CMOs, Duration Risk and a New Mortgage

This article presents an alternative mortgage that retains the fixed-rate feature of a fixed-rate mortgage (FRM), but accelerates the principal amortization when interest rates rise, exposing the buyer to less duration risk in a rising interest rate environment. This mortgage, labeled the adjustable amortization mortgage (AAM), is shown to have lessened interest rate risk for the buyer as well as lower default risk, suggesting that it should be priced higher (at a lower rate of interest) than the typical FRM. It is also shown that mortgage-backed securities collateralized by an AAM have much less price volatility than mortgage-backed securities backed by FRMs.

The Zero-Coupon/Interest-Only Fixed-Rate Mortgage: An Alternative for Funding Low-to-Moderate Income Housing

This proposal sets forth a concept for the public/private finance of owner-occupied, single-family homes for first-time homebuyers utilizing federal guarantees and private sector mortgages. Proposed funding requires no new tax revenues. The security that the program revolves around is a Zero-coupon/Interest-only Fixed-rate mortgage (ZIF). The ZIF has the potential to improve the allocation of resources for subsidizing low-income housing, to reduce risk exposure to rapidly declining property values, and to improve the self-esteem of a group of Americans who have been depressed for far too long by making homeownership a reality.

Case management for patients with chronic systolic heart failure in primary care : the HICMan exploratory randomised controlled trial

Background Chronic (systolic) heart failure (CHF) represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role) and supported by general practitioners (GPs). Methods This patient-randomised controlled trial (phase II) included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99) consisting of telephone monitoring and home visits or usual care (n = 100) for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ), CHF self-care (EHFScBS) and on quality of care (PACIC-5A). To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Results Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists) in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD) were 25.4 (8.4) and 25.0 (7.1). KCCQ overall summary scores (SD) were 65.4 (22.6) and 64.7 (22.7). We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6]) and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8]) improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]). Conclusions In this sample, with little room for improvement regarding evidence-based pharmacotherapy and CHF self-care, case management showed no improved health outcomes or health care utilisation. However, case management significantly improved performance and key intermediate outcomes. Our study provides evidence for the feasibility of the case management model