Tiered Provider Networks in Health insurance

Health insurers are increasingly using plan designs that incentivize consumers to shop for health care based on price. This dissertation studies the effects of one such plan design on demand and equilibrium prices. Tiered hospital networks group hospitals by price ranking and vary consumers\u27 out-of-pocket prices to reflect the price variation faced by the insurer. Proponents argue that tiered networks reduce health care spending by steering consumers toward lower-priced hospitals, and by giving insurers an additional bargaining lever in price negotiations with hospitals. To evaluate these claims, I estimate a structural model of health care demand and insurer-hospital bargaining over prices in the Massachusetts private health insurance market. The model extends the standard Nash bargaining framework to explicitly account for the multiplicity of possible tier outcomes. I find that the effects of tiered networks on demand alone can lead to moderate or sizable reductions in hospital spending, ranging from 1% to 8% depending on the consumer population and the concentration of the hospital market. The effects on negotiated hospital prices add an additional 2% to 4% savings, for a total savings from tiered networks of up to 12% under favorable market conditions. I conclude that insurance plan designs with demand-side incentives can have large health care spending reduction effects

Tell Me What You Do and I’ll Tell You What You Are: Learning Occupation-Related Activities for Biographies

Biography creation requires the identification of important events in the life of the individual in question. While there are events such as birth and death that apply to everyone, most of the other activities tend to be occupation-specific. Hence, occupation gives important clues as to which activities should be included in the biography. We present techniques for automatically identifying which important events apply to the general population, which ones are occupation-specific, and which ones are person-specific. We use the extracted information as features for a multi-class SVM classifier, which is then used to automatically identify the occupation of a previously unseen individual. We present experiments involving 189 individuals from ten occupations, and we show that our approach accurately identifies general and occupation-specific activities and assigns unseen individuals to the correct occupations. Finally, we present evidence that our technique can lead to efficient and effective biography generation relying only on statistical techniques

SoDa: a Web service on solar radiation

ISBN 3-9809656-4-3International audienceA Web service has been developed for answering the needs of industry and research for information on solar radiation parameters with a satisfactory quality. It intends to solve the three major problems identified by customers: i) improving access to information, ii) improving knowledge on space and time structure and iii) improving matching of delivered information to actual needs of customers. This service (http://www.soda-is.com) is also innovative with respect to the Internet technologies: it is performing a smart networking of information sources of different natures: databases (radiation, meteorology, elevation, geography...) and algorithms (computation of radiation on slopes, sizing of systems...). These sources were available separately and are geographically dispersed. The service SoDa makes them cooperating and combines them in order to answer to requests, ranging from a series of irradiation values to the sizing of a system

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Abstracts from the 20th International Symposium on Signal Transduction at the Blood-Brain Barriers

https://deepblue.lib.umich.edu/bitstream/2027.42/138963/1/12987_2017_Article_71.pd

Tiered provider networks in health insurance

Health insurers are increasingly using plan designs that incentivize consumers to shop for health care based on price. This dissertation studies the effects of one such plan design on demand and equilibrium prices. Tiered hospital networks group hospitals by price ranking and vary consumers\u27 out-of-pocket prices to reflect the price variation faced by the insurer. Proponents argue that tiered networks reduce health care spending by steering consumers toward lower-priced hospitals, and by giving insurers an additional bargaining lever in price negotiations with hospitals. To evaluate these claims, I estimate a structural model of health care demand and insurer-hospital bargaining over prices in the Massachusetts private health insurance market. The model extends the standard Nash bargaining framework to explicitly account for the multiplicity of possible tier outcomes. I find that the effects of tiered networks on demand alone can lead to moderate or sizable reductions in hospital spending, ranging from 1% to 8% depending on the consumer population and the concentration of the hospital market. The effects on negotiated hospital prices add an additional 2% to 4% savings, for a total savings from tiered networks of up to 12% under favorable market conditions. I conclude that insurance plan designs with demand-side incentives can have large health care spending reduction effects