title: Impact Of Health Care Delivery System Innovations On Total Cost Of Care.
abstract: Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation's Health Care Innovations Awards. The innovations' impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information technology or community health workers achieved the greatest cost savings. Savings were also relatively large in programs that targeted clinically fragile patients-clinically complex populations at risk for disease progression. While the magnitude of these effects was often substantial, none achieved conventional levels of significance in our analyses. Meta-analyses of a larger number of delivery system innovations are needed to more clearly establish their potential for patient care cost savings.
authors.affiliation: Kevin W. Smith (kevinsmith@rti.org) is a senior public health scientist at the Center for Advanced Methods Development at RTI International in Waltham, Massachusetts.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Smith
authors.affiliation: Anupa Bir is director of the Center for Advanced Methods Development at RTI International.
authors.forename: Anupa
authors.initials: A
authors.lastname: Bir
authors.affiliation: Nikki L. B. Freeman is a research associate in the Center for Advanced Methods Development at RTI International.
authors.forename: Nikki L B
authors.initials: NL
authors.lastname: Freeman
authors.affiliation: Benjamin C. Koethe is a research analyst at the Center for Advanced Methods Development at RTI International.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Koethe
authors.affiliation: Julia Cohen is a research associate at the Center for Advanced Methods Development at RTI International.
authors.forename: Julia
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Timothy J. Day is a social science research analyst at the Center for Medicare and Medicaid Innovation, in Baltimore, Maryland.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Day
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000458:organization & administration; D014487:Centers for Medicare and Medicaid Services, U.S.; D003150:Community Health Workers; D017046:Cost Savings; D003695:Delivery of Health Care / Q000191:economics*; D006801:Humans; D000073256:Information Technology; D009936:Organizational Innovation / Q000191:economics*; D014481:United States
keywords: Cost of Health Care; Delivery System; Health care innovation; Meta-analysis