Risk-Based Bonus Payments for the Patient-Centered Medical Home

Background The Patient-Centered Medical Home (PCMH) requires fundamental reform of health care financing. We propose a Risk-Based Comprehensive Payment system with risk-adjusted base and bonus payments. Bundled base payments cover the expected cost of primary care services but do not encourage quality. Bonus payments incentivize desired outcomes by rewarding better-than-expected performance in clinical quality, efficiency, and patient-centeredness. Base and bonus payments require credible risk adjustment to discourage practices from cherry-picking easy patients and dumping difficult ones. Methods We estimated models to predict thirteen cost and utilization measures in 17.4 million commercially insured people using diagnoses, age, and sex from Thomson-Reuters MarketScan® 2007 claims data. Using the same data, we imputed assignment of 456,781 people to 436 medium-sized primary care practitioner (PCP) panels (500 – 5000 patients). For each measure, a PCP’s performance is judged by summing the difference between observed (O) and expected (E) outcomes across panel members. For each outcome we calculated: mean; coefficient of variation, or CV = SD/mean; and both individual and grouped R2 as measures of predictive accuracy Results Using risk models to calculate expected outcomes explained 29-49% of the observed patient-level and 85-98% of practice-level variation in performance, with differential variability. Deviation from the mean in total health spending is more variable at the PCP level than other more targeted measures

Evaluating the impact of Brazil’s central audit program on municipal provision of health services

We evaluate the success of Brazil’s Corregedoria-Geral da União’s (CGU) anti-corruption program in fostering better outcomes in the health sector using panel data from 5560 Brazilian municipalities over the period from 2000 to 2011. Since 2003, the program has randomly selected municipalities to be investigated each year, and immediately disclosed its findings. We examine two mechanisms through which this program could matter: a deterrent effect whereby municipalities react to the threat of being audited, and an auditing effect, whereby municipalities change behavior only when actually audited. A regression discontinuity approach on four outcomes likely to react quickly to corruption changes finds no improvement due to the deterrent or auditing effect, while difference-in-difference models suggest statistically significant but a small short-run effect of actually being audited on the infant mortality rate. Overall, we do not find any meaningful effect of the anticorruption audit program on the health indicators studied

Interesting consequences of brane cosmology

We discuss cosmology in four dimensions within a context of brane-world scenario.Such models can predict chaotic inflation with very low reheat temperature depending on the brane tension. We notice that the gravitino abundance is different in the brane-world cosmology and by tuning the brane tension it is possible to get extremely low abundance. We also study Affleck-Dine baryogenesis in our toy model.Comment: 5 pages, Trivial changes to match the published versio

Mispricing in the medicare advantage risk adjustment model

The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees\u27 expected health care costs. We use Verisk Health\u27s diagnostic cost group (DxCG) Medicare models, refined descendants of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from CMS\u27 implementation. One comes from ignoring all diagnostic information for new enrollees (those with less than 12 months of prior claims). Another comes from continuing to use the simplified models that were originally adopted in response to assertions from some capitated health plans that submitting the claims-like data that facilitate richer models was too burdensome. Even the main CMS model being used in 2014 recognizes only 79 condition categories, excluding many diagnoses and merging conditions with somewhat heterogeneous costs. Omitted conditions are typically lower cost or vague and not easily audited from simplified data submissions. In contrast, DxCG Medicare models use a comprehensive, 394-HCC classification system. Applying both models to Medicare\u27s 2010-2011 fee-for-service 5% sample, we find mispricing and lower predictive accuracy for the CMS implementation. For example, in 2010, 13% of beneficiaries had at least 1 higher cost DxCG-recognized condition but no CMS-recognized condition; their 2011 actual costs averaged US$6628, almost one-third more than the CMS model prediction. As MA plans must now supply encounter data, CMS should consider using more refined and comprehensive (DxCG-like) models

Non-Critical Liouville String Escapes Constraints on Generic Models of Quantum Gravity

It has recently been pointed out that generic models of quantum gravity must contend with severe phenomenological constraints imposed by gravitational Cerenkov radiation, neutrino oscillations and the cosmic microwave background radiation. We show how the non-critical Liouville-string model of quantum gravity we have proposed escapes these constraints. It gives energetic particles subluminal velocities, obviating the danger of gravitational Cerenkov radiation. The effect on neutrino propagation is naturally flavour-independent, obviating any impact on oscillation phenomenology. Deviations from the expected black-body spectrum and the effects of time delays and stochastic fluctuations in the propagation of cosmic microwave background photons are negligible, as are their effects on observable spectral lines from high-redshift astrophysical objects.Comment: 15 pages LaTeX, 2 eps figures include

RadICAL stack: A localisation method for dynamic gamma/neutron fields

A variation of the RadICAL (Radiation Imaging Cylinder Activity Locator) system capable of operating in a dynamic environment, such as that created by active interrogation techniques, has been developed. RadICAL is a novel method for locating a radiological source using a rotating detector element. The detector geometry is that of a thin sheet and is rotated to present a constantly changing surface area to the source; it therefore generates a characteristic temporal response which can be used to determine the source direction. The time required to determine the direction of a source make it unsuitable for dynamic environments and so an alternative method is presented that uses a stack of identical scintillator slabs positioned at fixed horizontal angles around a central axis. By comparing count rates from each slab to a standard response curve, using a specially developed algorithm, the direction of a source can be determined without the need to rotate the detector. EJ-299-33 plastic scintillator was used to allow detection of separate neutron and gamma events in a mixed field through pulse shape discrimination. A four element detector was built and shown to achieve a positional accuracy of approximately 4.4 degrees when exposed to a 1.44MBq 137 Cs source at distances of up to 2m. The same detector was used to discriminate separate neutron and gamma events in a mixed field, which allows for the possibility of locating a neutron source within a gamma rich environment

Cosmic Strings and the String Dilaton

The existence of a dilaton (or moduli) with gravitational-strength coupling to matter imposes stringent constraints on the allowed energy scale of cosmic strings, $\eta$. In particular, superheavy gauge strings with $\eta \sim 10^{16} GeV$ are ruled out unless the dilaton mass m_{\phi} \gsim 100 TeV, while the currently popular value $m_{\phi} \sim 1 TeV$ imposes the bound \eta \lsim 3 \times 10^{11} GeV. Similar constraints are obtained for global topological defects. Some non-standard cosmological scenarios which can avoid these constraints are pointed out.Comment: 16 page

Implications on SUSY breaking mediation mechanisms from observing Bs→μ+μ−B_s \to \mu^+ \mu^- and the muon (g−2)(g-2)

We consider $B_s \to \mu^+ \mu^-$ and the muon $(g-2)_\mu$ in various SUSY breaking mediation mechanisms. If the decay $B_s \to \mu^+ \mu^-$ is observed at Tevatron Run II with a branching ratio larger than $\sim 2 \times 10^{-8}$, the noscale supergravity (including the gaugino mediation), the gauge mediation scenario with small number of messenger fields and low messenger scale, and a class of anomaly mediation scenarios will be excluded, even if they can accommodate a large muon $(g-2)_\mu$. On the other hand, the minimal supergravity scenario and similar mechanisms derived from string models can accommodate this observation.Comment: 4 pages, 3 figure

Supersymmetry and primordial black hole abundance constraints

We study the consequences of supersymmetry for primordial black hole (PBH) abundance constraints. PBHs with mass less than about 10^{11}g will emit supersymmetric particles when they evaporate. In most models of supersymmetry the lightest of these particles, the lightest supersymmetric particle (LSP), is stable and will hence survive to the present day. We calculate the limit on the initial abundance of PBHs from the requirement that the present day LSP density is less than the critical density. We apply this limit, along with those previously obtained from the effects of PBH evaporation on nucleosynthesis and the present day density of PBHs, to PBHs formed from the collpase of inflationary density perturbations, in the context of supersymmetric inflation models. If the reheat temperature after inflation is low, so as to avoid the overproduction of gravitinos and moduli, then the lightest PBHs which are produced in significant numbers will be evaporating around the present day and there are therefore no constraints from the effects of the evaporation products on nucleosynthesis or from the production of LSPs. We then examine models with a high reheat temperature and a subsequent period of thermal inflation. In these models avoiding the overproduction of LSPs limits the abundance of low mass PBHs which were previously unconstrained. Throughout we incorporate the production, at fixed time, of PBHs with a range of masses, which occurs when critical collapse is taken into account.Comment: 8 pages RevTeX file with 3 figures incorporated (uses RevTeX and epsf). Version to appear in Phys. Rev. D: minor change to calculation and added discussio

Physics Beyond the Standard Model and Cosmological Connections: A Summary from LCWS 06

The International Linear Collider (ILC) is likely to provide us important insights into the sector of physics that may supersede our current paradigm viz., the Standard Model. In anticipation of the possibility that the ILC may come up in the middle of the next decade, several groups are vigourously investigating its potential to explore this new sector of physics. The Linear Collider Workshop in Bangalore (LCWS06) had several presentations of such studies which looked at supersymmetry, extra dimensions and other exotic possibilities which the ILC may help us discover or understand. Some papers also looked at the understanding of cosmology that may emerge from studies at the ILC. This paper summarises these presentations.Comment: 8 pages (including cover page) LaTeX, Summary talk presented at the International Linear Collider Workshop in Bangalore, India in March 200