Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review.
Stroke
; 53(1): 268-278, 2022 01.
Article
em En
| MEDLINE
| ID: mdl-34727742
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.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Reembolso de Incentivo
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Custos de Cuidados de Saúde
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Gastos em Saúde
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Planos de Pagamento por Serviço Prestado
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Acidente Vascular Cerebral
Tipo de estudo:
Prognostic_studies
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Risk_factors_studies
/
Systematic_reviews
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Stroke
Ano de publicação:
2022
Tipo de documento:
Article