Why aren’t alternative payment models working?

Out of more than 50 alternative payment models (APM) that CMS has implemented only six have shown statistically significant cost savings and only four of these met the requirements to be expanded in duration and scope. That is not my opinion, CMS itself states this. We all want higher quality at lower cost; so the…

How adoption of new pharmaceuticals can impact US health system reimbursement under alternative payment models

This is the title of a new paper I have out today at JMCP with co-authors Shanshan Wang, Jaehong Kim, Slaven Sikirica, and Alexander Sandhu with the subtitle “An economic model measuring the impact of sotagliflozin among patients with heart failure and diabetes“. The abstract is below: BACKGROUND: Heart failure (HF) is among the leading…

Value-based payment flaws

While CMS has a target of getting 100% of Medicare beneficiaries into value-based payment (VBP) programs–such as accountable care organizations–by the end of the decade, implementing VBP in practice will be challenging. An editorial by Navathe et al. (2024) in Health Affairs provides some key considerations. Providers forego certain revenue for uncertain ‘bonus’ payments. “One…

Pharmacy quality metrics: An overview

A paper by Kogut (2024) has a nice overview of the organizations that develop pharmacy plan quality metrics. Pharmacy plan quality is vital since approximately 85% of the US population has prescription drug coverage through public (e.g., Medicare , Medicaid) or commercial (e.g., employer-provided) pharmacy plans. A helpful summary table is below. Quality measures are…

Are hospital quality metrics causal?

That is the question asked by a recent NBER working paper by Chandra et al. (2023). This question is important for a variety of reasons. First, quality measure data collection is expensive. Saraswathula et al. 2023 found that Johns Hopkins Hospital had to report 162 unique quality metrics, and the cost for collecting these data…

Does the 340B program improve quality of care?

According to a paper by Smith et al. 2023, the answer is ‘no’. The authors use data from AHRQ’s Healthcare Cost and Utilization Project (HCUP) State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and American Hospital Association Annual Survey for 15 states between 2008 to 2014. The…

Quality Measurement of German Hospitals

Public reporting of hospital quality of care could improve the care patients receive through at least two pathways. First, patients (or their physicians) could send patients to higher quality hospitals (i.e., the selection pathway). Alternatively, hospitals themselves could have behavioral responses to the metrics and may improve quality of care in response to public reporting…

Health impact of increasing access to physicians

Out recently is an interesting AEA paper by Okeke 2023, who examines a policy experiment by the Nigerian government that aimed determine whether expand access to physicians improved health outcomes. In this experiment, some communities were randomly selected to receive a new doctor. These doctors were posted to the local public health center. Prior to…