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Market-Based Solutions to Vital Economic Issues


Market-Based Solutions to Vital Economic Issues



For more than a year, researchers across the University of North Carolina at Chapel Hill’s (UNC) Kenan-Flagler Business School (KFBS) and School of Medicine (SOM) worked with Sharecare, Inc. (Sharecare) to establish a framework for measuring the true value of corporate well-being interventions and develop a measurement tool to quantify their impact over time. The goal of the research was to assess the value of implementing corporate well-being interventions to improve employee health and lower direct medical costs to employers.

The choice of location is a key facet of decision-making in operations. One such choice is whether to colocate activities, services, or personnel. Prior research, including in healthcare, has reported that colocation yields benefits. However, these benefits may need to be balanced with higher costs of colocation (e.g., due to operational constraints). Thus, it is critical to understand not only whether colocation makes a difference but also under what circumstances it is most beneficial, and the mechanisms through which those benefits are realized. We consider colocation in the context of healthcare services, and ask: Does colocation of mental and physical health resources improve patient outcomes? This colocation is important, as primary care serves as a gateway to address mental health concerns and referrals to specialists. We next study colocation's relationship with two important operational variables: continuity of care (CoC) with a provider, and patient severity. Finally, we examine the mediating role of patients' no-shows and medication adherence in the colocation-outcomes relationship. As America's largest integrated healthcare system, the Veterans Health Administration offers us an excellent setting to study these questions. We analyze over 300,000 patients – over an eleven-year period – who suffer from diabetes, a chronic condition, and show evidence of mental illness. We use an empirical approach to quantify the relationship between colocation and four key outcomes attributable to mental illness: hospitalizations, length of stay (LOS), 30-day readmissions, and suicidal behavior. We find that colocation is associated with improvement in outcomes. For example, a one standard deviation increase in the mean colocation measure is related to a 2.4% decrease in LOS – equivalent to an annual savings of approximately $1.5 million, on average, just for our cohort. In addition, we find that colocation and CoC are substitutes, in that colocation benefits patients whose care is fragmented. Further, we find that colocation offers greater benefits to patients whose mental health conditions are more severe. Finally, our analysis reveals that colocation improves outcomes (partially) through a reduction in the no-show rate and an increase in medication adherence. Our findings are validated by extensive robustness checks and sensitivity analyses. Our study has implications for both the theory and practice of healthcare operations. Theoretically, we advance the location literature, establish its connection with the continuity literature, and highlight key moderators and mediators in the colocation-outcomes relationship. Practically, our work offers insights into how to design an operationally efficient system and, in settings with limited resources, where to target colocation. Our study is particularly timely as it may help address the growing mental health crisis in America and around the world, further exacerbated during the COVID-19 pandemic.

Economic theory holds that competition drives innovation, improves the quality of goods and services, and lowers prices for consumers. Health care delivery is no exception.

The coronavirus disease 2019 pandemic has brought into focus the limits on flexibility and innovation associated with market consolidation in care delivery. While anecdotes about the ossification in care delivery predominate, broader economic indicators point to the negative outcomes of consolidation.

There are bipartisan Medicare payment proposals that would reduce Medicare payments included in previous Obama and Trump budgets that could go a long way to filling the budget shortfall. While previous policy proposals either proposed new revenue sources or payment reductions, recent policies are pragmatic in nature and attempt to modify either beneficiary or provider behavior.

Background: Influenza imposes heavy societal costs through healthcare expenditures, missed days of work, and numerous hospitalizations each year. Considering these costs, the healthcare and behavioral science literature offers suggestions on increasing demand for flu vaccinations. And yet, the adult flu vaccination rate fluctuated between 37% and 46% between 2010 and 2019.

Aim: Although a demand-side approach represents one viable strategy, an operations management approach would also highlight the need to consider a supply-side approach. In this paper, we investigate how to improve clinic vaccination rates by altering provider behavior.

With the upcoming November election and calls by President Trump for 1 or more vaccines for coronavirus disease 2019 (COVID-19) to be ready before the end of the year, if not by the election, many have started to wonder whether the US Food and Drug Administration (FDA) can withstand this type of political pressure.

Still in its infancy, the Hospital Compare overall hospital quality star rating program introduced by the Centers for Medicare & Medicaid Services (CMS) has generated intense industry debate.

As the country reopens, it’s important to assess how we can be better prepared to stave off such enormous economic losses during the next wave or the next epidemic.

This is the first part of a two-part post discussing the current state of health reform and where we should go from here. Part I examines the effects of the ACA and progressive reform initiatives. Part II will outline a market-driven path forward.

In December 2019, the University of North Carolina at Chapel Hill (UNC) Center for the Business of Health (CBOH) began a research partnership with Sharecare, a leading digital health company founded by technology entrepreneur, Jeff Arnold, to assess the economic value of changing various health behaviors via mobile health (mHealth) interventions.

The coronavirus pandemic of 2020 exemplifies a worst-case scenario for federal, state, and local disaster preparedness planning and illustrates some of the United States’ fundamental public health infrastructure flaws. While stay-at-home orders and economic shutdowns initially depressed disease spread, they harmed businesses and organizations, threatened individuals’ livelihoods, and negatively impacted community well-being. National standards for COVID-19 management tools and protocols were not available when needed, and state, local, and federal guidance differed, and often conflicted, in ways that confused the public and created economic uncertainty.