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Drug distribution within the body is a complex process influenced by several factors, including perfusion rate, the rate at which the bloodstream transports drugs to tissue. This limitation becomes particularly significant when dealing with highly lipophilic drugs. In such cases, the rate at which the drug can move across membranes is crucial, and if the membrane is highly permeable to the drug, distribution becomes rate-limited by perfusion.
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Distribution reliability in electrical power systems is critical for ensuring an uninterrupted power supply to consumers at minimal cost. According to IEEE Standard Terms, reliability is the probability that a device will function without failure over a specified time period or amount of usage. For electric power distribution, this translates to maintaining continuous power supply and addressing customer concerns over power outages. Several indices, as defined by IEEE Standard 1366-2012, are...
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Related Experiment Video

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An R-Based Landscape Validation of a Competing Risk Model
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Delivery system performance as financial risk varies.

Joseph P Newhouse1, Mary Price, John Hsu

  • 1Harvard University, 180 Longwood Ave, Boston, MA 02115.

The American Journal of Managed Care
|December 21, 2019
PubMed
Summary

Banner Health

Area of Science:

  • Healthcare economics
  • Health services research
  • Value-based care models

Background:

  • Banner Health implemented various Medicare and commercial insurance contracts with differing financial risk.
  • Transitioned from Medicare Advantage (MA) to a Medicare Pioneer Accountable Care Organization (ACO) in 2012.
  • Introduced a commercial ACO contract concurrently with the Medicare Pioneer ACO.

Purpose of the Study:

  • To investigate and compare healthcare utilization and spending across different payment models.
  • To assess the impact of Medicare Advantage, Medicare Pioneer ACO, and commercial ACO contracts on healthcare delivery.
  • To evaluate the financial performance of value-based care initiatives compared to traditional fee-for-service models.

Main Methods:

  • Utilized claims and encounter data for utilization and spending analysis.

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  • Employed risk adjustment using CMS and HHS Hierarchical Condition Categories (HCCs).
  • Compared risk-adjusted outcomes between ACOs (Medicare and commercial) and traditional Medicare (TM) and commercial fee-for-service (FFS) comparison groups.

    • Main Results:

    • Medicare Advantage enrollees showed lower risk-adjusted utilization and spending than Pioneer ACO participants and traditional Medicare.
    • The Pioneer ACO program demonstrated reduced hospitalization rates but ambiguous effects on total medical spending.
    • Commercial ACO and fee-for-service groups exhibited minimal risk-adjusted differences in utilization and spending.

    Conclusions:

    • Findings align with Centers for Medicare & Medicaid Services (CMS) initiatives to move away from pure fee-for-service reimbursement.
    • Value-based care models, including ACOs, show potential for impacting healthcare utilization, particularly hospitalizations.
    • Further analysis is needed to clarify the total medical spending impact of ACO participation.