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  • Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review

    Author(s)
    Brown, Kelby
    El Husseini, Nada
    Grimley, Rohan
    Ranta, Annemarei
    Kass-Hout, Tareq
    Kaplan, Samantha
    Kaufman, Brystana G
    Griffith University Author(s)
    Grimley, Rohan
    Year published
    2021
    Metadata
    Show full item record
    Abstract
    Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evaluates historical and current evidence regarding the impacts of alternative payment models on stroke outcomes, spending, and utilization. Included studies evaluated alternative payment models in 4 categories: pay-for-performance (n=3), prospective payments (n=14), shared savings (n=5), and capitated payments (n=14). Pay-for-performance models were not consistently associated ...
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    Stroke contributes an estimated $28 billion to US health care costs annually, and alternative payment models aim to improve outcomes and lower spending over fee-for-service by aligning economic incentives with high value care. This systematic review evaluates historical and current evidence regarding the impacts of alternative payment models on stroke outcomes, spending, and utilization. Included studies evaluated alternative payment models in 4 categories: pay-for-performance (n=3), prospective payments (n=14), shared savings (n=5), and capitated payments (n=14). Pay-for-performance models were not consistently associated with improvements in clinical quality indicators of stroke prevention. Studies of prospective payments suggested that poststroke spending was shifted between care settings without consistent reductions in total spending. Shared savings programs, such as US Medicare accountable care organizations and bundled payments, were generally associated with null or decreased spending and service utilization and with no differences in clinical outcomes following stroke hospitalizations. Capitated payment models were associated with inconsistent effects on poststroke spending and utilization and some worsened clinical outcomes. Shared savings models that incentivize coordination of care across care settings show potential for lowering spending with no evidence for worsened clinical outcomes; however, few studies evaluated clinical or patient-reported outcomes, and the evidence, largely US-based, may not generalize to other settings.
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    Journal Title
    Stroke
    DOI
    https://doi.org/10.1161/STROKEAHA.121.033983
    Subject
    Cardiology (incl. cardiovascular diseases)
    Clinical sciences
    Neurosciences
    health care reform
    prospective payment system
    quality of health care
    reimbursement
    stroke
    Publication URI
    http://hdl.handle.net/10072/410094
    Collection
    • Journal articles

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