Understanding Health Utilities in Women with Urinary Incontinence

Objectives: The purpose of this study was to compare the health utility of UI in women as derived from the EQ-5D with the gold standard, the Standard Gamble. The secondary aim of this study was to compare health utility values of affected patients to healthy controls. Materials and Methods: Clinical diagnosis was categorized as normal, stress, mixed or urge urinary incontinence. Healthy controls were read a scenario for stress or mixed UI. All subjects completed the Sandvik Severity Index (SSI), EQ-5D, and Standard Gamble (SG) conversation. Results: 50 healthy controls and 119 affected subjects were recruited. The mean utility value for incontinence varied based on method: EQ-5D (0.78 + 0.17) and SG (0.85 + 0.20). There was a significant difference between utility scores derived from SG and EQ-5D (p=0.0004). This significant difference was maintained in the subset of women with SUI: EQ-5D (0.81 + 0.16), SG (0.87 + 0.18), p=0.028; but not in women with MUI or UUI. When comparing healthy controls to women with SUI, there were significant differences in the utility values derived by SG (0.76 + 0.26 vs. 0.87 + 0.18, p=0.07) but not by EQ-5D. When comparing healthy controls to women with MUI, there was also a significant difference in the utility derived by SG (0.92 + 0.10 vs. 0.75 + 0.21, p=0.01) but not by EQ-5D. SSI scores moderately correlated with SG utility values and strongly correlated with EQ-5D utility values. Logistic regression analysis showed that utility values were unaffected by age and menopausal status. Conclusion: This study suggests that using the EQ-5D to quantify the utility of UI may over-estimate the degree of bother when compared to SG assessment. This is important because the SG process more closely approximates the decision to undergo surgery. Relying on the EQ-5D to assess health utilities in women with UI may not be valid

ACOs Holding Commercial Contracts Are Larger And More Efficient Than Noncommercial ACOs

Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variation in their performance. Using data from national surveys of 399 ACOs, we examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). Commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores, compared to noncommercial ACOs. Among all of the ACOs, there was low uptake of quality and efficiency activities. However, commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods than did noncommercial ACOs. Few ACOs reported having high-level performance monitoring capabilities. About two-thirds of the ACOs had established processes for distributing any savings accrued, and these ACOs allocated approximately the same amount of savings to the ACOs themselves, participating member organizations, and physicians. Our findings demonstrate that ACO delivery systems remain at a nascent stage. Structural differences between commercial and noncommercial ACOs are important factors to consider as public policy efforts continue to evolve

ACOs Holding Commercial Contracts Are Larger And More Efficient Than Noncommercial ACOs

Accountable care organizations (ACOs) have diverse contracting arrangements and have displayed wide variations in their performance. Using data from national surveys of 399 ACOs, we examined differences between the 228 commercial ACOs (those with commercial payer contracts) and the 171 noncommercial ACOs (those with only public contracts, such as with Medicare or Medicaid). Commercial ACOs were significantly larger and more integrated with hospitals, and had lower benchmark expenditures and higher quality scores, compared to noncommercial ACOs. Among all of the ACOs, there was low uptake of quality and efficiency activities. However, commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods than did noncommercial ACOs. Few ACOs reported having high-level performance monitoring capabilities. About two-thirds of the ACOs had established processes for distributing any savings accrued, and these ACOs allocated approximately the same amount of savings to the ACOs themselves, participating member organizations, and physicians. Our findings demonstrate that ACO delivery systems remain at a nascent stage. Structural differences between commercial and noncommercial ACOs are important factors to consider as public policy efforts continue to evolve