Framework for Optimizing Air Ambulance Locations.

Air ambulances can provide more rapid access to medical care than ground ambulances for rural, underserved, and hard to reach populations. However, the existing allocation of ambulance bases across metropolitan and rural areas is driven primarily by individual operator decisions rather than a health outcomes-based approach. This paper describes a framework for optimizing air ambulance services delivery based on healthcare demand and locational constraints to other modes of transportation.

Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events.

Background: Suboptimal adherence to aspirin therapy for secondary prevention of cardiovascular (CV) events is an important public health problem. Prior studies have demonstrated non-adherent patients are at higher risk of experiencing CV events.

Objectives: This study aimed to estimate the clinical and economic outcomes of aspirin non-adherence in patients with a prior primary CV event.

Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach.

To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories.

Exploring Variation in Transformation of Primary Care Practices to Patient-Centered Medical Homes: A Mixed Methods Approach.

The objective was to quantify the activities required for patient-centered medical home (PCMH) transformation in a sample of small to medium-sized National Committee for Quality Assurance (NCQA) recognized practices, and explore barriers and facilitators to transformation. Eleven small to medium-sized PCMH practices in Southeastern Pennsylvania completed a survey, which was adapted from the 2011 NCQA standards. Semistructured follow-up interviews were conducted, descriptive statistics were computed for the quantitative analysis, and a process of thematic coding was deployed for the qualitative analysis.

Hedging Medical Spending Growth: An Adaptive Expectations Approach.

Long-term health insurance provides consumers with protection against persistent, negative health shocks. While the stochastic rise in medical spending growth may make some health risks harder to insure, financial assets could act as a hedge for medical spending growth risk. The purpose of this research was to determine whether such hedges exist.

Economics of genomic testing for women with breast cancer.

Background: Creating the value proposition for innovations in personalized genomic medicine requires generation of evidence-based demonstrations of clinical utility and cost-effectiveness.

Objectives: To assess economic studies of genomic testing for women with breast cancer and to understand the value of genomic testing for multiple stakeholders.

Study Design: Literature review.

Analyzing the health care cost curve: a case study.

This case study uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. The analysis shows that one statistical property of the health care cost curve is that costs rise continuously, not on an annual or monthly basis. Graphical analysis indicates that managed care techniques used to restrain costs can also smooth utilization, producing the continuously growing cost curve observed.

An economic model to value companion diagnostics in non-small-cell lung cancer.

Aim: An economic model was used to evaluate the potential economic impact and cost-effectiveness of companion diagnostic testing for patients with non-small-cell lung cancer (NSCLC).

Materials & Methods: A decision analysis model examined alternative patient management strategies for patients with advanced NSCLC who were not amenable to surgical treatment. A review of the literature provided the variables used to develop a timely base case and sensitivity analysis.

Budget impact model: epigenetic assay can help avoid unnecessary repeated prostate biopsies and reduce healthcare spending.

Background: The diagnosis of prostate cancer involves invasive, sometimes harmful, procedures that can entail negative quality-of-life implications to individuals and high additional costs to the US healthcare system when these procedures result in retesting and iatrogenic harms. It is estimated that $1.86 billion is spent annually on prostate-specific antigen (PSA) testing alone.

How risky is individual health insurance?

This paper describes the relationship between type of insurance coverage in one period and the likelihood of becoming uninsured in the next. We find that for people at the median health status, becoming uninsured is most likely for those with individual insurance, less likely for those with small-group insurance, and least likely for those with large-group insurance. However, for people in poor or fair health, the chances of losing coverage are much greater for people who had small-group insurance than for those who had individual insurance.

Hospital quality: a PRIDIT approach.

Background: Access to high quality medical care is an important determinant of health outcomes, but the quality of care is difficult to determine.

Objective: To apply the PRIDIT methodology to determine an aggregate relative measure of hospital quality using individual process measures.

Design: Retrospective analysis of Medicare hospital data using the PRIDIT methodology.