This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform desi...

BACKGROUND Pneumonia in South African children remains a major public health concern. The costs of hospital admission for pneumonia should be determined, especially where human immunodeficiency virus (HIV) infection is common. OBJECTIVE To determine the hospital costs of children (HIV-infected vs. non-HIV-infected) admitted for the management of pneumonia and compare them in the public and fe...

BACKGROUND Pediatric rehabilitation considers Family-centered service (FCS) as a way to increase participation of children with a physical disability in daily life. An important principal is that parents greatly contribute to their child's participation at school, at home, and in the community. However, it is unclear what kind of information is available from literature about what parents actua...

Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. From 2010 through 2014, a Medicare Advantage plan prospectively deployed the CPPM, averaging 30,561 members with costs tha...

IMPORTANCE The Pioneer Accountable Care Organization (ACO) Model aims to drive health care organizations to reduce expenditures while improving quality for fee-for-service (FFS) Medicare beneficiaries. OBJECTIVE To determine whether FFS beneficiaries aligned with Pioneer ACOs had smaller increases in spending and utilization than other FFS beneficiaries while retaining similar levels of care ...

For providers of composite services, service level agreements (SLAs) provide a means to guarantee a certain service quality to prospective customers. Usually, violating SLAs is associated with costs. However, the means necessary to ensure SLA conformance also generate costs. Oftentimes, it is therefore optimal from a business perspective to violate certain SLAs sometimes, instead of trying for ...