Article
Health Care Sciences & Services
Kathryn E. Gunter, Jacob P. Tanumihardjo, Yolanda O'Neal, Monica E. Peek, Marshall H. Chin
Summary: Social factors impact the health outcomes of patients with diabetes, and there is interest in these areas from health systems, researchers, and policymakers. To improve population health and outcomes, organizations are integrating medical and social care, working with community partners, and seeking sustainable financing. This article summarizes promising examples and future opportunities for integrated medical and social care across three themes: primary care transformation, addressing individual social needs and structural changes, and payment reform. Achieving equitable health outcomes through integrated care requires a significant shift in healthcare financing and delivery.
JOURNAL OF GENERAL INTERNAL MEDICINE
(2023)
Review
Clinical Neurology
Kelby Brown, Nada El Hussein, Rohan Grimley, Annemarei Ranta, Tareq Kass-Hout, Samantha Kaplan, Brystana G. Kaufman
Summary: This systematic review evaluates the impacts of alternative payment models on stroke outcomes, spending, and utilization. The findings suggest that pay-for-performance models are not consistently associated with improvements in stroke prevention, while prospective payments shift poststroke spending between care settings without reducing total spending. Shared savings models show potential for lowering spending and service utilization without worsened clinical outcomes, but capitated payment models have inconsistent effects on poststroke spending and utilization.
Article
Nursing
Olga Yakusheva, Betty Rambur, Monica O'Reilly-Jacob, Peter I. Buerhaus
Summary: This series emphasizes the significance of value-based payment for nurses to improve patient care and gain empowerment. It discusses the concept of value-informed nursing practice and the ethical basis for embracing value-based nursing practice. It also highlights the emerging goal of healthcare systems to provide high-value care and urges nurses to become leaders in producing high-value healthcare.
Review
Health Care Sciences & Services
Costase Ndayishimiye, Marzena Tambor, Katarzyna Dubas-Jakobczyk
Summary: This study aimed to identify, systematize, and map the existing literature on the factors that influence health-care provider payment reforms. The study included 51 publications and found that the factors influencing payment reforms are often contextual and interrelated, encompassing various perspectives. When planning reforms, potential barriers should be anticipated and appropriate interventions should be devised.
RISK MANAGEMENT AND HEALTHCARE POLICY
(2023)
Article
Surgery
Joseph Lopez, Anaeze C. Offodile, Deana Shenaq, Loren Schechter, Larry Chavis, Charles S. Hultman, Amir H. Dorafshar
Summary: The review discusses the impact of value-based care on surgeon compensation and suggests the use of a congruence model to determine appropriate compensation methods. Researchers in organizational behavior have provided a framework for health care leaders to design financial compensation plans for surgeons in value-based care settings.
PLASTIC AND RECONSTRUCTIVE SURGERY
(2021)
Review
Medicine, General & Internal
Ashwanee A. Kjelsnes, Eli Feiring
Summary: This study used horizon scanning methodologies to search for and assess new integrated care models for older people with frailty. The results identified nine integrated care models and interventions, with the Walcheren integrated care model and EuFrailSafe receiving the highest scores. The study also highlighted the barriers to adopting horizon scanning in healthcare decision-making.
Article
Health Care Sciences & Services
Zosha K. Kandel, Diane R. Rittenhouse, Salma Bibi, Taressa K. Fraze, Stephen M. Shortell, Hector P. Rodriguez
Summary: Based on national surveys of physician practices, it was found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities, whether in SIM Round 1, SIM Round 2, or non-SIM states.
MEDICAL CARE RESEARCH AND REVIEW
(2021)
Article
Health Care Sciences & Services
Newel Salet, Bianca I. Buijck, Dianne H. K. Van Dam-Nolen, Jan A. Hazelzet, Diederik W. J. Dippel, Erik Grauwmeijer, F. T. Schut, Bob Roozenbeek, Frank Eijkenaar
Summary: This study explores the factors and mechanisms influencing the introduction of value-based payment in stroke care, highlighting facilitating factors such as trust-based relations, shared dissatisfaction with the status quo, regulatory compatibility, and involvement of a trusted third party. However, challenges include friction between short- and long-term goals, unwillingness to forgo professional and organizational autonomy, resource discontinuity, and limited access to real-time data for improvement. Successful payment and delivery system reform require long-term commitment and careful consideration of creating the 'right' contextual circumstances.
INTERNATIONAL JOURNAL OF INTEGRATED CARE
(2023)
Article
Health Care Sciences & Services
Sean M. Reed, Erin Austin, Kathryn Colborn, Lisa M. Schilling, Jean S. Kutner
Summary: This study developed a new reimbursement structure for palliative care (PC) services based on changes in patient functional status and estimated the reimbursement for the first year of implementation. The results showed that the new structure provides reimbursement for sustainable PC services and is cost-advantageous compared to the previous structure.
AMERICAN JOURNAL OF MANAGED CARE
(2022)
Review
Health Care Sciences & Services
Eline F. De Vries, Zoe T. M. Scheefhals, Mieneke De Bruin-Kooistra, Caroline A. Baan, Jeroen N. Struijs
Summary: This study provides an overview of alternative payment models in maternity care, discussing key design elements and risk mitigation strategies. The findings suggest that risk mitigation strategies are important tools to increase the uptake of alternative payment models and protect providers from financial risks. While empirical evidence on the effects of these models is limited, further research is needed to understand how these payment reforms can align with their goals effectively.
INTERNATIONAL JOURNAL OF INTEGRATED CARE
(2021)
Article
Health Policy & Services
Andrew S. Hyatt, Miriam C. Tepper, Colleen J. O'Brien
Summary: The rapid rise of value-based payment models presents new opportunities and challenges for behavioral health providers, especially in health systems serving low-income and marginalized communities. This column discusses the experience of a community health care system as an early adopter of VBP to showcase the constraints and possibilities health systems face when implementing these models, providing valuable lessons for others seeking to do the same.
PSYCHIATRIC SERVICES
(2021)
Article
Public, Environmental & Occupational Health
Anna L. Thorndike, Lauren Peterson, Sivan Spitzer, Shilpa Patel, Anne Smithey, Jennifer E. Moore, Scott C. Cook, Marshall H. Chin
Summary: This paper explores how multi-stakeholder teams operationalized the Roadmap to Advance Health Equity model during early stages of their journey to build cultures of equity and integrate health equity into care transformation and payment reform initiatives. The study provides practical strategies that can inform future efforts to build intra- and inter-organizational cultures of equity and integrate health equity into care delivery and payment systems.
FRONTIERS IN PUBLIC HEALTH
(2023)
Article
Surgery
Nicholas L. Berlin, Neil Kamdar, John Syrjamaki, Erika D. Sears
Summary: The study aims to assess the timing, duration, and nature of healthcare service utilization for three common elective surgical procedures not currently included in federal bundled payment programs. A retrospective cohort study was conducted using a private insurer's claims database, comparing trends in service utilization pre and post surgery. The findings highlight the need for tailored timing and duration of clinical episodes for different surgical procedures.
JOURNAL OF SURGICAL RESEARCH
(2023)
Review
Pediatrics
Daniella Gratale, Janet Viveiros, Katie Boyer
Summary: This review aims to summarize the elements of emerging paediatric alternative payment models (APMs), strategies to overcome implementation barriers, and policy approaches. The development of paediatric value-based care and APMs should consider the unique health needs of children and adolescents. The adoption of paediatric APMs is hindered by the longer time needed to achieve cost savings, limited existing model tests, and challenges with cross-sector data-sharing and pooled financing.
CURRENT OPINION IN PEDIATRICS
(2022)
Article
Health Care Sciences & Services
Joseph T. T. Kannarkat, Soleil Shah, Natasha Parekh, Francis J. J. Crosson
Summary: The Center for Medicare and Medicaid Innovation (CMMI) aims to develop evidence-based alternative payment models (APM) to enhance healthcare quality and decrease costs, but its achievement in these goals has been inconsistent. In October 2021, CMMI released its Innovation Strategy Refresh to address challenges in payment models and propose new strategies. However, there are still unresolved issues, including engaging physicians and patients in APMs, minimizing conflicting incentives, reducing selection bias, and transitioning from fee-for-service framework. This article offers guidance and solutions to improve CMMI's vision and tackle these challenges.
Article
Medicine, General & Internal
Rose J. Geurten, Arianne M. J. Elissen, Henk J. G. Bilo, Jeroen N. Struijs, Chantal van Tilburg, Dirk Ruwaard
Summary: The study identified and described the Dutch type 2 diabetes population from 2016 to 2018, revealing that pharmaceutical care, medical specialist care, and general practitioner consultations are commonly utilized. A high percentage of patients also received specialized care for diabetes-related complications. Medical specialist care accounted for the largest share of healthcare expenditures in this population, indicating a potential need for a shift towards a person-centered and integrated care approach.
Article
Environmental Sciences
Bahareh Goodarzi, Corine Verhoeven, Durk Berks, Eline F. de Vries, Ank de Jonge
Summary: This study investigated the distribution of different models of risk selection across regions in The Netherlands and examined their impact on the satisfaction of primary care midwives and obstetricians. The findings indicate variations in the involvement of obstetricians in the care of healthy pregnant women among these models, with no significant difference in professionals' level of satisfaction.
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
(2022)
Article
Economics
Rose J. Geurten, Jeroen N. Struijs, Arianne M. J. Elissen, Henk J. G. Bilo, Chantal van Tilburg, Dirk Ruwaard
Summary: Healthcare utilization and expenditures related to medical specialist care and medication of the entire type 2 diabetes population in the Netherlands are diverse, with a skewed distribution of spending. These heterogeneous healthcare use patterns may be caused by comorbidities, and a small fraction of the population is responsible for a large share of the expenditures. A shift towards more patient-centered care could lead to health improvements and a reduction in overall costs, subsequently promoting the sustainability of healthcare systems.
PHARMACOECONOMICS-OPEN
(2022)
Article
Endocrinology & Metabolism
Emma A. Nieuwenhuijse, Jeroen N. Struijs, Stephen P. Sutch, Mattijs. E. Numans, Rimke C. Vos
Summary: This study investigated the association between registered mental illness and treatment targets for type 2 diabetes mellitus, taking into account health expenditure and social determinants of health. The results showed that individuals with registered mental illness were comparable or better at achieving treatment targets for HbA(1c) than those without mental illness. Social disadvantage, such as low income and migrant background, lowered the likelihood of reaching treatment targets.
Article
Health Policy & Services
Josefien de Bruin, Cheryl Bos, Jeroen Nathan Struijs, Hanneke Wil-Trees Drewes, Caroline Astrid Baan
Summary: This study aims to understand learning within regional cross-sectoral partnerships for health by mapping the concept of Learning Health System (LHS). Through a qualitative analysis of literature, the study found that the interpretation of LHS varied widely and identified the aims, design elements, and process of learning within LHS. Three types of learning were identified, but one type was underrepresented and the three types rarely occurred simultaneously. The study suggests specifying LHS aims, operationalizing design elements, and choosing appropriate learning types for a better understanding of learning within regional cross-sectoral partnerships for health.
LEARNING HEALTH SYSTEMS
(2023)
Review
Oncology
Liza van Deursen, Anke Versluis, Rosalie van der Vaart, Lucille Standaar, Jeroen Struijs, Niels Chavannes, Jiska J. Aardoom
Summary: This systematic review examined eHealth interventions for Dutch patients with and survivors of cancer and their impact on population health, quality of care, and per capita costs. The results showed that eHealth interventions can positively affect sleep quality, fatigue, and physical activity of cancer patients and survivors. However, the impact on daily functioning, quality of life, psychological complaints, and psychological adjustment to the disease was inconclusive. Overall, eHealth has the potential to improve outcomes in terms of population health and quality of care.
Article
Health Care Sciences & Services
Joyce M. Molenaar, Inge C. Boesveld, Jessica C. Kiefte-de Jong, Jeroen N. Struijs
Summary: The Dutch Solid Start program aims to improve collaboration between the medical and social sectors to provide the best start in life for every child. This study developed an indicator set for local coalitions to monitor their Solid Start program. The indicator set includes 19 indicators covering the preconception, pregnancy, and after birth phases, and prioritizes social and medical topics such as poverty, psychological/psychiatric problems, and smoking. The development agenda identifies topics and indicators that lack data or clear operationalization.
INTERNATIONAL JOURNAL OF INTEGRATED CARE
(2022)
Article
Public, Environmental & Occupational Health
J. M. Molenaar, L. van der Meer, L. C. M. Bertens, E. F. de Vries, A. J. M. Waelput, M. Knight, E. A. P. Steegers, J. C. Kiefte-de Jong, J. N. Struijs
Summary: This study aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on social risk and protective factors, and validate these classes against adverse outcomes. The study found that vulnerability in pregnant women was characterized by high risk factors in a specific domain and protective factors in others. Furthermore, multidimensional vulnerability was associated with adverse outcomes such as premature birth and caesarean section.
EUROPEAN JOURNAL OF PUBLIC HEALTH
(2023)
Article
Endocrinology & Metabolism
Emma A. Nieuwenhuijse, Teske B. van Hof, Mattijs. E. Numans, Jeroen N. Struijs, Rimke C. Vos
Summary: The impact of social determinants of health (SDOH) on the development of diabetes-related complications in young adults with type 2 diabetes was investigated in this study. It was found that men of non-Western origin and those with poor glycemic control were more likely to develop complications, while income level was not associated with complications.
PRIMARY CARE DIABETES
(2023)
Article
Health Care Sciences & Services
F. H. Ardesch, M. C. Meulendijk, J. M. Kist, R. C. Vos, H. M. M. Vos, J. C. Kiefte-de Jong, M. Spruit, M. A. Bruijnzeels, M. J. Bussemaker, M. E. Numans, J. N. Struijs
Summary: Improving population health and reducing inequalities through better integrated health and social care services is a priority for policymakers worldwide. Cross-domain partnerships have emerged in several countries, aiming to achieve better population health, quality of care, and lower costs. These partnerships rely on data and continuous learning.
Article
Oncology
Liza van Deursen, Rosalie van der Vaart, Eva E. Alblas, Jeroen N. Struijs, Niels H. Chavannes, Jiska J. Aardoom
Summary: This study aims to identify improvement opportunities in the colorectal cancer care pathway using e-health and examine how they contribute to the Quadruple Aim. Through semi-structured interviews, it was found that e-health technology can be better utilized in CRC care, with 12 improvement opportunities identified. The study demonstrates the potential of e-health in addressing challenges in cancer care.
SUPPORTIVE CARE IN CANCER
(2023)
Article
Health Policy & Services
Margot M. Rakers, Hine J. A. van Os, Kasper Recourt, Georgio Mosis, Niels H. Chavannes, Jeroen N. Struijs
Summary: This study aimed to identify the barriers and facilitators of structural reimbursement of remote patient monitoring (RPM) in hospital care in the Netherlands and propose actionable recommendations. The interviews with relevant stakeholders revealed several barriers, such as cost-benefit mismatch, lack of uniform quality and outcome indicators, and difficulties in implementing cross-sector models. Facilitators included interdisciplinary cooperation, alternative payment models, and help from the Dutch Healthcare Authority. These findings are important for supporting reimbursement of RPM and stimulating collaboration among healthcare stakeholders.
HEALTH POLICY AND TECHNOLOGY
(2023)
Article
Medicine, General & Internal
Janet M. Kist, Rimke C. Vos, Albert T. A. Mairuhu, Jeroen N. Struijs, Petra G. van Peet, Hedwig M. M. Vos, Hendrikus J. A. van Os, Edith D. Beishuizen, Yvo W. J. Sijpkens, Mohammad A. Faiq, Mattijs E. Numans, Rolf H. H. Groenwold
Summary: This study aimed to assess the performance of the four SCORE2 cardiovascular disease (CVD) risk prediction models in a diverse population in the Netherlands. The results showed that the CVD risk was underestimated in the low socioeconomic and Surinamese ethnic subgroups. Therefore, it is recommended to include socioeconomic status and ethnicity as predictors in CVD risk models and implement CVD risk adjustment.
Article
Medicine, General & Internal
Janet M. Kist, Gideon W. G. Smit, Albert T. A. Mairuhu, Jeroen N. Struijs, Rimke C. Vos, Petra G. van Peet, Hedwig M. M. Vos, Edith D. Beishuizen, Yvo W. J. Sijpkens, Rolf H. H. Groenwold, Mattijs E. Numans
Summary: This study investigated cardiovascular death rates stratified by ethnicity and socioeconomic factors in an urban population in The Hague, the Netherlands, revealing large health disparities across ethnic and socioeconomic subgroups. Identifying high-risk subgroups and implementing targeted preventive efforts may help improve cardiovascular health equity within communities.
Meeting Abstract
Endocrinology & Metabolism
R. J. Geurten, A. M. J. Elissen, H. J. G. Bilo, J. N. Struijs, C. Van Tilburg, D. Ruwaard