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Cost sharing in healthcare

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https://www.readbyqxmd.com/read/28070707/value-based-assessment-of-radiology-reporting-using-radiologist-referring-physician-two-way-feedback-system-a-design-thinking-based-approach
#1
Faiq Shaikh, Kenneth Hendrata, Brian Kolowitz, Omer Awan, Rasu Shrestha, Christopher Deible
In the era of value-based healthcare, many aspects of medical care are being measured and assessed to improve quality and reduce costs. Radiology adds enormously to health care costs and is under pressure to adopt a more efficient system that incorporates essential metrics to assess its value and impact on outcomes. Most current systems tie radiologists' incentives and evaluations to RVU-based productivity metrics and peer-review-based quality metrics. In a new potential model, a radiologist's performance will have to increasingly depend on a number of parameters that define "value," beginning with peer review metrics that include referrer satisfaction and feedback from radiologists to the referring physician that evaluates the potency and validity of clinical information provided for a given study...
January 9, 2017: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/28056968/co-payments-for-general-practitioners-in-denmark-an-analysis-using-two-policy-models
#2
Camilla Hansen, Despena Andrioti
BACKGROUND: The increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark. METHODS: The study was conducted as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method...
January 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28039014/what-can-five-high-cost-patients-teach-us-about-healthcare-spending
#3
Ishani Ganguli, Ryan W Thompson, Timothy G Ferris
The highest cost patients account for a disproportionately large share of American healthcare costs and are increasingly the focus of research and policy efforts to stem the rapid growth of these costs. These patients tend to be medically complex and frail, but we know little about how such characteristics influence healthcare spending from the perspectives of the patients and their caregivers. Therefore, we examined five of the highest cost patients at an academic medical center in a case series. We interviewed the patients, their family members, and their clinicians and analyzed their claims data and medical charts to explore how patient and health system characteristics influenced their health costs...
December 27, 2016: Healthcare
https://www.readbyqxmd.com/read/28034410/a-review-of-electronic-medical-record-keeping-on-mobile-medical-service-trips-in-austere-settings
#4
REVIEW
Christopher Dainton, Charlene H Chu
INTRODUCTION: Electronic medical records (EMRs) may address the need for decision and language support for Western clinicians on mobile medical service trips (MSTs) in low resource settings abroad, while providing improved access to records and data management. However, there has yet to be a review of this emerging technology used by MSTs in low-resource settings. The aim of this study is to describe EMR systems designed specifically for use by mobile MSTs in remote settings, and accordingly, determine new opportunities for this technology to improve quality of healthcare provided by MSTs...
February 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28009694/can-emergency-department-hospital-discharge-and-death-data-be-used-to-monitor-burden-of-drug-overdose-in-rhode-island
#5
Yongwen Jiang, James V McDonald, Jennifer Koziol, Meghan McCormick, Samara Viner-Brown, Nicole Alexander-Scott
CONTEXT: Drug overdoses are a growing public health problem in the United States. Rhode Island is also confronted with a serious epidemic of drug overdose deaths and ranks sixth worst in the United States for age-adjusted drug overdose death rate. OBJECTIVE: To monitor trends of drug overdose-related emergency department (ED) visits, hospitalizations, and deaths and classify the drug overdoses by demographics, discharge status, intent, and specific drug involved to plan for health care resource allocation, mental health services, drug abuse treatment, prevention, and policies...
December 22, 2016: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/27994712/examining-the-value-of-subsidies-of-health-plans-and-cost-sharing-for-prescription-drugs-in-the-health-insurance-marketplace
#6
Surachat Ngorsuraches, Jane R Mort
BACKGROUND: The Affordable Care Act (ACA) initiated federally and state-run health insurance exchanges, or marketplaces, with health plans offering subsidies for plan members as well as coverage for essential health benefits, to help individuals, families, and small businesses find health plans that fit their specific needs. A recent study found that the value of these healthcare subsidies varied with the number of health plans in the different geographic rating areas, but that study only examined the premiums and the deductibles of those health plans...
October 2016: American Health & Drug Benefits
https://www.readbyqxmd.com/read/27993174/reconciling-evidence-based-medicine-and-precision-medicine-in-the-era-of-big-data-challenges-and-opportunities
#7
Jacques S Beckmann, Daniel Lew
This era of groundbreaking scientific developments in high-resolution, high-throughput technologies is allowing the cost-effective collection and analysis of huge, disparate datasets on individual health. Proper data mining and translation of the vast datasets into clinically actionable knowledge will require the application of clinical bioinformatics. These developments have triggered multiple national initiatives in precision medicine-a data-driven approach centering on the individual. However, clinical implementation of precision medicine poses numerous challenges...
December 19, 2016: Genome Medicine
https://www.readbyqxmd.com/read/27983624/sharing-the-load-amish-healthcare-financing
#8
Kristyn Rohrer, Lauren Dundes
When settling healthcare bills, the Old Order Amish of Lancaster County, Pennsylvania rely on an ethos of mutual aid, independent of the government. Consonant with this philosophy, many Amish do not participate in or receive benefits from Social Security or Medicare. They are also exempted from the Affordable Care Act of 2010. This study expands the limited documentation of Amish Hospital Aid, an Amish health insurance program that covers major medical costs. Interview data from 11 Amish adults in Lancaster County depict how this aid program supplements traditional congregational alms coverage of medical expenses...
December 14, 2016: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/27971027/cost-sharing-in-healthcare-an-approach-for-pharmaceutical-care-in-greece
#9
I Kyriopoulos, A Petropoulou, V Naoum, N Oikonomou, K Athanasakis, J Kyriopoulos
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27956088/an-overview-of-nonhuman-primates-in-aging-research
#10
Julie A Mattison, Kelli L Vaughan
A graying human population and the rising costs of healthcare have fueled the growing need for a sophisticated translational model of aging. Nonhuman primates (NHPs) experience aging processes similar to humans and, as a result, provide an excellent opportunity to study a closely related species. Rhesus monkeys share >92% homology and are the most commonly studied NHP. However, their substantial size, long lifespan, and the associated expense are prohibitive factors. Marmosets are rapidly becoming the preferred NHP for biomedical testing due to their small size, low zoonotic risk, reproductive efficiency, and relatively low-cost...
December 10, 2016: Experimental Gerontology
https://www.readbyqxmd.com/read/27936112/genome-wide-association-of-heroin-dependence-in-han-chinese
#11
Gursharan Kalsi, Jack Euesden, Jonathan R I Coleman, Francesca Ducci, Fazil Aliev, Stephen J Newhouse, Xiehe Liu, Xiaohong Ma, Yingcheng Wang, David A Collier, Philip Asherson, Tao Li, Gerome Breen
Drug addiction is a costly and recurring healthcare problem, necessitating a need to understand risk factors and mechanisms of addiction, and to identify new biomarkers. To date, genome-wide association studies (GWAS) for heroin addiction have been limited; moreover they have been restricted to examining samples of European and African-American origin due to difficulty of recruiting samples from other populations. This is the first study to test a Han Chinese population; we performed a GWAS on a homogeneous sample of 370 Han Chinese subjects diagnosed with heroin dependence using the DSM-IV criteria and 134 ethnically matched controls...
2016: PloS One
https://www.readbyqxmd.com/read/27924216/atrial-fibrillation-management-in-older-heart-failure-patients-a-complex-clinical-problem
#12
REVIEW
Giovanni Pulignano, Donatella Del Sindaco, Maria Denitza Tinti, Stefano Tolone, Giovanni Minardi, Antonio Lax, Massimo Uguccioni
BACKGROUND: Atrial fibrillation (AF) and heart failure (HF), two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients...
January 2016: Heart International
https://www.readbyqxmd.com/read/27902648/incidence-and-burden-of-pertussis-among-infants-less-than-1-year-of-age
#13
Cristina Masseria, Carolyn K Martin, Girishanthy Krishnarajah, Laura K Becker, Ami Buikema, Tina Q Tan
BACKGROUND: Infant-specific pertussis data, especially among neonates, are limited and variable. This study (NCT01890850) provides overall and age-specific pertussis incidence and associated healthcare utilization and costs among commercially insured infants in the United States. METHODS: Nearly 1.2 million infants born from 2005-2010 with commercial health plan coverage were followed during their first 12 months of life. Pertussis cases were identified from medical claims (ICD-9-CM 033...
November 28, 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27897016/open-data-for-discovery-science
#14
Philip R O Payne, Kun Huang, Nigam H Shah, Jessica Tenenbaum
The modern healthcare and life sciences ecosystem is moving towards an increasingly open and data-centric approach to discovery science. This evolving paradigm is predicated on a complex set of information needs related to our collective ability to share, discover, reuse, integrate, and analyze open biological, clinical, and population level data resources of varying composition, granularity, and syntactic or semantic consistency. Such an evolution is further impacted by a concomitant growth in the size of data sets that can and should be employed for both hypothesis discovery and testing...
2016: Pacific Symposium on Biocomputing
https://www.readbyqxmd.com/read/27896681/financial-impact-of-direct-acting-oral-anticoagulants-in-medicaid-budgetary-assessment-based-on-number-needed-to-treat
#15
Kathleen A Fairman, Lindsay E Davis, Courtney R Kruse, David A Sclar
BACKGROUND: Faced with rising healthcare costs, state Medicaid programs need short-term, easily calculated budgetary estimates for new drugs, accounting for medical cost offsets due to clinical advantages. OBJECTIVE: To estimate the budgetary impact of direct-acting oral anticoagulants (DOACs) compared with warfarin, an older, lower-cost vitamin K antagonist, on 12-month Medicaid expenditures for nonvalvular atrial fibrillation (NVAF) using number needed to treat (NNT)...
November 28, 2016: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/27896623/effect-of-the-new-maternity-insurance-scheme-on-medical-expenditures-for-caesarean-delivery-in-wuxi-china-a-retrospective-pre-post-reform-case-study
#16
Chun Chen, Zhihong Cheng, Ping Jiang, Mei Sun, Qi Zhang, Jun Lv
Aiming to control rising medical expenditures and help improve China's healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals' C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004-2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform...
November 28, 2016: Frontiers of Medicine
https://www.readbyqxmd.com/read/27893144/effectiveness-of-shared-medical-appointments-targeting-the-triple-aim-among-patients-with-overweight-obesity-or-diabetes
#17
Kristi H Trickett, Paul M Matiaco, Kathryn Jones, Bernadette Howlett, Kathaleen Briggs Early
BACKGROUND: Obesity and diabetes are epidemic in the United States, with many treatment options having limited long-term efficacy. A possible effective medical management tool is the shared medical appointment (SMA), which offers an efficient and cost-effective approach to behavior change and aligns with the Triple Aim (reduce costs, improve population health, and improve patient care experience) set forth by the Institute for Healthcare Improvement. OBJECTIVES: To assess the effectiveness of SMAs to achieve the Triple Aim and to improve the management of overweight/obesity or diabetes...
December 1, 2016: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/27888437/estimated-budget-impact-of-adopting-the-affordable-care-act-s-required-smoking-cessation-coverage-on-united-states-healthcare-payers
#18
Christine L Baker, Cheryl P Ferrufino, Marianna Bruno, Stacey Kowal
INTRODUCTION: Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice...
November 25, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27878711/a-framework-for-guiding-efforts-to-reward-value-instead-of-volume
#19
Taylor J Christensen
The U.S. healthcare system is in the midst of a major shift from fee-for-service to value-based reimbursement models. To date, these new reimbursement models have been focused on quality-contingent bonuses and cost-of-care risk sharing for providers, both of which have yielded only modest success.An analysis of health policy and business strategy literature was performed to identify the mechanisms of how value is rewarded in other industries and to understand the barriers to those mechanisms operating in the healthcare industry...
June 2016: Int J Health Econ Manag
https://www.readbyqxmd.com/read/27870546/integrated-care-organizations-medicare-financing-for-care-at-home
#20
Karen Davis, Amber Willink, Cathy Schoen
OBJECTIVES: As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use. METHODS: This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending...
November 2016: American Journal of Managed Care
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