Nejm Catalyst Innovations in Care Delivery最新文献

{"title":"Higher Costs and Stagnant Revenue Are the New Normal for Health Care Organizations","authors":"Jonathan Bees","doi":"10.1056/cat.23.0286","DOIUrl":"https://doi.org/10.1056/cat.23.0286","url":null,"abstract":"SummaryInterviews from NEJM Catalyst Insights Council members on how their organizations are dealing with higher staffing costs and other cost increases.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Does the Inflation Reduction Act Mean for Patients and Physicians?","authors":"Amitabh Chandra, Benedic Ippolito","doi":"10.1056/cat.23.0138","DOIUrl":"https://doi.org/10.1056/cat.23.0138","url":null,"abstract":"SummaryThe debate around prescription drug measures in the recently passed U.S. Inflation Reduction Act (IRA), which limit some patients’ out-of-pocket costs, has not fully addressed their effect on physicians and patients via their effect on payers. Reducing patients’ costs for prescription drugs under Medicare Part D will improve their adherence, health, and financial security. However, payers use cost sharing to negotiate lower prices, and a payer that reduces cost sharing without increasing utilization management may not be able to keep premiums low enough to keep its business viable. Therefore, the IRA provisions will increase Part D payers’ reliance on other ways to manage drug costs, such as prior authorization and/or requirements to try less expensive drugs first. These methods impose paperwork burdens on physicians and may delay or change the care received by patients. The authors discuss these features of the IRA and outline priorities for leaders who aim to further value-based care more generally.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"187 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Case for Administrative Benchmarks (and Some Challenges)","authors":"Michael E. Chernew, J. Michael McWilliams, Shivani A. Shah","doi":"10.1056/cat.23.0194","DOIUrl":"https://doi.org/10.1056/cat.23.0194","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136308679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Federal Policies to Reduce or Limit Commercial Plan Payments to Hospitals and Physicians","authors":"Michael Cohen, Daria Pelech, Karen Stockley","doi":"10.1056/cat.22.0432","DOIUrl":"https://doi.org/10.1056/cat.22.0432","url":null,"abstract":"SummaryThe Congressional Budget Office (CBO) is a nonpartisan federal agency that, aligned with its mission to support the U.S. Congressional budget process, frequently analyzes policies affecting health care providers’ payment rates or their costs of providing care. Such policies can directly affect providers’ revenues by changing the administered prices for services covered by Medicare or by affecting the negotiated prices paid to providers by commercial insurers. CBO does not make policy recommendations. Rather, the agency’s role is to produce independent analyses of policy approaches and examine their implications for the federal budget and other related outcomes. Here, the authors describe a September 2022 report that was prepared on the basis of a congressional request. The agency reviewed three families of policies that are frequently mentioned as solutions for the growth in the negotiated prices paid in commercial plans: promoting competition among providers, promoting price transparency, and capping the level or growth rate of prices. The effects on prices expected within the first 10 years for each of the approaches considered would range from very small reductions if the price transparency policies were adopted (0.1%–1.0%) to small reductions if the competition policies were adopted (more than 1.0%–3.0%) and moderate (more than 3.0%–5.0%) to large (more than 5.0%) reductions if both the level and growth of prices were capped. Those estimates, although uncertain, represent CBO’s best assessments of the effects of the policies using evidence from the research literature and the most recently available data. CBO projects that, under current law, commercial insurers would pay $1.5 trillion in claims from hospitals and physicians in 2032. If hospital and physician prices fell by 1%, premiums for commercial health insurance plans could be reduced by a total of $13 billion in that year. Reductions in premiums in turn would reduce the federal budget deficit by increasing tax revenues (because the amount of premiums excluded from taxable income would be lower) and by reducing subsidies for health insurance for the self-employed and people eligible for subsidies under the Patient Protection and Affordable Care Act. As a result, the federal government’s subsidies for commercial health insurance premiums would be reduced by $4.8 billion in 2032 or 0.2% of the budget deficit projected for that year under current law. The authors did not project the effects of the policies on outcomes other than prices, premiums, and the federal budget — such as access to care, quality of care, and providers’ costs — because of limited and conflicting evidence and because the policies’ effects on prices were generally small. CBO recently issued a call for more research on the effects of policies significantly affecting providers’ revenues on other outcomes that would help the agency better analyze the effect of related policies in the future.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136313141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaccinating Health Care Supply Chains Against Market Failure: The Case of Civica Rx","authors":"Carter Dredge, Stefan Scholtes","doi":"10.1056/cat.23.0167","DOIUrl":"https://doi.org/10.1056/cat.23.0167","url":null,"abstract":"SummaryThis article focuses on the value of introducing novel business models into health care to address market failures that are hurting people — delving deeply into learning from real-world examples within the generic drug supply chain and its failure to supply critical medicines reliably at a low cost. Some problems in health care are so complex that traditional private-sector or governmental interventions alone have not been able to solve the problems. In an original response to ongoing generic drug shortages, in 2018, seven U.S. health systems and three philanthropic organizations founded a novel not-for-profit drug manufacturer, Civica Rx, to address the issue. Civica is a new entrant in this supply chain and utilizes a new business model called a health care utility that prioritizes access over profit. The company has been scaled rapidly and now provides more than 75 critical medications that are most at risk for shortages to more than 55 health systems across the United States. This article provides the first empirical evidence of Civica’s effect on security and cost of supply for one of its member health systems by utilizing internal supply chain, pharmacy, and external market data between 2016 and 2022. Results show that Civica was able to improve generic drug access above the wholesaler model. Using data related to 55 Civica orders of 20 distinct products between 2020 and 2022, the authors estimate Civica’s fulfillment of its contractually guaranteed volume at 96% (95% confidence interval [CI] = 92%–100%), whereas data on 302 wholesale orders for the same products over the same period estimate the wholesaler order fulfillment rate at 86% (95% CI = 82%–90%); the difference between these rates is statistically significant (P = 0.03). In addition, through its reserve supply of product, Civica offered a product access benefit of a further 43% above the Civica-guaranteed minimum viable volume floor. Wholesaler prices, at the order level, were estimated to be on average 46% above the Civica price for the same product in the same year (95% CI = 27%–64%, N = 302), with a P value of the difference of less than 0.001. However, through optimizing its wholesaler orders by buying more volume when prices were low from the 62 different non-Civica manufacturers, this closed the actual achieved cost-savings gap between the wholesalers and Civica to 2.7% in aggregate, with Civica still being the lower-cost option.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136309192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy — Key Lever to Changing Health Care Delivery","authors":"Namita Seth Mohta, Edward Prewitt, Lisa Gordon, Thomas H. Lee","doi":"10.1056/cat.23.0280","DOIUrl":"https://doi.org/10.1056/cat.23.0280","url":null,"abstract":"SummaryThis issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on the impact of the U.S. Inflation Reduction Act, federal policy implications for prices and reimbursement, the role of appropriate benchmarks in payer-provider contracts, novel business models to address challenges in drug supply, critical care in rural settings, and health system finances.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136314006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health System Finances Struggle to Regain Pre-Pandemic Footing","authors":"Alice Pope, Baligh Yehia","doi":"10.1056/cat.23.0277","DOIUrl":"https://doi.org/10.1056/cat.23.0277","url":null,"abstract":"SummaryA survey of the NEJM Catalyst Insights Council finds that financial health for the majority of health care organizations has not recovered from pre–Covid-19 pandemic levels, with 10% saying it will never recover.","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136307999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical Care Anywhere: A Novel Emergency Critical Care Consult Service in a Rural Health Network","authors":"Katelin Morrissette, Skyler Lentz, Ramsey Herrington, Mariah McNamara, Jada Barton, William E. Baker","doi":"10.1056/cat.23.0154","DOIUrl":"https://doi.org/10.1056/cat.23.0154","url":null,"abstract":"SummaryIn areas with limited access to critical care services, the intensivist’s reach can be expanded by removing the silo of the ICU and providing care wherever the patient is located. The University of Vermont Health Network includes a tertiary care center, two community hospitals, and three critical access hospitals, and often experiences limited ICU bed availability. The community hospitals have ICU services; however, only the tertiary site has consistent staffing for many subspeciality services. For example, the University of Vermont Medical Center is the only Vermont hospital to offer inpatient dialysis services or continuous electroencephalogram. The tertiary center ICU beds can be occupied by patients with brief ICU needs, but who remain in the ICU due to constraints in system throughput. The critical care transition (CCT) service was created in October 2022 to provide critical care consults for patients outside of the ICU. CCT serves the tertiary care ED and hospital wards, and provides peer-to-peer support for emergency physicians at the rural network EDs via telehealth. Dual-boarded emergency medicine/critical care medicine (EM/CCM) physicians provide the consults and offer procedural assistance within the tertiary care site. By increasing this access to critical care consults — independent of patient location — the long-term goals are to reduce short (<24-hour) ICU admissions, reduce the rates of transfer declines to the ICU due to capacity, decrease the time to evaluation by the intensivist for critically ill patients, and improve patient-centered measures of quality, such as inter-facility transfers and mortality. Short-term measures of success included demonstration of value and sustainability through either cost avoidance or revenue generation, favorable staff satisfaction evaluated via surveys, and successful deployment of telehealth to support rural network providers. The authors present the pilot phase of this care delivery model in a rural setting. Work is ongoing to expand and improve the ways in which critical care can be effectively delivered where and when needed. The initial 9 months of coverage, through August 2023, suggest improved access to ICU care, mitigation of avoidable high-cost services, and positive feedback from staff in the management of complex patients. The service, which started with just two EM/CCM physicians (limited, sporadic shifts, 60% full-time equivalent [FTE]) was approved in April 2023 for full-time staffing of one shift per day (2.3 FTEs) with a goal to continue data collection for evaluation of long-term objectives, continued rapid cycle improvement testing to increase patient volumes, and expanded use of telehealth opportunities throughout the network. This model of a peri-ICU consult service, focused on critical care anywhere, utilized the same physicians to concurrently support patients and providers outside of an ICU in multiple health care settings. The health system has demonstrated the fe","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136309244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Digital Technology Reshapes Care Delivery","authors":"E. Prewitt, N. Mohta, L. Gordon, Thomas H. Lee","doi":"10.1056/cat.23.0242","DOIUrl":"https://doi.org/10.1056/cat.23.0242","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80841721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pap Hub: A Novel Centralized System for Cervical Cancer Screening and Prevention","authors":"K. Das, Anna Ayers Looby, Abhishek Chandra, S. Asche, Katie Krumwiede","doi":"10.1056/cat.23.0114","DOIUrl":"https://doi.org/10.1056/cat.23.0114","url":null,"abstract":"","PeriodicalId":19057,"journal":{"name":"Nejm Catalyst Innovations in Care Delivery","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77883231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}