It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 1: dentists.

Increasing difficulties in recruitment and retention of dentists and dental care professionals in general dental practice in the UK is affecting delivery of NHS dental services. Reports of dissatisfaction among the general dental practice workforce indicate there is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding the factors related to job satisfaction and dissatisfaction of dental professionals would be useful in managing recruitment and retention issues and ensure a dental workforce exists which is able to meet the needs of the population. The aim of this literature review was to identify factors which contribute to job satisfaction and dissatisfaction of clinical staff in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Part 1 of this two-part series discusses the factors relating to dentists. Twenty-two relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Target-driven and restrictive contractual arrangements are a major factor contributing to dissatisfaction of dentists, as well as time pressures, poor quality equipment, and unfair remuneration. Dental contract reform should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, if sufficient numbers of dentists are to be persuaded to continue to provide state-funded dentistry.

Facts about hospital-insurer contracting.

OBJECTIVES: To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting. STUDY DESIGN: Retrospective analysis of 10 price transparency data files from HCA Healthcare. METHODS: Cross-sectional qualitative analysis of 524 hospital-insurer contracts across 10 hospitals. RESULTS: We ascertain 4 empirical regularities in these files. First, hospitals contract with many payers, ranging from 35 to 82 across the hospitals in the sample. Second, contract structure varies significantly within and across hospitals: Of the 524 contracts in our sample, the median contract contained 9 contract elements, whereas the mean contract contained 1285 contract elements. Third, most of the contracts in our sample contained multiple contracting methodologies (eg, both fixed fee and percentage of charges). Fourth, these contracts indicated substantial variation for the same service within and across hospitals, validating findings from analyses based on claims data and hospital price transparency files. CONCLUSIONS: Hospital-insurer contracts dictate the flow and structure of a significant portion of total health care expenditure in the US. Increased attention by both researchers and policy makers would lead to a greater understanding of this vital-yet understudied-element of the market for hospital services.

Medicare Part D Coverage of Drugs Selected for the Drug Price Negotiation Program.

This cross-sectional study describes and historically benchmarks Medicare Part D coverage in 2019 and 2023 for the first 10 drugs selected for negotiation.

All-payer value-based contracting in organizations with Medicare ACOs.

OBJECTIVES: To measure the prevalence of non-Medicare value-based contracting and participation in contracts with downside risk among organizations participating in the Medicare Shared Savings Program (MSSP). STUDY DESIGN: Cross-sectional analysis of 2022 accountable care organization (ACO) survey. METHODS: The author analyzed surveys from 100 organizations participating in the MSSP that reported the number of covered lives they have in value-based contracts in traditional Medicare (ACOs), Medicare Advantage (MA), commercial payers, Medicaid managed care organizations, Medicaid, and direct-to-employer arrangements. We analyzed the distribution of covered lives across shared-savings, shared-risk, and full-risk contracts and analyzed changes between 2018 and 2022. RESULTS: Respondents reported 15.5 million covered lives in value-based contracts. All respondents have Medicare ACO contracts, and roughly 75% reported value-based contracts with commercial and MA plans. Approximately one-third reported such contracts with Medicaid managed care plans. Seventy percent of covered lives in respondents' Medicare ACO contracts included downside risk for losses compared with 51% of lives in commercial plans and 45% in MA plans. Compared with a similar 2018 survey, the proportion of respondents in value-based MA contracts doubled, and the proportion in commercial contracts rose by half. CONCLUSIONS: Organizations that participate in Medicare ACO models have substantially increased their participation in value-based contracts with other payers. They reported a higher proportion of Medicare ACO covered lives in downside risk arrangements than in commercial or MA contracts.

Modelling of pricing, crashing, and coordination strategies of prefabricated construction supply Chain with power structure.

In the prefabricated construction industry, consumers are sensitive to the construction delivery time, and different power structures are very common. This research uses methods of Stackelberg game, Nash game and supply chain coordination, introduces a manufacturer crashing strategy into a prefabricated construction supply chain and investigates the assembler pricing, manufacturer crashing, and supply chain coordination strategies under three different power structures. It finds that adopting a crashing strategy improves the supply chain's profit, while the dynamic wholesale price contract achieves supply chain coordination. Meanwhile, when consumer time and price sensitivity are low, it is easier to achieve high profits in the supply chain under unequal power distribution. Conversely, the supply chain profit is higher in the case of a Nash game. This study innovatively introduces the thought of power structure and crashing strategy into the prefabricated construction supply chain, and provides the optimal price and delivery time under three different power structures for prefabricated construction enterprises and realizes supply chain coordination. The conclusion can provide decision suggestions for the prefabricated construction enterprises under different competitive environments.

Examining the case for direct contracting: A multistakeholder case study.

BACKGROUND: Employers and pharmacies are challenged by a complex system for prescription payment. Cost plus direct contracts for prescriptions and bundled services may yield benefits. OBJECTIVES: This study aimed to (1) explore direct contracting using multistakeholder interviews, (2) compare employer costs and employee copays for 6 months of prescription charges under their pharmacy benefit manager (PBM) with projected costs under a pharmacy direct contract, (3) project pharmacy revenue, costs, and net profit had these prescriptions been processed through the direct contract, and (4) assess employee satisfaction under the direct contract. METHODS: Semistructured stakeholder interviews were recorded transcribed and analyzed to identify different perspectives on direct contracting. Employer PBM invoices for 412 employee prescriptions over 6 months were analyzed to calculate employer and employee costs and reanalyzed for the invoice cost plus $12 professional fee direct contract. For the pharmacy financial analysis projection, invoice costs and a $9.82 cost of dispensing were subtracted from total revenue to yield an estimated profit had the parties been under the arrangement. A 34-item satisfaction survey was mailed using a 4-contact design with cash incentives to the 20 employees serviced by the direct contract that were analyzed descriptively. RESULTS: Eight stakeholder interviews described the benefits and potential challenges of such direct contracts. The financial analysis suggested the employer costs would be $5664 lower and employee copays would have been $1918 lower had all prescriptions been paid using the direct contract. The estimated profit for the pharmacy was projected at $899. Survey respondents were generally satisfied with the direct contract, but few used the bundled services. CONCLUSION: The direct contract may be financially beneficial for all parties. It also may offer more transparent pricing that may be desirable for the employer and pharmacy. Greater uptake of bundled services may increase the value to the employer.

Research on differential game strategy of debt restructuring supported by government.

This paper studies the debt restructuring equilibrium decision problem composed of creditors and debt enterprises with the participation of the government and asset management companies. With the differential game, the dynamic optimization models of debt restructuring under three situations: centralized decision-making, decentralized decision-making, and Stackelberg game after introducing cost-sharing contract are constructed, respectively. The optimal equilibrium strategy of debt restructuring, the optimal trajectory of debt restructuring synergy, and the optimal profit under three decision-making situations are investigated and compared. It is found that the synergy effect and total profit of debt restructuring are the highest under centralized decision-making, and the Stackelberg game is superior to decentralized decision-making, which shows that the cost-sharing contract can achieve the coordination of overall interests, improve the debt restructuring environment, and promote the debt restructuring process. Finally, the sensitivity analysis of relevant parameters is carried out through an example, which verifies the effectiveness of the conclusion and provides the scientific basis for the government and asset management companies to participate in debt restructuring successfully.

Coordinating a three-level contract farming supply chain with option contracts considering risk-averse farmer and retailer.

We considered a three-level contract farming supply chain comprising a risk-averse farmer, a risk-neutral supplier, and a risk-averse retailer. The farmer plants and grows fresh agricultural products with yield uncertainty, the supplier is the leader of the supply chain and the designer of the contracts, and the retailer sells processed products with random demand. Under CVaR criterion, this paper discusses three option contracts between the supplier and the retailer, as well as wholesale price contracts or replenishment cost-sharing contracts between the supplier and the farmer. Results show that when the farmer is risk-neutral, option contracts with or without replenishment cost-sharing contracts can maximize the total profit and increase the profits of all members simultaneously. When the farmer and the retailer are risk-averse, only option contracts with replenishment cost-sharing contracts can ensure supply chain full coordination and Pareto improvement by adjusting the option parameters and making the farmer's sharing ratio equal to his risk aversion coefficient. Moreover, through numerical analysis, we discovered that the interval of the Pareto improvement decreases with the retailer's risk aversion coefficient and the quantity loss rate, and increases with the farmer's risk aversion coefficient. The supplier will not be able to increase his own profits when the loss rate is excessively large. Therefore, the leader should consider the risk aversion degree of all parties and the quantity loss rate of fresh agricultural products before choosing contracts.

Research the effect of anticipated regret and fairness concerns on retailer-led supply chain.

Considering the consumer's anticipated regret caused by price discount, the impact of anticipated regret and manufacturers' fairness concerns on pricing and profits is explored, and a revenue-sharing contract to optimize the profits of supply chain is explored. In centralized decision-making model with manufacturer's fairness neutrality and retailer-led decentralized decision-making model with the manufacturer's fairness concerns, numerical simulation and model comparison is used to analyse regret sensitivity coefficient, consumer heterogeneity, the fairness concern coefficient on pricing decisions and profit coordination. Our results reveal that consumer's anticipated regret has a negative impact on product prices, retailer's profit and manufacturer's profit. Manufacturer's fairness concerns also increase product price and reduce profits of all parties. Retailer-led supply chain can share the revenue to achieve Pareto optimization. When formulating promotional strategies, retailers should consider the characteristics of anticipated regrets of consumers.

Differences between integrated and non-integrated plans in Medicare Advantage.

OBJECTIVE: To understand differences in financial performance, quality performance, supplemental benefits provision, and enrollee composition between integrated and non-integrated plans in the Medicare Advantage (MA) program. DATA SOURCES: We used data from the Center for Medicare and Medicaid Services for 2015-2017. We included 156 integrated MA plans (31 unique contracts) and 2096 non-integrated MA plans (392 unique contracts). STUDY DESIGN: We estimated linear probably models for financial performance, quality performance, supplemental benefits provision, and enrollee composition with state fixed effects and contract random effects. We adjusted for county-level market structure-related factors, cost-related factors, and demand-related factors. Our primary independent variable was an indicator of plan-provider integration. PRINCIPAL FINDINGS: Integrated MA plans were associated with $19.4 (95% CI: 9.2, 29.7) and $16.6 (95% CI: 10.3, 22.9) higher Part C and Part D monthly premiums, but were associated with higher star quality ratings. There were no significant differences in revenues and plan payments per enrollee between integrated and non-integrated MA plans. Integrated MA plans were associated with $40.5 (95% CI: -54.0, -26.9) lower non-claims costs than non-integrated MA plans. There was limited evidence that integrated MA plans provided more generous supplemental benefits than non-integrated MA plans. Enrollment rates in integrated MA plans were particularly low among socially marginalized groups (3.4 [95% CI: -5.9, -1.0], 4.7 [95% CI: -8.5, -0.9], and 4.4 [95% CI: -6.4, -2.4] percentage points lower among non-Hispanic Black, Medicare-Medicaid dual eligible, and the disabled). CONCLUSIONS: Our findings suggest that integrated MA plans may achieve higher efficiency and quality, but these benefits may not be experienced by all beneficiaries due to disparities in enrollment. As these models continue to spread, it is critical to develop policies to ensure that MA enrollees have equal access to integrated plans.