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Health Care Payment Approaches

Journal Article

Quality of Quality Measurement: Impact of Risk Adjustment, Hospital Volume, and Hospital Performance

Monte Carlo simulation was used to examine the accuracy of performance profiling as a function of statistical methodology, case volume, and the extent to which hospital or physician performance deviates from the average.

Dec 31, 2020
Journal Article

Feasibility of Report Cards for Measuring Anesthesiologist Quality for Cardiac Surgery

We conducted a study of 55,436 patients undergoing cardiac surgery between 2009 and 2012. Hierarchical logistic regression modeling was used to examine the variation in in-hospital mortality or major complications.

Dec 30, 2020
Report

RAND Technical Expert Panel Medicare Advantage (MA) and Part D Contract Star Ratings, July 22, 2020 Meeting

On July 22, 2020, the RAND Corporation convened a Technical Expert Panel (TEP) web meeting to gather input on analyses that could be conducted to further enhance the Medicare Advantage (MA) and Part D Contract Star Ratings program.

Dec 23, 2020
Journal Article

Anesthesiologists and the Transformation of the Healthcare System: A Call to Action

This is the second in a series of six editorials on the changing definitions of safety across the perioperative period and how anesthesiologists can participate in and lead the transformation of health care with focus on patient value.

Dec 18, 2020
Journal Article

Evaluation Report of the First Three Years (2017-2019) of the Medicare Advantage Value-Based Insurance Design Model Test

CMMI contracted with the RAND Corporation to evaluate the first three years of the MA VBID model test. This report serves as our second and final evaluation of the first three years of the model test.

Oct 21, 2020
Journal Article

First Annual Evaluation Report of the Medicare Advantage Value-Based Insurance Design Model Test: 2017, Year 1 of the Intervention

RAND researchers are evaluating a five-year model test to assess whether value-based insurance design can increase use of high-value services, reduce use of avoidable services, improve quality of care, and improve health outcomes and reduce spending.

Oct 21, 2020
Journal Article

A Scoping Review of Strategies for Financing the Implementation of Evidence-Based Practices in Behavioral Health Systems: State of the Literature and Future Directions

We conducted a scoping review that assessed the current state of evidence on EBP financing strategies for behavioral health. We defined financing strategies as techniques that secure and direct financial resources to support evidence-based practice implementation.

Sep 15, 2020
Journal Article

Factors Influencing Physician Practices' Adoption of Behavioral Health Integration in the United States: A Qualitative Study

Practices currently using behavioral health integration face barriers to implementing and sustaining behavioral health integration. Tailored, context-specific technical support to guide practices' implementation and payment models that improve the business case for practices may enhance the dissemination and long-term sustainability of behavioral health integration.

Aug 5, 2020
Journal Article

CMS Reimbursement Reform and the Incidence of Hospital-Acquired Pulmonary Embolism or Deep Vein Thrombosis

CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery.

Aug 5, 2020
Journal Article

Quality Of End-Of-Life Care Is Higher In The VA Compared To Care Paid For By Traditional Medicare

The Medicare-reliant veterans were significantly more likely to receive high-intensity care, in the form of chemotherapy, hospital stays, admission to the intensive care unit, more days spent in the hospital, and death in the hospital. However, they were significantly less likely than VA-reliant patients to have multiple emergency department visits. Higher-intensity end-of-life care may be driven by financial incentives present in fee-for-service Medicare but not in the VA's integrated system.

Aug 5, 2020
Report

Practice Expense Methodology and Data Collection Research and Analysis: Interim Phase II Report

In this report, the authors address how the Centers for Medicare and Medicaid Services can improve the methodology or update data used for setting practice expense payment rates under the Medicare Physician Fee Schedule.

Aug 4, 2020
Report

Advancing the Development of a Framework to Capture Non–Fee-for-Service Health Care Spending for Primary Care

This report describes work conducted to understand what non-fee-for-service payment data are being collected by states and other stakeholders to support more complete measurement of primary care spending as a proportion of total health care spending.

Jul 30, 2020
Dissertation

Three Essays In Health Policy and Economics: Surprise Out-of-Network Medical Bills and Out-of-Network Health Care Provider Payment in the United States

Three essays addressing surprise out-of-network medical bills and out-of-network health care provider payment.

Jul 16, 2020
Commentary

Why States' 'Netflix Model' Prescription Drug Arrangements Are No Silver Bullet

Despite the buzz and catchy notion that subscription models are "Netflix for drugs," it's hard to come up with a theoretical case that supports subscription models over traditional price negotiation between payers and manufacturers over a per-dose or per-unit price.

Jul 1, 2020
Journal Article

Accounting for the Burden and Redistribution of Health Care Costs: Who Uses Care and Who Pays for It

The dollar value of health care received declines as income rises as does health care received as a percent of income.

Jun 25, 2020
Blog

COVID-19, Out-of-Network Hospital Payments, Russia's Economy: RAND Weekly Recap

This weekly recap focuses on COVID-19, limiting out-of-network hospital payments, Russia's sluggish economy, RAND's largest-ever fundraising campaign, and more.

Mar 13, 2020
News Release

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps. Because such an approach has the possibility to sharply cut hospital revenues, any cap would need to be set carefully as to not overly disrupt hospital operations.

Mar 12, 2020
Report

The Effects of Limiting Payments to Hospitals for Out-of-Network Care

There is growing interest among U.S. policymakers to use out-of-network payment limits to curb surprise medical bills and as a tool to control rising health care costs. How might such limits affect negotiated in-network prices and total payments for hospital care?

Mar 11, 2020
Report

RAND Medicare Advantage (MA) and Part D Contract Star Ratings Technical Expert Panel November 7th, 2019 Meeting

On November 7, 2019, the RAND Corporation convened a Technical Expert Panel (TEP) web meeting to gather input on analyses that could be conducted to further enhance the Medicare Advantage (MA) and Part D Contract Star Ratings program.

Feb 7, 2020
Journal Article

Payment for Services Rendered: Updating Medicare's Valuation of Procedures

Medicare appears to be overpaying surgeons for post-operative care associated many medical procedures. Federal officials should incorporate ways to more objectively measure the amount of postoperative care surgeons provide to patients

Jan 24, 2020

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