Toward Innovative Models of Health Care and Financing

Bazinsky, Katharine R.; Herrera, Laura; Sharfstein, Joshua M.

doi:10.1001/jama.2012.364

Cited by 9 publications

(7 citation statements)

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“…These findings have implications for the role of EMS in addressing the inordinate burden and challenges to the study population and to the U.S.'s historically fragmented health care systems in managing chronic conditions. In the context of U.S. health care reform and the formation of medical homes in networks of integrated medical and behavioral health services, EMS is well positioned for identifying and facilitating the access of vulnerable, high‐cost service users to and optimal engagement in health services . The findings call for interventions to promote the coordination and integration of EMS delivery with comprehensive, community‐based health services networks for contributing to goals of improved health outcomes and reduced health care costs .…”

Section: Discussionmentioning

confidence: 99%

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

et al. 2013

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Objectives To optimize healthcare utilization, health outcomes, and costs, research is needed to improve an understanding of frequent users of emergency health services. Frequent use of emergency services is associated with high costs of healthcare and may be indicative of challenges accessing, or poor outcomes of, healthcare. We identified patient demographics and health factors related to frequent use of the emergency medical services (EMS) system of a mid-sized city. Study findings will aid in the development of targeted interventions to improve population health. Methods We reviewed 9-1-1 call dispatch data and Baltimore City Fire Department EMS records in 2008–10. Frequent use was defined as six or more EMS incidents in the 23 month period. Analyses used census data to compare demographics of EMS users to their population distribution; and examined differences in demographics and health problems of frequent EMS users compared to non-frequent users. Results Frequent EMS users (n=1,969) had a range of 6–199 EMS incidents (mean 11.2) during the observation period; and though they accounted for only 1.5% of EMS users, they were involved in 12.0% of incidents. Frequent users, as compared to non-frequent users and to the population, were more likely to be male, African American, or 45 years or older. Of frequent users, the modal age group was 45–54 years, accounting for 29.7% of frequent users, which represented twice this age group’s population distribution. Furthermore, this age group had the greatest overrepresentation of males (63.0% of frequent users), and was the peak age group for substance abuse related incidents (28.0% of frequent users’ incidents in this age group). Frequent users compared to non-frequent users had lower levels of trauma related incidents (5.1% versus 16.7%) and higher levels of medical incidents (94.8% versus 82.9%). As proportions of EMS incidents among frequent versus non-frequent users, respiratory, mental health, and seizure related incidents were highest in the youngest age groups; and substance abuse related incidents were highest in those middle aged (35–44 years and 45–54 years). Of health problems, behavioral health (mental health or substance use) problems most contributed to frequent EMS use (23.4% of frequent users’ incidents). Across all incidents, 65.8% of frequent users had an indication of behavioral health problems, representing a 6.6-fold higher odds than non-frequent users (22.5%). Frequent compared to non-frequent users also had higher levels of select chronic conditions (diabetes: 39.9% vs. 14.6%, respectively; asthma: 40.9% vs. 13.4%; and HIV: 9.1% vs. 2.4%), with unadjusted odds almost 4 to 7 times higher. Conclusions The study findings revealed the major role of chronic somatic and behavioral health problems in frequent EMS use; and that rates of frequent use were highest among those middle aged, African American, and male. The results suggest the need for coordination of EMS with community-based, integrated medical and behavioral health services to impro...

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Section: Discussionmentioning

confidence: 99%

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

et al. 2013

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“…11 TPR is a voluntary alternative hospital financing strategy developed by the Health Services Cost Review Commission (HSCRC) covering all inpatient and outpatient services for rural hospitals. 12–14 TPR revenue constraint systems were made available to hospitals operating in regions of the state characterized by an absence of densely overlapping service areas. 14 The program changed incentives for hospitals by providing a global budget that guarantees a specified annual revenue for each hospital regardless of the number of patients treated and the amount of services provided.…”

Section: Introductionmentioning

confidence: 99%

“…14 The approved revenue is adjusted based on each hospital's relative performance on specific quality measures. 12 Annual adjustments to the budget also include adjustment for population changes and growth, reversal of any previous retroactive adjustments, and differential readjustments due to payer mix changes and bad debt. 14 If participating hospitals lower spending by reducing admissions, readmissions or by other strategies, they keep the resulting savings.…”

Section: Introductionmentioning

confidence: 99%

“…14 If participating hospitals lower spending by reducing admissions, readmissions or by other strategies, they keep the resulting savings. 12 However, if costs increase beyond the budget allotment, the hospital bears financial risk, and can adjust their prices within a 5% corridor in the next year. 13,14,17 Focusing efforts on reducing readmission rates to improve quality of care and reduce costs is a strategy that has proven to be effective.…”

Section: Introductionmentioning

confidence: 99%

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Innovative payment mechanisms in Maryland Hospitals: An empirical analysis of readmissions under total patient revenue

Mortensen

Perman²,

Chen

2014

Healthcare

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Background The state of Maryland implemented innovative budgeting of outpatient and inpatient services in eight rural hospitals under the Total Patient Revenue (TPR) system in July, 2010. Methods This paper uses data on Maryland discharges from the 2009-2011 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Individual inpatient discharges from eight treatment hospitals and three rural control hospitals (n=374,353) are analyzed. To get robust estimates and control for trends in the state, we also compare treatment hospitals to all hospitals in Maryland that report readmissions (n=1,997,164). Linear probability models using the difference-in-differences approach with hospital fixed effects are estimated to determine the effect of the innovative payment mechanisms on hospital readmissions, controlling for patient demographics and characteristics. Results Difference-in-differences estimates show that after implementation of TPR in the treatment hospitals, there were no statistically significant changes in the predicted probability of readmissions. Conclusions Early evidence from the TPR program shows that readmissions were not affected in the 18 months after implementation. Implications : As the health care system innovates, it is important to evaluate the success of these innovations. One of the goals of TPR was to lower readmission rates, however these rates did not show consistent downward trends after implementation. Our results suggest that payment innovations that provide financial incentives to ensure patients receive care in the most appropriate setting while maintaining quality of care may not have immediate effects on commonly used measures of hospital quality, particularly for rural hospitals that may lack coordinated care delivery infrastructure.

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“…But even in dense urban centers, strategies are emerging that bridge traditional boundaries. 7 Could there be a clinically driven business case for an urban AMC to share with the public sector the cost of combating smoking beyond the institution’s premises, or promoting access to childhood immunizations among local populations? AMCs, many with depth in prevention and in health services research, are uniquely positioned to model the potential financial impact of specific interventions that extend beyond the persons for whom they are already providing care, and to lead in implementing and evaluating interventions that bridge this divide.…”

Section: Clinical Care and Population Healthmentioning

confidence: 99%

Population Health and the Academic Medical Center

Gourevitch

2014

Academic Medicine

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Optimizing the health of populations, whether defined as persons receiving care from a health care delivery system or more broadly as persons in a region, is emerging as a core focus in the era of health care reform. To achieve this goal requires an approach in which preventive care is valued and “nonmedical” determinants of patients’ health are engaged. For large, multimission systems such as academic medical centers, navigating the evolution to a population-oriented paradigm across the domains of patient care, education, and research poses real challenges but also offers tremendous opportunities, as important objectives across each mission begin to align with external trends and incentives. In clinical care, opportunities exist to improve capacity for assuming risk, optimize community benefit, and make innovative use of advances in health information technology. Education must equip the next generation of leaders to understand and address population-level goals in addition to patient-level needs. And the prospects for research to define strategies for measuring and optimizing the health of populations have never been stronger. A remarkable convergence of trends has created compelling opportunities for academic medical centers to advance their core goals by endorsing and committing to advancing the health of populations.

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Toward Innovative Models of Health Care and Financing

Cited by 9 publications

References 1 publication

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

Patient Demographic and Health Factors Associated With Frequent Use of Emergency Medical Services in a Midsized City

Innovative payment mechanisms in Maryland Hospitals: An empirical analysis of readmissions under total patient revenue

Population Health and the Academic Medical Center

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