Policy Flight Simulators: Accelerating Decisions to Adopt Evidence-Based Health Interventions.

Area of Science:

• Health economics
• Healthcare management
• Health services research

Background:

• The Transitional Care Model (TCM) aims to reduce hospital readmissions for high-risk older adults.
• Hospital adoption of evidence-based interventions like TCM is influenced by economic factors.

Purpose of the Study:

• To simulate the economic impact of the TCM on U.S. hospitals.
• To identify factors influencing hospital adoption of the TCM.

Main Methods:

• Developed a simulation model using Monte Carlo methods.
• Parameterized simulations with Centers for Medicare & Medicaid Services (CMS) data and TCM trial data.
• Conducted four experiments varying readmission penalties, diagnosis groups, cost-sharing, and payment models.

Main Results:

• Under current conditions, few hospitals financially benefit from TCM.
• Doubling readmission penalties or targeting specific diagnoses increases benefiting hospitals to 300.
• Full payer reimbursement for TCM costs benefits 2,000 hospitals; capitated models benefit 1,500.

Conclusions:

• Current CMS penalties have minimal economic impact on TCM adoption.
• Facilitating TCM adoption requires payer reimbursement and focusing on hospitals with high occupancy and revenue patients.