money to travel home. The purpose of this study was to investigate whether the participant co-funded assistance program ('Return to Country' [R2C]), when offered to low socio-economic individuals experiencing homelessness, represented an effective use of scarce resources. STUDY DESIGN: In northern Australia, a remote and sparsely populated area, Indigenous persons who travel to regional centres cannot always afford airfares home; they therefore become stranded away from their 'country' leading to rapidly deteriorating health, isolation and separation from family and kin...
January 24, 2018: Public Health
Robert J Graham, Michael L McManus, Angie Mae Rodday, Ruth Ann Weidner, Susan K Parsons
OBJECTIVE: To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure. DESIGN: All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data...
February 3, 2018: Pediatric Critical Care Medicine
Rebecca D Onie, Risa Lavizzo-Mourey, Thomas H Lee, James S Marks, Rocco J Perla
The US health care system has recently begun to account for patients' unmet social needs in care delivery and payment reform. This article presents a twenty-year qualitative case study of five stages of diffusion-testing and learning, standardization, replication, shifting from doing to enabling, and catalyzing broad adoption-of a practical approach for integrating social needs into clinical care. This case study of Health Leads and its funders confirms the importance of focusing on a clear aim, investing in model testing and standardization to enable subsequent responsiveness to the market, and the willingness of innovators and their investors to cede control of a model to allow local adaption and accelerate broad adoption...
February 2018: Health Affairs
Rocco J Perla, Hoangmai Pham, Richard Gilfillan, Donald M Berwick, Richard J Baron, Peter Lee, C Joseph McCannon, Kevin Progar, William H Shrank
Congress established the Center for Medicare and Medicaid Innovation (CMMI) to design, test, and spread innovative payment and service delivery models that either reduce spending without reducing the quality of care or improve the quality of care without increasing spending. CMMI sought to leverage these models to foster market innovation and accelerate the transformation of payment and care delivery to achieve the Triple Aim of better health, better care, and lower cost. This article provides a perspective on the design and execution of CMMI's five initial models, the resulting outcomes and lessons, and how their core concepts evolved within and spread beyond CMMI...
February 2018: Health Affairs
O Kenrik Duru, Carol M Mangione, Hector P Rodriguez, Dennis Ross-Degnan, J Frank Wharam, Bernard Black, Abel Kho, Nathalie Huguet, Heather Angier, Victoria Mayer, David Siscovick, Jennifer L Kraschnewski, Lizheng Shi, Elizabeth Nauman, Edward W Gregg, Mohammed K Ali, Pamela Thornton, Steven Clauser
PURPOSE OF REVIEW: Diabetes incidence is rising among vulnerable population subgroups including minorities and individuals with limited education. Many diabetes-related programs and public policies are unevaluated while others are analyzed with research designs highly susceptible to bias which can result in flawed conclusions. The Natural Experiments for Translation in Diabetes 2.0 (NEXT-D2) Network includes eight research centers and three funding agencies using rigorous methods to evaluate natural experiments in health policy and program delivery...
February 5, 2018: Current Diabetes Reports
Kelly Fox, Ruth McCorkle
Health care expenditures, patient satisfaction, and timely access to care will remain problematic if dramatic changes in health care delivery models are not developed and implemented. To combat this challenge, a Triple Aim approach is essential; Innovation in payment and health care delivery models is required. Using the Donabedian framework of structure, process, and outcome, this article describes a nurse-led employee-centered care model designed to improve consumers' health care experiences, improve employee health, and increase access to care while reducing health care costs for employees, age 18 and older, in a corporate environment...
January 1, 2018: Workplace Health & Safety
Karen S Palmer, Adalsteinn D Brown, Jenna M Evans, Husayn Marani, Kirstie K Russell, Danielle Martin, Noah M Ivers
BACKGROUND: As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways...
2018: PloS One
Clifford C Sheckter, Shantanu N Razdan, Joseph J Disa, Babak J Mehrara, Evan Matros
Rising health care costs and quality demands have driven both the Centers for Medicare and Medicaid Services and the private sector to seek innovations in health system design by placing institutions at financial risk. Novel care models, such as bundled reimbursement, aim to boost value though quality improvement and cost reduction. The Center for Medicare and Medicaid Innovation is leading the charge in this area with multiple pilots and mandates, including Comprehensive Care for Joint Replacement. Other high-cost and high-volume procedures could be considered for bundling in the future, including breast reconstruction...
February 2018: Plastic and Reconstructive Surgery
Kaitlyn M Yim, April W Armstrong, Dennis H Oh, Karen McKoy, Aleksandra Florek
BACKGROUND: Teledermatology is rapidly advancing in the United States. The last comprehensive survey of U.S. teledermatology programs was conducted in 2011. INTRODUCTION: This article provides an update regarding the state of teledermatology programs in the United States. MATERIALS AND METHODS: Active programs were identified and surveyed from November 2014 to January 2017. Findings regarding practice settings, consult volumes, payment methods, and delivery modalities were compared to those from the 2011 survey...
January 22, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Ronit Amit, Susan K Jacobson
Reducing costs and increasing benefits for rural communities coexisting with large carnivores is necessary for conservation of jaguar (Panthera onca) and puma (Puma concolor). To design acceptable incentives, stakeholders must be involved in the process. We conducted an innovative structured group communication process, based on a Delphi technique, as a template for identifying potential incentives. Community workshops with 133 members of 7 communities and iterative surveys with 25 multidisciplinary experts from government, NGOs and academia provided iterative data to design a plan of incentives through 4 rounds of discussion...
January 22, 2018: Conservation Biology: the Journal of the Society for Conservation Biology
Veronica X Vela, Elizabeth W Patton, Darshak Sanghavi, Susan F Wood, Peter Shin, Sara Rosenbaum
CONTEXT: Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. METHODS: Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies...
January 9, 2018: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
Sara S Bachman, Madeline Wachman, Leticia Manning, Alexander M Cohen, Robert W Seifert, David K Jones, Therese Fitzgerald, Rachel Nuzum, Patricia Riley
OBJECTIVES: To critically analyze social work's role in Medicaid reform. METHODS: We conducted semistructured interviews with 46 stakeholders from 10 US states that use a range of Medicaid reform approaches. We identified participants using snowball and purposive sampling. We gathered data in 2016 and analyzed them using qualitative methods. RESULTS: Multiple themes emerged: (1) social work participates in Medicaid reform through clinical practice, including care coordination and case management; (2) there is a gap between social work's practice-level and systems-level involvement in Medicaid innovations; (3) factors hindering social work's involvement in systems-level practice include lack of visibility, insufficient clarity on social work's role and impact, and too few resources within professional organizations; and (4) social workers need more training in health transformation payment models and policy...
December 2017: American Journal of Public Health
Amrita G Shenoy, Charles E Begley, Lee Revere, Stephen H Linder, Stephen P Daiger
INTRODUCTION: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. BACKGROUND: A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals...
December 7, 2017: Healthcare
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