Amol S. Navathe
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View article: Transplantation in Mandatory Kidney Payment Models: Understanding the Potential Influence of the ESRD Treatment Choices Model on the Increasing Organ Transplant Access Model
Transplantation in Mandatory Kidney Payment Models: Understanding the Potential Influence of the ESRD Treatment Choices Model on the Increasing Organ Transplant Access Model Open
View article: Unfairness toward rural beneficiaries in Medicare's hierarchical conditions categories score
Unfairness toward rural beneficiaries in Medicare's hierarchical conditions categories score Open
Risk adjustment is used in healthcare payment to mitigate the payer incentive to select for healthier populations and to improve fairness of quality assessment. The Centers for Medicare and Medicaid Services (CMS) has used a spending-based…
View article: Comparative Evaluation of Difference in Differences Methods for Staggered Adoption Interventions
Comparative Evaluation of Difference in Differences Methods for Staggered Adoption Interventions Open
Staggered adoption is a common approach for implementing healthcare interventions, where different units adopt the program at different times. Difference-in-differences (DiD) methods are frequently used to evaluate the effects of such inte…
View article: Performance Drift in a Nationally Deployed Population Health Risk Algorithm in the US Veterans Health Administration
Performance Drift in a Nationally Deployed Population Health Risk Algorithm in the US Veterans Health Administration Open
Importance Clinical risk algorithms inform clinical decision support and system-level quality metrics. However, algorithm performance can drift over time and possibly promote misinformed decision-making and resource allocation. The Veteran…
View article: Ambulatory care for individuals dually eligible for Medicare and Medicaid
Ambulatory care for individuals dually eligible for Medicare and Medicaid Open
Introduction Individuals dually eligible for insurance through both Medicaid and Medicare (“duals”) have more comorbidities, higher costs, and poorer outcomes compared to other groups. Unfortunately, policy and care redesign initiatives su…
View article: Variation, Overlap, and Stability in Defining Safety Net Hospitals
Variation, Overlap, and Stability in Defining Safety Net Hospitals Open
Importance The lack of universally accepted definitions for safety net hospitals (SNHs) has made it difficult to effectively design policies to support these hospitals and the populations they serve. Objective To evaluate the overlap, vari…
View article: Physician and Hospital Performance in Medicare’s Updated Bundled-Payment Model for Joint Replacement
Physician and Hospital Performance in Medicare’s Updated Bundled-Payment Model for Joint Replacement Open
Importance Independent evaluations of Bundled Payments for Care Improvement Advanced (BPCI-A) have focused on hospitals and have not assessed the performance of physicians in participating physician group practices (PGPs). However, PGPs ar…
View article: Savings Associated With Bundled Payments for Outpatient Spine Surgery Among Medicare Beneficiaries
Savings Associated With Bundled Payments for Outpatient Spine Surgery Among Medicare Beneficiaries Open
Importance Few value-based payment programs have targeted outpatient surgery, although these procedures comprise most surgeries performed in hospitals. In 2018, the Centers for Medicare and Medicaid Services introduced Bundled Payments for…
View article: Aligning incentives: the importance of behavioral economic perspectives in AI adoption
Aligning incentives: the importance of behavioral economic perspectives in AI adoption Open
View article: Racial Bias in Clinical and Population Health Algorithms: A Critical Review of Current Debates
Racial Bias in Clinical and Population Health Algorithms: A Critical Review of Current Debates Open
Among health care researchers, there is increasing debate over how best to assess and ensure the fairness of algorithms used for clinical decision support and population health, particularly concerning potential racial bias. Here we first …
View article: Behavioural economics to improve and motivate vaccination in primary care using nudges through the electronic health record: rationale and design of the BE IMMUNE randomised clinical trial
Behavioural economics to improve and motivate vaccination in primary care using nudges through the electronic health record: rationale and design of the BE IMMUNE randomised clinical trial Open
Introduction Annual influenza vaccination reduces disease burden but vaccination rates are suboptimal, with persistent disparities among subpopulations. The purpose of this trial is to evaluate multicomponent behavioural economic nudge int…
View article: Association of Participation in Medicare's Oncology Care Model With Spending, Utilization, and Quality Outcomes Among Commercially Insured and Medicare Advantage Members
Association of Participation in Medicare's Oncology Care Model With Spending, Utilization, and Quality Outcomes Among Commercially Insured and Medicare Advantage Members Open
PURPOSE The Oncology Care Model (OCM), a value-based payment model for traditional Medicare beneficiaries with cancer, yielded total spending reductions that were outweighed by incentive payments, resulting in net losses to the Centers for…
View article: Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes
Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes Open
Objective To determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid.…
View article: Differential Hospital Participation in Bundled Payments in Communities with Higher Shares of Marginalized Populations
Differential Hospital Participation in Bundled Payments in Communities with Higher Shares of Marginalized Populations Open
View article: Clinician Perspectives on Virtual Specialty Palliative Care for Patients With Advanced Illnesses
Clinician Perspectives on Virtual Specialty Palliative Care for Patients With Advanced Illnesses Open
Background: Patients with serious illnesses have unmet symptom and psychosocial needs. Specialty palliative care could address many of these needs; however, access varies by geography and health system. Virtual visits and aut…
View article: Association of Electronic Self-Scheduling and Screening Mammogram Completion
Association of Electronic Self-Scheduling and Screening Mammogram Completion Open
View article: The role of payment and financing in achieving health equity
The role of payment and financing in achieving health equity Open
Objective The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms. Data Sources and Study Setting AHRQ convened…
View article: Eliminating Algorithmic Racial Bias in Clinical Decision Support Algorithms: Use Cases from the Veterans Health Administration
Eliminating Algorithmic Racial Bias in Clinical Decision Support Algorithms: Use Cases from the Veterans Health Administration Open
The Veterans Health Administration uses equity- and evidence-based principles to examine, correct, and eliminate use of potentially biased clinical equations and predictive models. We discuss the processes, successes, challenges, and next …
View article: Association of High‐Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease
Association of High‐Deductible Health Plans With Health Care Use and Costs for Patients With Cardiovascular Disease Open
Background By increasing cost sharing, high‐deductible health plans (HDHPs) aim to reduce low‐value health care use. The association of HDHPs with health care use and costs in patients with chronic cardiovascular disease is unknown. Method…
View article: Association Between a Bundled Payment Program for Lower Extremity Joint Replacement and Patient Outcomes Among Medicare Advantage Beneficiaries
Association Between a Bundled Payment Program for Lower Extremity Joint Replacement and Patient Outcomes Among Medicare Advantage Beneficiaries Open
Importance Much of the evidence for bundled payments has been drawn from models in the traditional Medicare program. Although private insurers are increasingly offering bundled payment programs, it is not known whether they are associated …
View article: Growth of Medicare Advantage After Plan Payment Reductions
Growth of Medicare Advantage After Plan Payment Reductions Open
Importance Various policy proposals would reduce federal payments to Medicare Advantage (MA) plans. However, it is unclear whether payment reductions would compromise beneficiary access to the MA program. Objective To quantify the associat…
View article: Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare
Selection and Causal Effects in Voluntary Programs: Bundled Payments in Medicare Open
View article: Performance of Physician Groups and Hospitals Participating in Bundled Payments Among Medicare Beneficiaries
Performance of Physician Groups and Hospitals Participating in Bundled Payments Among Medicare Beneficiaries Open
Importance Hospital participation in bundled payment initiatives has been associated with financial savings and stable quality of care. However, how physician group practices (PGPs) perform in bundled payments compared with hospitals remai…
View article: The Association between Bundled Payment Participation and Changes in Medical Episode Outcomes among High-Risk Patients
The Association between Bundled Payment Participation and Changes in Medical Episode Outcomes among High-Risk Patients Open
Background: Bundled payments for medical conditions are associated with stable quality and savings through shorter skilled nursing facility (SNF) length of stay. However, effects among clinically higher-risk patients remain unknown. Object…
View article: Characteristics of Hospitals Eligible for Rural Emergency Hospital Designation
Characteristics of Hospitals Eligible for Rural Emergency Hospital Designation Open
This cross-sectional study compares the characteristics, finances, services, and challenges at hospitals that are eligible vs not eligible to become rural emergency hospitals.
View article: Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic
Performance drift in a mortality prediction algorithm among patients with cancer during the SARS-CoV-2 pandemic Open
Sudden changes in health care utilization during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic may have impacted the performance of clinical predictive models that were trained prior to the pandemic. In this stu…
View article: Early Findings From Medicare’s End-Stage Renal Disease Treatment Choices Model
Early Findings From Medicare’s End-Stage Renal Disease Treatment Choices Model Open
Financial Incentives to Facilities and Clinicians Treating End-stage Kidney Disease and Use of Home Dialysis
View article: Trends in Enrollment in Employer-Sponsored Health Insurance in the US Before and During the COVID-19 Pandemic, January 2019 to June 2021
Trends in Enrollment in Employer-Sponsored Health Insurance in the US Before and During the COVID-19 Pandemic, January 2019 to June 2021 Open
This cross-sectional study compares trends in employer-sponsored health insurance coverage in the US before and during the COVID-19 pandemic.
View article: Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries
Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries Open
In this cross-sectional study of Medicare beneficiaries, those enrolled in MA had lower rates of low-value care than those enrolled in TM; elements of insurance design present in the MA program and absent in TM were associated with reducti…
View article: Evaluation of Spending Differences Between Beneficiaries in Medicare Advantage and the Medicare Shared Savings Program
Evaluation of Spending Differences Between Beneficiaries in Medicare Advantage and the Medicare Shared Savings Program Open
In this study, utilization and spending were consistently higher for MSSP than MA beneficiaries within the same health system even after adjusting for granular metrics of clinical risk. Nonclinical factors likely contribute to the large di…