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We aim to assess the healthcare value achieved from a shared savings program for pediatric appendectomy. All appendectomy patients covered by our health plan were included. Quality targets were 15% reduction in time to surgery, length of stay, readmission rate, and patient satisfaction. Quality targets and costs for an appendectomy episode in two 6-month performance periods (PP1, PP2) were compared to baseline. 640 patients were included (baseline:317, PP1:167, PP2:156). No quality targets were met in PP1. Two quality targets were met during PP2: readmission rate (−57%) and patient satisfaction. No savings were realized because the cost reduction threshold (−9%) was not met during PP1 (+1.7%) or PP2 (−0.4%). Payer-provider partnerships can be a platform for testing value-based reimbursement models. Setting achievable targets, identifying affectable quality metrics, considering case mix index, and allowing sufficient time for interventions to generate cost savings should be considered in future programs. •Assessed the medical value of a Shared Savings Program for pediatric appendicitis.•Quality targets included time to surgery, length of stay, readmission, and patient satisfaction.•Two quality targets were met during the study period, readmission and satisfaction.•However, no savings were realized because the cost threshold was not met.•Payer-provider partnerships can be a platform for testing value-based reimbursement.

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

Background This study explores the facilitating and inhibiting factors in the design/development, implementation, and applicability/evaluation of value-based payment models of integrated care. The Delphi technique was used to reach consensus among a panel of (inter)national experts on these factors. Methods An expert panel of 15 members participated in a three-round Delphi study. Factors from experts and literature were used to compile a list of 40 facilitators and 40 inhibitors. Afterwards, experts were asked to rate the importance of these factors using a 5-point Likert scale. Results Eight facilitating (e.g., transparency, communication, and trust among involved stakeholders) and seven inhibiting factors (e.g., lack of motivation and engagement among involved stakeholders) achieved full consensus. Timely availability of data and an integrated information technology system for data registration (a facilitator) were the only factors achieving full consensus through a very high agreement. Conclusions Adequate outcome measures, targets, benchmarks, and incentives are important in value-based payment models. The less quantifiable items, such as strong leadership, transparency, communication and trust, and motivation and engagement of the involved stakeholders, are also important for successful adoption of these models and promote high-quality care at lower or equal costs. Highlights – Delphi study identifies key facilitating and inhibiting factors for effective value-based payment models. – Success of these models relies on measurable factors such as outcome measures, and intangibles like trust and leadership. – \"Hard-to-measure\" contextual factors play an important role in value-based payment model success across healthcare organizations. – Prioritize teamwork and clear goals before tailoring these models for optimal value, benefiting patients globally.

Companies operating in the energy market in Poland conduct business activity on the basis of special regulations applicable to this type of entity. However, they are, like any other entrepreneur, exposed to the risk of delays in payments, non-payment, restructuring, or even bankruptcy of their contractor. Appropriate instruments should be used to mitigate these risks. There are many methods available today to deal with trading risks. However, they should be tailored to the individual needs of each entrepreneur based on an in-depth analysis of its contractors. This article analyzes the five largest companies selling electricity in Poland in terms of the risk of late payments in the period 2018–2023. It turned out that in the surveyed companies in the period 2018–2013, the amount of receivables was constantly increasing, and the average recovery term was longer than the average payment term in enterprises in general. The real impact of delayed payments on the profitability of the surveyed companies was also calculated. Then, the available methods of transaction risk mitigation (tangible collateral, personal collateral, form of paying, other legal, banking and insurance instruments) were analyzed and described, and whether and to what extent they are used in the surveyed companies. The conducted research also allowed the author to conclude that, unfortunately, despite the existence of many instruments, they are not used due to the costs and formalities associated with their acquisition.

Policy Points Because bundled payments are relatively new and require a different type of collaboration among payers, providers, and other actors, their design and implementation process is complex. By sorting the 53 key elements that contribute to this complexity into specific pre‐ and postcontractual phases as well as the actors involved in the health system, this framework provides a comprehensive overview of this complexity from a payer's perspective. Strategically, the design and implementation of bundled payments should not be approached by payers as merely the introduction of a new contracting model, but as part of a broader transformation into a more sustainable, value‐based health care system. Context Traditional fee‐for‐service (FFS) payment models in health care stimulate volume‐driven care rather than value‐driven care. To address this issue, increasing numbers of payers are adopting contracts based on bundled payments. Because their design and implementation are complex, understanding the elements that contribute to this complexity from a payer's perspective might facilitate their adoption. Consequently, the objective of our study was to identify and structure the key elements in the design and implementation of bundled payment contracts. Methods Two of us independently and systematically examined the literature to identify all the elements considered relevant to our objective. We then developed a framework in which these elements were arranged according to the specific phases of a care procurement process and actors’ interactions at various levels of the health system. Findings The final study sample consisted of 147 articles in which we identified the 53 elements included in the framework. These elements were found in all phases of the pre‐ and postcontractual procurement process and involved actors at different levels of the health care system. Examples of elements that were cited frequently and are typical of bundled payment procurement, as opposed to FFS procurement, are (1) specification of care services, patients’ characteristics, and corresponding costs, (2) small and heterogeneous patient populations, (3) allocation of payment and savings/losses among providers, (4) identification of patients in the bundle, (5) alignment of the existing care delivery model with the new payment model, and (6) limited effects on quality and costs in the first pilots and demonstrations. Conclusions Compared with traditional FFS payment models, bundled payment contracts tend to introduce an alternative set of (financial) incentives, touch on almost all aspects of governance within organizations, and demand a different type of collaboration among organizations. Accordingly, payers should not strategically approach their design and implementation as merely the adoption of a new contracting model, but rather as part of a broader transformation toward a more sustainable value‐based health care system, based less on short‐term transactional negotiations and more on long‐term collaborative relationships between payers and providers.

We study the design of provider incentives in the post-acute care setting—a highstakes but under-studied segment of the healthcare system. We focus on long-term care hospitals (LTCHs) and the large (approximately $13,500) jump in Medicare payments they receive when a patient's stay reaches a threshold number of days. Discharges increase substantially after the threshold, with the marginal discharged patient in relatively better health. Despite the large financial incentives and behavioral response in a high mortality population, we are unable to detect any compelling evidence of an impact on patient mortality. To assess provider behavior under counterfactual payment schedules, we estimate a simple dynamic discrete choice model of LTCH discharge decisions. When we conservatively limit ourselves to alternative contracts that hold the LTCH harmless, we find that an alternative contract can generate Medicare savings of about $2,100 per admission, or about 5% of total payments. More aggressive payment reforms can generate substantially greater savings, but the accompanying reduction in LTCH profits has potential out-of-sample consequences. Our results highlight how improved financial incentives may be able to reduce healthcare spending, without negative consequences for industry profits or patient health.

Medicare's voluntary bundled payment programs have demonstrated generally favorable results. However, it remains unknown whether uneven hospital participation in these programs in communities with greater shares of minorities and patients of low socioeconomic status results in disparate access to practice redesign innovations. Examine whether communities with higher proportions of marginalized individuals were less likely to be served by a hospital participating in Bundled Payments for Care Improvement Advanced (BPCI-Advanced). Cross-sectional study using ordinary least squares regression controlling for patient and community factors. Medicare fee-for-service patients enrolled from 2015-2017 (pre-BPCI-Advanced) and residing in 2,058 local communities nationwide defined by Hospital Service Areas (HSAs). Each community's share of marginalized patients was calculated separately for each of the share of beneficiaries of Black race, Hispanic ethnicity, or dual eligibility for Medicare and Medicaid. Dichotomous variable indicating whether a given community had at least one hospital that ever participated in BPCI-Advanced from 2018-2022. Communities with higher shares of dual-eligible individuals were less likely to be served by a hospital participating in BPCI-Advanced than communities with the lowest quartile of dual-eligible individuals (Q4: -15.1 percentage points [pp] lower than Q1, 95% CI: -21.0 to -9.1, p < 0.001). There was no consistent significant relationship between community proportion of Black beneficiaries and likelihood of having a hospital participating in BPCI-Advanced. Communities with higher shares of Hispanic beneficiaries were more likely to have a hospital participating in BPCI-Advanced than those in the lowest quartile (Q4: 19.2 pp higher than Q1, 95% CI: 13.4 to 24.9, p < 0.001). Communities with greater shares of dual-eligible beneficiaries, but not racial or ethnic minorities, were less likely to be served by a hospital participating in BPCI-Advanced Policymakers should consider approaches to incentivize more socioeconomically uniform participation in voluntary bundled payments.

Electronic payments are the cornerstone of web-based commerce. A steady decrease in cash usage has been observed, while various digital payment technologies are taking over. They process sensitive personal information raising concerns about its potentially illicit usage. Several payment models that confront this challenge have been proposed. They offer varying levels of anonymity and readiness for adoption. The aim of this study was to broaden the portfolio with a solution that assures the highest level of anonymity and is well applicable. An empirical design research study with prototyping and conceptual research with a proposed construct were employed for this purpose. As a result, the Activity-Based Payment (ABP) model was proposed. It introduces a different mode of completing a payment transaction based on performing specific activities on a web location indicated by the payee. The anonymity properties of the solution, as well as its performance and applicability have been evaluated showing its particular suitability to micropayment and small payment scenarios.

This paper aims to ascertain the determinants by which individuals decide to use credit cards as a payment method rather than cash; that is, to understand changes in socioeconomic factors on the long-term use of alternatives to cash. Using the data from the waves (2002-2017) of the Spanish Survey of Household Finances (SSHF) and a panel data estimation (static and dynamic), we identify education, age, income and wealth as the main drivers of credit cards as a payment method. We disentangle the effect of age and the cohort effect. We check for nonlinearity problems and card use persistence. A secondary aim is to establish, using a controlled experiment, some of the financial consequences of being a cashless economy.

An argument sometimes used to support renewable energy is that it may contribute to job creation. On the other hand, these technologies often face local opposition. In the case of Denmark, the country with the longest wind power experience, we examine whether the installation of new turbines had local economic benefits. Using the Danish master data register of wind turbines and detailed data on the municipal budget, personal income and sectoral employment from Statistics Denmark, we build a panel covering 250 municipalities. We use a quasi-experimental set-up and exploit time and regional variations at the municipal level. We find that the deployment of wind power contributed to the increase in personal income for entrepreneurs and reduced dependence on social benefits. As municipalities received payments from wind investors ahead of the construction, the new wind revenues were also followed by increases in local public spending. We find only very minor effects on employment in some sectors, and the aggregate local employment does not change significantly. Heterogeneity analyses indicate that the increases in local entrepreneurial income are largely driven by small installations, whilst increases in municipal budget and reductions in the dependence on social benefits are induced by larger installations.