Integrated Delivery Networks: In Search of Benefits and Market Effects

Integrated Delivery Networks (IDNs) have very different stated purposes than mere collections of hospitals: to coordinate care across the continuum of health services and to manage population health. IDN advocates claim that these complex enterprises yield both societal benefits and performance advantages over less integrated competitors. The purpose of this analysis is to evaluate the evidence to support these claims.For the study, researchers performed a review of the academic literature on IDN performance, as well as an analysis of publicly available quality and financial data from 15 of the biggest not-for-profit IDNs in the U.S., including Sutter Health in Northern California. The authors compared the publicly available performance information on the IDNs' flagship hospital in its principal regional market with that flagship's most significant in-market competitor. The study found that it is possible for integrated delivery networks to offer meaningful benefits, but there is little evidence they have reduced costs or improved the quality of care. Findings include:Hospital-physician integration has raised physician costs, hospital prices and per capita medical care spending;Hospital integration into health plan operations and capitated contracting was not associated either with clinical efficiency or financial efficiencyProviders are likely to see a decrease in operating margins and return on capital as they invest in IDN developmen

Sensitivity calculations for a 2D, inviscid, supersonic forebody problem

The use of a sensitivity equation method to computer derivatives for optimization based design algorithms are discussed. The problem of designing an optimal forebody simulator is used to motivate the algorithm and to illustrate the basic ideas. Finally, how an existing computational fluid dynamics (CFD) code can be modified to compute sensitivities and a numerical example is presented

The Best Decision by Design: Professional Services Selection

Working with a design professional will give you the advantage of his or her expertise and innovative approaches to your project to provide more successful project outcomes: durable and sustainable facilities, lower construction costs, shorter construction schedules, and lower life-cycle costs. Join us to gain a critical perspective on why owners choose to hire design professionals based on a negotiated procurement process instead of bidding

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A Novel and Cost-Effective Monitoring Approach for Outcomes in an Australian Biodiversity Conservation Incentive Program

We report on the design and implementation of ecological monitoring for an Australian biodiversity conservation incentive scheme - the Environmental Stewardship Program. The Program uses competitive auctions to contract individual land managers for up to 15 years to conserve matters of National Environmental Significance (with an initial priority on nationally threatened ecological communities). The ecological monitoring was explicitly aligned with the Program's policy objective and desired outcomes and was applied to the Program's initial Project which targeted the critically endangered White Box-Yellow Box-Blakely's Red Gum Grassy Woodland and Derived Native Grassland ecological community in south eastern Australia. These woodlands have been reduced to <3% of their original extent and persist mostly as small remnants of variable condition on private farmland. We established monitoring sites on 153 farms located over 172,232 sq km. On each farm we established a monitoring site within the woodland patch funded for management and, wherever possible, a matched control site. The monitoring has entailed gathering data on vegetation condition, reptiles and birds. We also gathered data on the costs of experimental design, site establishment, field survey, and data analysis. The costs of monitoring are approximately 8.5% of the Program's investment in the first four years and hence are in broad accord with the general rule of thumb that 5-10% of a program's funding should be invested in monitoring. Once initial monitoring and site benchmarking are completed we propose to implement a novel rotating sampling approach that will maintain scientific integrity while achieving an annual cost-efficiency of up to 23%. We discuss useful lessons relevant to other monitoring programs where there is a need to provide managers with reliable early evidence of program effectiveness and to demonstrate opportunities for cost-efficiencies.Specialist staff within SEWPaC assisted in the design of the monitoring program to ensure its policy relevance. The funders contributed to development of the monitoring program but this did not prejudice the content of the paper in any way. The funders had no role in data collection, analysis and interpretation of results. The funders read and suggested improvements to the manuscript and agreed to publication