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Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review.

Publication ,  Journal Article
Brown, K; El Husseini, N; Grimley, R; Ranta, A; Kass-Hout, T; Kaplan, S; Kaufman, BG
Published in: Stroke
January 2022

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.

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

January 2022

Volume

53

Issue

1

Start / End Page

268 / 278

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Reimbursement, Incentive
  • Reimbursement Mechanisms
  • Neurology & Neurosurgery
  • Medicare
  • Humans
  • Hospitalization
  • Health Expenditures
  • Health Care Costs
 

Citation

APA
Chicago
ICMJE
MLA
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Brown, K., El Husseini, N., Grimley, R., Ranta, A., Kass-Hout, T., Kaplan, S., & Kaufman, B. G. (2022). Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review. Stroke, 53(1), 268–278. https://doi.org/10.1161/STROKEAHA.121.033983
Brown, Kelby, Nada El Husseini, Rohan Grimley, Annemarei Ranta, Tareq Kass-Hout, Samantha Kaplan, and Brystana G. Kaufman. “Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review.Stroke 53, no. 1 (January 2022): 268–78. https://doi.org/10.1161/STROKEAHA.121.033983.
Brown K, El Husseini N, Grimley R, Ranta A, Kass-Hout T, Kaplan S, et al. Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review. Stroke. 2022 Jan;53(1):268–78.
Brown, Kelby, et al. “Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review.Stroke, vol. 53, no. 1, Jan. 2022, pp. 268–78. Pubmed, doi:10.1161/STROKEAHA.121.033983.
Brown K, El Husseini N, Grimley R, Ranta A, Kass-Hout T, Kaplan S, Kaufman BG. Alternative Payment Models and Associations With Stroke Outcomes, Spending, and Service Utilization: A Systematic Review. Stroke. 2022 Jan;53(1):268–278.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

January 2022

Volume

53

Issue

1

Start / End Page

268 / 278

Location

United States

Related Subject Headings

  • United States
  • Stroke
  • Reimbursement, Incentive
  • Reimbursement Mechanisms
  • Neurology & Neurosurgery
  • Medicare
  • Humans
  • Hospitalization
  • Health Expenditures
  • Health Care Costs