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Innovative medical products offer significant and potentially transformative impacts on health, but they create concerns about rising spending and whether this rise is translating into higher value. The result is increasing pressure to pay for therapies in a way that is tied to their value to stakeholders through improving outcomes, reducing disease complications, and addressing concerns about affordability. Policy responses include the growing application of health technology assessments based on available evidence to determine unit prices, as well as alternatives to volume-based payment that adjust product payments based on predictors or measures of value. Building on existing frameworks for value-based payment for health care providers, we developed an analogous framework for medical products, including drugs, devices, and diagnostic tools. We illustrate each of these types of alternative payment mechanisms and describe the conditions under which each may be useful. We discuss how the use of this framework can help track reforms, improve evidence, and advance policy analysis involving medical product payment.
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http://dx.doi.org/10.1377/hlthaff.2019.00771 | DOI Listing |
J Robot Surg
September 2025
Department of Orthopedic Surgery, Orthopedic and Rheumatology Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, A4144195, USA.
Robotic-assisted total joint arthroplasty (RA-TJA) is projected to account for 70% of all arthroplasties by 2030, yet its economic value and operational efficiency have yet to be thoroughly synthesized. While early literature emphasized technical precision, evolving payment models and implementation costs have shifted focus toward cost-effectiveness and workflow integration. To evaluate the economic and institutional viability of RA-TJA by synthesizing available evidence on capital costs, perioperative expenses, learning curves, throughput, and long-term adoption trends.
View Article and Find Full Text PDFJAMA Netw Open
September 2025
Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor.
Importance: Among men with favorable-risk (ie, low-risk or favorable intermediate-risk) prostate cancer, confirmatory testing substantially improves the detection of aggressive cancers that may merit treatment instead of conservative management. Despite guideline recommendations, confirmatory testing is inconsistently used, and more than half of men do not receive it. Value-based interventions and payment incentives may improve care quality by motivating adherence to guideline-concordant care.
View Article and Find Full Text PDFHealth Serv Res
September 2025
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Objective: To assess the relationship between the changing Accountable Care Organizations-ACO workforce and ACOs' shared savings earnings and quality performance.
Data Sources: Medicare Shared Savings Program-MSSP provider-level research identifiable files, performance year financial and quality report public use files, and National Physician Compare data (2013-2021).
Study Setting And Design: We characterized 865 MSSPs, separately pre- (2013-2019) and post-pandemic (2020-2021) according to the percentage of primary care physicians (PCPs), non-physicians, specialists, and other specialty, financial risk model, assigned Medicare beneficiary demographics, clinical risk factors, and provider supply by specialty within the MSSP's primary service state, (total and per-capita) shared savings earnings/losses owed and quality score.
J Healthc Manag
September 2025
Pennsylvania State University, University Park, Pennsylvania.
Goal: In today's healthcare ecosystem, quality measures are theorized to inform the spectrum of healthcare delivery and evaluation, including specific functional areas such as quality improvement, regulation, accreditation, and value-based payment. Yet, the ways in which expectations about quality-real or perceived-shape and inform transactional relationships between healthcare stakeholders have not been well elucidated. We elicited the perspectives of healthcare decision-makers to understand their experiences with quality and how they may influence transactions and strategic alliances.
View Article and Find Full Text PDFJ Patient Exp
August 2025
Strive Health, Denver, CO, USA.
Patients living with chronic kidney disease (CKD) suffer significantly higher readmission rates after discharge than the national all-hospital 30-day rate. Federal-based programs have introduced payment models incentivizing prevention-oriented activities, like transitional care management (TCM) programs, that help patients safely transition from one care facility to their homes. In this quality improvement case study, we assessed our value-based kidney care organization's TCM clinical program, which empowers patients in their post-hospitalization journey by promoting increased awareness of their condition, adherence to medications, and care navigation, ultimately minimizing the likelihood of complications or readmission.
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