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Market-Based Solutions to Vital Economic Issues


Market-Based Solutions to Vital Economic Issues



We present a mathematical modeling approach that determines the optimal allocation of care manager's time and quantifies the costs and benefits of Collaborative Care. In particular, we model Collaborative Care management at the clinic level as an infinite horizon Markov Dynamic Program. The objective is a weighted sum of total patient QALYs and the clinic profits. The model incorporates insurance payment, resource utilization costs, and disease progression of comorbid diabetes and depression. We derive structural properties of the optimal allocation of the care manager's time. Using these structural properties, we develop a practical and easy-to-implement solution approach that performs close to the optimal solution. We calibrate the model with data obtained from a large academic medical center and show that our solutions could potentially improve total QALYs and clinic profits when compared to current practices. We also perform sensitivity analysis to different payment models to derive insights relevant to healthcare policy.

While access and quality of healthcare in the U.S. are shaped by several factors—location, work, insurance—a simple change can make a big difference for patients. According to a new study led by the institute-affiliated Center for the Business of Health Faculty Director Brad Staats, delivering mental and physical care at the same location can improve patient experience and care efficiency. This week’s Kenan Insight offers a chance for our experts to explore the findings of this new study.

As featured in our 2021 Trends in Entrepreneurship Report, hear experts discuss leveraging analytics to drive improved healthcare access, treatments and delivery.

AI. CRISPR. mRNA. Key components of the rapidly expanding alphabet soup of technologies driving a boom in healthcare innovation. In this Kenan Insight, we explore why the 2021 Trends in Entrepreneurship Report names emerging technology in the healthcare industry as a key trend, along with some of the challenges that come with fast-moving technological advancements.

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.

The factors that determine our health go far beyond what happens in the doctor’s office. In this Kenan Insight, we explore how the physical well-being of many Americans has been placed in jeopardy by upstream social and economic factors such as racism, food and job insecurity, and a lack of community and social support systems.

Join the Center for the Business of Health virtually as they discuss the complexity of the healthcare ecosystem and how innovation and interconnectivity are necessary to build a more robust and flexible system.

The global COVID-19 pandemic has been a recurring theme throughout the 2020 U.S. elections, and its health and economic consequences will be felt far beyond November 3. In this Kenan Insight, we look at both the challenges and potential opportunities the pandemic has created for accelerating innovations in healthcare delivery and pharmaceutical development.

The global COVID-19 pandemic has been a recurring theme throughout the 2020 U.S. elections, and its health and economic consequences will be felt far beyond November 3. In this Kenan Insight, we look at both the challenges and potential opportunities the pandemic has created for accelerating innovations in healthcare delivery and pharmaceutical development.

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.

North Carolina Governor Roy Cooper has named Dr. James H. Johnson Jr., William R. Kenan Distinguished Professor of Strategy and Entrepreneurship and director of the Kenan Institute-affiliated Urban Investment Strategies Center, to the newly created Andrea Harris Social, Economic, Environmental, and Health Equity Task Force.

The staffing of parallel servers in a queue has interested operations researchers for decades, resulting in countless mathematical models studying queuing behavior. But to achieve tractability, these models typically assume the service rate and productivity of individual servers is independent of other servers and the status of the system. We question this assumption and consider whether inter-server dependence impacts queue performance, specifically through server task selection.