Beyond Capitation: How New Payment Experiments Seek to Find the \u27Sweet Spot\u27 in Amount of Risk Providers and Payers Bear

A key issue in the decades-long struggle over US health care spending is how to distribute liability for expenses across all market participants, from insurers to providers. The rise and abandonment in the 1990s of capitation payments—lump-sum, per person payments to health care providers to provide all care for a specified individual or group—offers a stark example of how difficult it is for providers to assume meaningful financial responsibility for patient care. This article chronicles the expansion and decline of the capitation model in the 1990s. We offer lessons learned and assess the extent to which these lessons have been applied in the development of contemporary forms of provider cost sharing, particularly accountable care organizations, which in effect constitute a search for the “sweet spot,” or appropriate place on a spectrum, between providers and payers with respect to the degree of risk they absorb

Image Indexing and Retrieval from Digital Libraries

As digital image libraries grow, methods for indexing and searching such libraries based on image content become more important. In this paper we focus on three specific approaches to the representation of images for content-based image indexing and retrieval [13,20,29] although others will be discussed briefly. The work of [13] represents one of many methods which blends color histograms with some spatial information. The work of [20] is a multiresolution approach which indexes images in a compressed domain. There are several methods discussed in [29]---one for objects, one for shapes, and one for textures. Their common feature is that they explicitly capture the dominant geometric features of images. 1 Introduction Today, digital images are being generated at rates and stored in volumes far too large for manual indexing or retrieval. For example: ffl the FBI receives 40,000 fingerprint images per day [12]; ffl by the year 2000, the NASA Earth Observing System will generate terabytes..

Protection or Harm? Suppressing Substance-Use Data

What if it were impossible to closely study a disease affecting 1 in 11 Americans over 11 years of age — a disease that’s associated with more than 60,000 deaths in the United States each year, that tears families apart, and that costs society hundreds of billions of dollars? What if the affected population included vulnerable and underserved patients and those more likely than most Americans to have costly and deadly communicable diseases, including HIV–AIDS? What if we could not thoroughly evaluate policies designed to reduce costs or improve care for such patients