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Cited by 54Health Policy Implementation ScienceHealth Systems, Economic Evaluations, Quality of LifeHealthcare Policy and Management

Translating economic evaluations into financing strategies for implementing evidence-based practices

Open access
Dopp, Alex R., Kerns, Suzanne E. U., Panattoni, Laura, Ringel, Jeanne S., Eisenberg, Daniel, Powell, Byron J., Low, Roger, Raghavan, Ramesh·2021·Implementation Science
DOI 10.1186/s13012-021-01137-9PMC PMC8240424
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Abstract

Background: Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment. Main body: We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder. Conclusions: EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.

AI snapshot

Written from the paper’s full text.

TL;DR

This paper argues that economic evaluations alone rarely change financing for evidence-based practices (EBPs); complementary research on financing strategies is needed to translate cost and benefit findings into policy and practice. It uses three US case examples—Pay-for-Success for multisystemic therapy, Medicare’s Oncology Care Model, and fiscal mapping for INSPIRE—to propose a five-part research agenda.

Key findings

  • Financing strategies can bridge economic evaluation and implementation: Colorado’s Pay-for-Success project selected multisystemic therapy (MST) partly because economic evaluations estimated over $3 in benefits per $1 spent within 2 years; with a predicted 28% reduction in youth recidivism, state savings were conservatively predicted at over $8 million across 3 years, though MST costs typically $8,000–13,000 per 4–6 month episode and required almost a year of negotiation.
  • The Oncology Care Model used a simulation budget impact analysis to set a $160 monthly enhanced oncology services case management payment ($960 per 6-month episode); Medicare could break even if practices reduced other service utilization costs by roughly 4%, but reliable performance benchmarks may limit the model to larger practices (>100 episodes/year). As of February 2020, OCM included 139 practices, over 6,000 practitioners, approximately 25% of Medicare fee-for-service chemotherapy-related cancer care (>150,000 beneficiaries per year), and 10 non-Medicare payors.
  • The INSPIRE pragmatic trial uses a five-step fiscal mapping process to match resources and funding objectives to candidate financing strategies (e.g., fee-for-service reimbursement, grants/contracts, internal budgets), identifying Medicaid billing options and a need for private funding for technology; its clinical and economic impacts are still being evaluated.
  • The proposed research agenda covers five areas: maximize relevance of economic evaluations for real-world EBP implementation; study ongoing changes in financing systems; identify conditions under which a financing strategy is most beneficial; explore financing strategies across pre-implementation, active implementation, and sustainment; and advance research through stakeholder partnerships while attending to power imbalance and transparency.

Methods

  • Conceptual/commentary paper: provides an overview of EBP implementation financing and key stakeholder decision points, illustrated by three case examples; it is not a primary empirical study or systematic review.
  • Cases: (1) Colorado Pay-for-Success financing for multisystemic therapy in underserved areas; (2) the US Centers for Medicare and Medicaid Services Oncology Care Model alternative payment model; and (3) fiscal mapping during a pragmatic clinical trial of INSPIRE, an adapted family support intervention for opioid use disorder.
  • Synthesis: narrative description and a comparison table of financing strategies, service sectors, clinical problems, EBPs, evidence base, stakeholders, and role of economic evaluation, concluding with a proposed research agenda.

Limitations

  • Stated: the authors are US-based and present US cases; cases focus on EBP treatment models, not preventive interventions, screening/assessment tools, or policy solutions; and an in-depth analysis of COVID-19 effects on EBP financing is not included.
  • Stated/evident: the case examples are illustrative rather than a comparative evaluation of financing strategies; INSPIRE’s clinical and economic results are pending in the pragmatic trial, and OCM’s performance in EBP implementation and financial viability still needs evaluation.
  • Evident: there is no systematic search or quantitative synthesis, so findings may not generalize to other countries or financing contexts, although the authors note global comparisons are needed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13012-021-01137-9

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 108 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    Projected cost-savings were the basis of selecting MST for implementation in Case 1.

    “Projected cost-savings were the basis of selecting MST for implementation”
    Quote in the paperNot a substantial claim
  • Findingcitation

    In 2018, the Colorado Office of State Planning and Budgeting chose to implement MST as one of the state's inaugural Pay-for-Success projects.

    “In 2018, the Colorado Office of State Planning and Budgeting, in coordination with other state agencies and outside experts, chose to implement a behavioral health EBP called multisystemic therapy (MST [33]) as one of the state’s inaugural Pay-for-Success projects.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The INSPIRE team's fiscal mapping activities identified a need for private funding to purchase technology that support persons can use to participate.

    “These activities have identified Medicaid billing options that could most sustainably finance INSPIRE groups and a need for private funding to purchase technology that support persons can use to participate.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The INSPIRE team's fiscal mapping activities identified Medicaid billing options that could most sustainably finance INSPIRE groups.

    “These activities have identified Medicaid billing options that could most sustainably finance INSPIRE groups and a need for private funding to purchase technology that support persons can use to participate.”
    Quote in the paperSubstantial claim
  • Findingnone given

    The initial OCM modeling did not separate implementation versus sustainment costs.

    “The initial OCM modeling did not separate implementation versus sustainment costs, and a professional organization has advocated that much higher monthly case management payments ($225–675) could be necessary to achieve financially sustainable offsets in service utilization [74].”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 28
  • May combine two claims. 26

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    A simulation budget impact analysis was conducted for the new payment models based on prior studies in Case 2.

    “A simulation budget impact analysis was conducted for the new payment models based on prior studies”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Cost data are being collected and evaluated during the pragmatic trial in Case 3.

    “Cost data are being collected and evaluated during the pragmatic trial”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The INSPIRE team has taken a more collaborative approach that involves all stakeholder groups-intervention developers, health systems, and funding agencies-working together from the beginning to plan for the complex realities of financing INSPIRE's implementation.

    “The INSPIRE team has taken a more collaborative approach that involves all stakeholder groups—intervention developers, health systems, and funding agencies—working together from the beginning to plan for the complex realities of financing INSPIRE’s implementation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Detention and incarceration remain common, albeit largely ineffective, responses to serious youth behavioral problems in the USA and Colorado.

    “Detention and incarceration remain common, albeit largely ineffective, responses to serious youth behavioral problems in the USA [29, 30] and Colorado specifically [31].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [29] Hazel N. Cross-national comparison of youth justice. London, UK: Youth Justice Board; 2008.

      Not checked in the free run.

    • cites [30] Lambie I, Randell I. The impact of incarceration on juvenile offenders. Clin Psychol Rev. 2013;33(3):448–59. https://doi.org/10.1016/j.cpr.2013.01.007. source

      Not checked in the free run.

    • cites [31] Fox DR, Wass TS, McGuire S, Friss C. The impact of secure detention for truancy on educational and juvenile justice outcomes: a cross system analyses in Colorado. J Applied Juvenile Justice Services. 2016; http://npjs.org/jajjs/?page_id=192.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Complex economic considerations limit availability of MST, despite strong evidence of its economic benefits from reduced recidivism and out-of-home placements.

    “Complex economic considerations limit availability of MST, despite strong evidence of its economic benefits from reduced recidivism and out-of-home placements [38].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Eisenberg D, Raghavan R. Investments in children’s mental health. In: Oxford Research Encyclopedia of Economics and Finance.; 2019. https://doi.org/10.1093/acrefore/9780190625979.013.411. source

      Not checked in the free run.

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    Premisecitation

    MST is a well-defined intervention with numerous rigorous evaluations demonstrating immediate and long-term effectiveness.

    “it is a well-defined intervention with numerous rigorous evaluations demonstrating immediate and long-term effectiveness [33, 35].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [33] Henggeler SW, Schaeffer CM. Multisystemic therapy®: clinical overview, outcomes, and implementation research. Fam Process. 2016;55(3):514–28. https://doi.org/10.1111/famp.12232. source

      Not checked in the free run.

    • cites [35] Sawyer AM, Borduin CM. Effects of multisystemic therapy through midlife: a 21.9-year follow-up to a randomized clinical trial with serious and violent juvenile offenders. J Consult Clin Psych. 2011. https://doi.org/10.1037/a0024862. source

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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Important MST outcomes such as recidivism and out-of-home placements can be regularly tracked at the local or state level to document success.

    “Important MST outcomes such as recidivism and out-of-home placements can be regularly tracked at the local or state level to document success.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The scoping review's findings and recommendations were consistent with those from a systematic review of alternative payment models for cancer care.

    “its findings and recommendations were consistent with those from a systematic review of alternative payment models for cancer care [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Aviki EM, Schleicher SM, Mullangi S, Matsoukas K, Korenstein D. Alternative payment and care-delivery models in oncology: a systematic review. Cancer. 2018;124(16):3293–306. https://doi.org/10.1002/cncr.31367. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Economic evaluations are one of many important factors in decision-making about EBP use.

    “Research from varied global contexts consistently shows that economic evaluations are one of many important factors in decision-making about EBP use [16–18].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] Anderson R. Systematic reviews of economic evaluations: utility or futility? Health Econ. 2010;19(3):350–64. https://doi.org/10.1002/hec.1486. source

      Not checked in the free run.

    • cites [17] Hoffman C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health-care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities. Value Health. 2002;5(2):71–8. https://doi.org/10.1046/j.1524-4733.2002.52109.x. source

      Not checked in the free run.

    • cites [18] Yothasamut J, Tantivess S, Teerawattananon Y. Using economic evaluation in policy decision-making in Asian countries: mission impossible or mission probable? Value Health. 2009;12:S26–30. https://doi.org/10.1111/j.1524-4733.2009.00623.x. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In July 2016, the US Centers for Medicare and Medicaid Services launched the 5-year Oncology Care Model (OCM), its first major initiative to pilot the transition from fee-for-service payments to value-based purchasing in oncology for Medicare insurance beneficiaries.

    “In July 2016, the US Centers for Medicare and Medicaid Services launched the 5-year Oncology Care Model (OCM), its first major initiative to pilot the transition from fee-for-service payments to value-based purchasing in oncology for Medicare insurance beneficiaries [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Patel K, Patel M, Lavender T, Mehta D, Gor A, Naidu S, et al. Two-sided risk in the Oncology Care Model. Am J Managed C. 2019; https://www.ajmc.com/view/twosided-risk-in-the-oncology-care-model.

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    Premisecitation

    The cost of cancer care has grown dramatically and was projected to reach $173 billion by 2020.

    “The cost of cancer care has grown dramatically and was projected to reach $173 billion by 2020 [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Health and economic costs of chronic diseases: Cancer; 2020. https://www.cdc.gov/chronicdisease/about/costs/index.htm.

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The scoping review focused on behavioral health services but also documented usage of financing strategies in health and social services more broadly.

    “The review focused on behavioral health services, but also documented usage in health and social services more broadly [24]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Dopp AR, Narcisse MR, Mundey P, Silovsky JF, Smith AB, Mandell D, et al. A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: state of the literature and future directions. Implementation Research and Practice. 2020;1:263348952093998. https://doi.org/10.1177/2633489520939980. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Studies demonstrate the benefits of having diverse revenue streams.

    “for example, studies demonstrate the benefits of having diverse revenue streams [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Froelich KA. Diversification of revenue strategies: evolving resource dependence in nonprofit organizations. Nonprofit Volunt Sec Q. 1999;28(3):246–68. https://doi.org/10.1177/0899764099283002. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The social and economic benefits of an EBP accumulate over long periods of time and appear in other sectors, raising questions about which sectors should fund implementation (the "wrong pockets" problem).

    “In what has been termed the “wrong pockets” problem [20], the social and economic benefits of the EBP accumulate over long periods of time and appear in other sectors, raising questions about which sectors should fund implementation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Roman J. Solving the wrong pockets problem: how pay for success promotes investment in evidence-based best practices. Washington, DC: Urban Institute; 2015.

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  • May combine two claims.

    Premisecitation

    A recent scoping review compiled the first dedicated list of 23 potential financing strategies that support EBP implementation and sustainment and characterized their frequency of use in health services research.

    “a recent scoping review compiled the first dedicated list of “financing strategies” that support EBP implementation and sustainment [24]. The authors defined 23 potential financing strategies and characterized their frequency of use in health services research.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Dopp AR, Narcisse MR, Mundey P, Silovsky JF, Smith AB, Mandell D, et al. A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: state of the literature and future directions. Implementation Research and Practice. 2020;1:263348952093998. https://doi.org/10.1177/2633489520939980. source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Financing strategies that support EBP implementation and sustainment remain under-researched, with a lack of rigorous research on their role within EBP implementation.

    “Such strategies remain under-researched, but a recent scoping review compiled the first dedicated list of “financing strategies” that support EBP implementation and sustainment [24].”
    • Also stated in: § Background · plain
      “The authors noted a lack of rigorous research on the role of financing strategies within EBP implementation and recommended that implementation scientists begin investigating these strategies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Dopp AR, Narcisse MR, Mundey P, Silovsky JF, Smith AB, Mandell D, et al. A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: state of the literature and future directions. Implementation Research and Practice. 2020;1:263348952093998. https://doi.org/10.1177/2633489520939980. source

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  • May combine two claims.

    Premisecitation

    Behavioral health EBPs can address risk for ongoing behavioral problems and reduce criminal recidivism, offering alternatives to youth detention and incarceration.

    “Behavioral health EBPs can address risk for ongoing behavioral problems and reduce criminal recidivism, offering alternatives to youth detention and incarceration”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Bruns EJ, Kerns SEU, Pullmann MD, Hensley SW, Lutterman T, Hoagwood KE. Research, data, and evidence-based treatment use in state behavioral health systems, 2001–2012. Psychiatr Serv. 2016;67(5):496–503. https://doi.org/10.1176/appi.ps.201500014. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In economic evaluations, societal costs and benefits are often aggregated across various actors and across fixed and variable costs.

    “In economic evaluations, societal costs and benefits are often aggregated across various actors (e.g., patients, health service organizations, government agencies, taxpayers) and across fixed and variable costs [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Sanders G, Neumann P, Basu A, Brock D, Feeny D, Krahn M, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103. https://doi.org/10.1001/jama.2016.12195. source

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  • May combine two claims.

    Premisecitation

    Community-based behavioral health agencies that deliver MST pay up-front for implementation, often with support from juvenile justice partners, whereas Medicaid and adult criminal justice realize most of the eventual benefits from decreased arrests and out-of-home placements.

    “For example, community-based behavioral health agencies that deliver MST pay up-front for implementation, often with support from juvenile justice partners, whereas Medicaid and adult criminal justice realize most of the eventual benefits from decreased arrests and out-of-home placements [36].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Dopp AR, Coen AS, Smith AB, Reno J, Bernstein DH, Kerns SEU, et al. Economic impact of the statewide implementation of an evidence-based treatment: multisystemic therapy in New Mexico. Behav Ther. 2018;49(4):551–66. https://doi.org/10.1016/j.beth.2017.12.003. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Examples of currently used financing strategies include enhanced fee-for-service reimbursement rates (with the additional reimbursement covering implementation costs) and the use of grants, contracts, and budget line-items to fund EBP adoption.

    “Examples of currently used financing strategies included enhanced fee-for-service reimbursement rates (with the additional reimbursement covering implementation costs) and the use of grants, contracts, and budget line-items to fund EBP adoption.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Dopp AR, Narcisse MR, Mundey P, Silovsky JF, Smith AB, Mandell D, et al. A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: state of the literature and future directions. Implementation Research and Practice. 2020;1:263348952093998. https://doi.org/10.1177/2633489520939980. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Intervention developers create effective interventions, then seek to convince funders to pay for them.

    “Intervention developers create effective interventions, then seek to convince funders to pay for them [59].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [59] O’Cathain A, Croot L, Duncan E, Rousseau N, Sworn K, Turner KM, et al. Guidance on how to develop complex interventions to improve health and healthcare. BMJ Open. 2019;9(8):e029954. https://doi.org/10.1136/bmjopen-2019-029954. source

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    Premisecitation

    Typically, health service providers offer services for which funding agencies are willing to offer payment.

    “Typically, health service providers offer services for which funding agencies are willing to offer payment [23] (see also Fig. 1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Knapp M, Funk M, Curran C, Prince M, Grigg M, Mcdaid D. Economic barriers to better mental health practice and policy. Health Policy Plann. 2016;21(3):157–70. https://doi.org/10.1093/heapol/czl003. source

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  • May combine two claims.

    Interpretationown data

    The paper's case examples show how financing strategies may overcome cost-related barriers for EBPs by organizing stakeholders around complex interventions (case #1), optimize the clinical and economic benefits of an intervention package (case #2), and link available funds to financing needs (case #3).

    “Our case examples show how financing strategies may overcome cost-related barriers for EBPs by organizing stakeholders around complex interventions (case #1), optimize the clinical and economic benefits of an intervention package (case #2), and link available funds to financing needs (case #3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The provision of "between office visit" care (e.g., patient navigator, care planning) is not funded by fee-for-service reimbursements, and 24/7 access to providers is typically underfunded.

    “The provision of “between office visit” care (e.g., patient navigator, care planning) is not funded by fee-for-service reimbursements, and 24/7 access to providers is typically underfunded [44]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [44] Centers for Medicare & Medicaid Services Innovation Center (CMMI). Oncology Care Model: key drivers and change package. Baltimore, MD: Author; 2020. https://innovation.cms.gov/files/x/ocm-keydrivers-changepkg.pdf

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  • May combine two claims.

    Premisecitation

    The performance-based payments are linked to quality measures and total cost of care per episode, incentivizing physicians to reduce costs while sustaining higher-quality care.

    “The performance-based payments are linked to quality measures and total cost of care per episode, incentivizing physicians to reduce costs while sustaining higher-quality care [41, 44].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Patel K, Patel M, Lavender T, Mehta D, Gor A, Naidu S, et al. Two-sided risk in the Oncology Care Model. Am J Managed C. 2019; https://www.ajmc.com/view/twosided-risk-in-the-oncology-care-model.

      Not checked in the free run.

    • cites [44] Centers for Medicare & Medicaid Services Innovation Center (CMMI). Oncology Care Model: key drivers and change package. Baltimore, MD: Author; 2020. https://innovation.cms.gov/files/x/ocm-keydrivers-changepkg.pdf

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  • May combine two claims.

    Interpretationreasoning

    Overall, financing strategies help translate findings from economic evaluation research into policy and practice, enabling the public health and economic impacts of EBPs.

    “Overall, financing strategies help translate findings from economic evaluation research (What should we fund?) into policy and practice (How should we fund it?), enabling the public health and economic impacts of EBPs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    As of February 2020, the OCM included 139 participating practices, over 6000 practitioners, approximately 25% of Medicare fee-for-service chemotherapy-related cancer care (>150,000 beneficiaries per year), and 10 non-Medicare payors.

    “As of February 2020, the OCM included 139 participating practices, over 6000 practitioners, approximately 25% of Medicare fee-for-service chemotherapy-related cancer care (>150,000 beneficiaries per year), and 10 non-Medicare payors [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Centers for Medicare & Medicaid Services Innovation Center (CMMI). Oncology Care Model: key drivers and change package. Baltimore, MD: Author; 2020. https://innovation.cms.gov/files/x/ocm-keydrivers-changepkg.pdf

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The major drawback of Pay-for-Success is its complexity and scope, requiring almost a year of negotiation to establish all necessary financing, service provider, and evaluation agreements.

    “The major drawback of Pay-for-Success is its complexity and scope, requiring almost a year of negotiation to establish all necessary financing, service provider, and evaluation agreements.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Pay-for-Success shifted the financial risks of implementation from service and intermediary organizations to private investors, who could better afford to take such risks for the public good.

    “Pay-for-Success shifted the financial risks of implementation from service and intermediary organizations to private investors, who could better afford to take such risks for the public good.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The State of Colorado sought to decrease youth detention, incarceration, and recidivism by implementing MST in regions underserved for youth behavioral health.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    To develop the $160 monthly case management payment ($960 per 6-month episode), the analysts used the US Bureau of Labor Statistics wage estimates to model the costs for the additional staff and spread the costs across the average number of episodes per practice.

    “To develop the $160 monthly case management payment ($960 per 6-month episode), the analysts used the US Bureau of Labor Statistics wage estimates to model the costs for the additional staff and spread the costs across the average number of episodes per practice [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Kline RM, Muldoon LD, Schumacher HK, Strawbridge LM, York AW, Mortimer LK, et al. Design challenges of an episode-based payment model in oncology: the Centers for Medicare & Medicaid Services Oncology Care Model. J Oncol Pract. 2017;13(7):e632–45. https://doi.org/10.1200/JOP.2016.015834. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Fiscal mapping is a five-step process adapted from Intervention Mapping, a well-established method recommended for tailored selection of implementation strategies.

    “Fiscal mapping is a five-step process adapted from Intervention Mapping, a well-established method recommended for tailored selection of implementation strategies [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Bartholomew Eldrege LK, Markham CM, Ruiter RAC, Fernandez ME, Kok G, Pracel GS. Planning health promotion programs: an intervention mapping approach, 8th ed. San Francisco, CA: Jossey-Bass; 2016.

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  • May combine two claims.

    Interpretationreasoning

    Pay-for-Success financing offered a viable strategy to raise the upfront capital, share risk across public and private investors, and enable agencies to establish sustainable MST teams that may continue to produce a return on investment in the years ahead.

    “Pay-for-Success financing offered a viable strategy to raise the upfront capital, share risk across public and private investors, and enable agencies to establish sustainable MST teams that may continue to produce a return on investment in the years ahead.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Implementation costs were the primary barrier to MST dissemination in Colorado.

  • May combine two claims.

    Premisecitation

    The OCM was developed partly to address the rising costs of oncology care and the significant regional variation in quality and costs.

    “The model was developed partly to address the rising costs of oncology care [42] and the significant regional variation in quality and costs [43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Kline RM, Bazell C, Smith E, Schumacher H, Rajkumar R, Conway PH. Centers for Medicare and Medicaid Services: using an episode-based payment model to improve oncology care. J Oncol Pract. 2015;11(2):114–6. https://doi.org/10.1200/JOP.2014.002337. source

      Not checked in the free run.

    • cites [43] Brooks GA, Li L, Sharma DB. Regional variation in spending and survival for older adults with advanced cancer. J Natl Cancer Inst. 2013;105(9):634–42. https://doi.org/10.1093/jnci/djt025. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The INSPIRE developers are working with primary care systems and funding agency representatives to evaluate its clinical and economic impacts in a pragmatic clinical trial.

    “The INSPIRE developers are working with primary care systems and funding agency representatives to evaluate its clinical and economic impacts in a pragmatic clinical trial [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Osilla KC, Becker K, Ecola L, Hurley B, Manuel JK, Ober A, et al. Study design to evaluate a group-based therapy for support persons of adults on buprenorphine/naloxone. Addict Sci Clin Pract. 2020. https://doi.org/10.1186/s13722-020-00199-2. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    This last case highlights how selection of financing strategies is also an important consideration during intervention development.

    “This last case highlights how selection of financing strategies is also an important consideration during intervention development.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Practices have the option to choose between two payment models: (1) can receive incentives but are not financially penalized for failing to meet performance targets (one-sided risk to payors); and (2) can earn larger incentives for meeting more stringent performance metrics, but also face the risk of financial penalties (two-sided risk to providers and payors).

    “Practices have the option to choose between two payment models: (1) can receive incentives but are not financially penalized for failing to meet performance targets (one-sided risk to payors); and (2) can earn larger incentives for meeting more stringent performance metrics, but also face the risk of financial penalties (two-sided risk to providers and payors) [41].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Patel K, Patel M, Lavender T, Mehta D, Gor A, Naidu S, et al. Two-sided risk in the Oncology Care Model. Am J Managed C. 2019; https://www.ajmc.com/view/twosided-risk-in-the-oncology-care-model.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most organizations have limited control over the financing strategies available to them, though they may engage in strategic decisions or negotiations about which they use.

    “Most organizations have limited control over the financing strategies available to them, though they may engage in strategic decisions or negotiations about which they use [75, 76].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [75] Decker SL. In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Affairs. 2012;31(8):1673–9. https://doi.org/10.1377/hlthaff.2012.0294. source

      Not checked in the free run.

    • cites [76] Jaramillo ET, Willging CE, Green AE, Gunderson LM, Fettes DL, Aarons GA. “Creative financing”: funding evidence-based interventions in human service systems. J Behav Health Ser R. 2019. https://doi.org/10.1007/s11414-018-9644-5. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The paper described how financing strategies function under more stable conditions, not how they respond to shocks to the system such as the COVID-19 pandemic.

    “Finally, an in-depth analysis of how the COVID-19 pandemic has affected EBP financing would be useful to investigate how financing strategies respond to “shocks to the system,” whereas we described how strategies function under more stable conditions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

    Premisecitation

    A professional organization has advocated that much higher monthly case management payments ($225-675) could be necessary to achieve financially sustainable offsets in service utilization.

    “The initial OCM modeling did not separate implementation versus sustainment costs, and a professional organization has advocated that much higher monthly case management payments ($225–675) could be necessary to achieve financially sustainable offsets in service utilization [74].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [74] American Society of Clinical Oncology. ASCO patient-centered oncology payment: a community-based oncology medical home model. Alexandria, VA: Author; 2019. https://practice.asco.org/sites/default/files/drupalfiles/content-files/billing-coding-reporting/documents/2019%20PCOP%20-%20FINAL_WEB_LOCKED.pdf

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Commercial funders consider payment models proprietary and tend to only release details when the payment model showed economic benefits.

    “However, there remains considerable information asymmetry between payors and providers in the healthcare marketplace: Providers may resist sharing the true costs of care to avoid scrutiny from funders, and commercial funders consider payment models proprietary and tend to only release details when the payment model showed economic benefits [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Aviki EM, Schleicher SM, Mullangi S, Matsoukas K, Korenstein D. Alternative payment and care-delivery models in oncology: a systematic review. Cancer. 2018;124(16):3293–306. https://doi.org/10.1002/cncr.31367. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Returns on investment for preventive interventions, screening/assessment tools, or policy solutions tend to be diffuse and unfold slowly over time.

    “where returns on investment tend to be diffuse and unfold slowly over time [77].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Commun H. 2017;71(8):827–34. https://doi.org/10.1136/jech-2016-208141. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The authors are US-based researchers and presented cases from the US.

    “Further, we are US-based researchers, and presented cases from the US.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The OCM payment model assumes that shifting financial incentives from the payor to the provider will result in the successful adoption of EBPs by practices and use with patients.

    “For example, the OCM payment model (case #2) assumes that shifting financial incentives from the payor to the provider will result in the successful adoption of EBPs by practices and use with patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Health systems are being transformed by the needs of chronic disease management, health promotion, management of health risks at a population level, and paying for outcomes (vs. fee-for-service).

    “Health systems are being transformed by the needs of chronic disease management, health promotion, management of health risks at a population level, and paying for outcomes (vs. fee-for-service) [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Halfon N, Long P, Chang DI, Hester J, Inkelas M, Rodgers A. Applying a 3.0 transformation framework to guide large-scale health system reform. Health Affairs. 2014. https://doi.org/10.1377/hlthaff.2014.0485. source

      Not checked in the free run.

44 of 44

  • The paper relies on this without support.

    There is little guidance for policymakers and leaders of health service organizations regarding how to use findings from economic evaluations to optimize EBP implementation and sustainment outcomes at a reasonable cost.

    “Yet there is little guidance for policymakers and leaders of health service organizations regarding how to use findings from economic evaluations to optimize EBP implementation and sustainment outcomes at a reasonable cost.”

  • The paper relies on this without support.

    Determining how to finance EBPs and implementation strategies is a major remaining challenge.

    “A major remaining challenge—and the focus of this paper—is determining how to finance EBPs and implementation strategies.”

  • The paper relies on this without support.

    Additional information about economic evaluations is needed by key healthcare delivery and financing decision-makers.

    “but additional information is needed by key healthcare delivery and financing decision-makers.”

  • The paper relies on this without support.

    The per-patient costs of delivering MST are substantial, typically ranging from $8000–13,000 per 4–6 month treatment episode.

    “The per-patient costs of delivering MST are substantial, typically ranging from $8000–13,000 per 4–6 month treatment episode, as the intervention requires intensive services, small caseloads, and ongoing training, consultation, and quality assurance activities.”

  • The paper relies on this without support.

    Initial implementation costs related to readiness planning, training, and lost productivity are often a disincentive for behavioral health agencies to adopt MST.

    “Further, initial implementation costs related to readiness planning, training, and lost productivity are often a disincentive for behavioral health agencies to adopt MST.”

  • The paper relies on this without support.

    The State of Colorado sought to decrease youth detention, incarceration, and recidivism by implementing MST in regions underserved for youth behavioral health.

    “the State of Colorado sought to decrease youth detention, incarceration, and recidivism by implementing MST in regions underserved for youth behavioral health.”

  • The paper relies on this without support.

    Implementation costs were the primary barrier to MST dissemination in Colorado.

    “Implementation costs were the primary barrier to MST dissemination in Colorado”

  • The paper relies on this without support.

    Medicare used economic analyses to design a novel payment strategy intended to promote delivery of higher-quality oncology care at the same or lower cost.

    “Medicare used economic analyses to design a novel payment strategy intended to promote delivery of higher-quality oncology care at the same or lower cost.”

  • The paper relies on this without support.

    The oncology care EBPs required by the OCM were selected based on extensive clinical and economic evidence.

    “The oncology care EBPs required by the OCM were selected based on extensive clinical and economic evidence”

  • The paper relies on this without support.

    The goal of OCM was to design a financing strategy that was ideally suited to supporting those EBPs.

    “The goal of OCM was to design a financing strategy that was ideally suited to supporting those EBPs”

  • The paper relies on this without support.

    INSPIRE (Integrating Support Persons Into Recovery) is a novel approach to working with support persons of patients with OUD.

    “INSPIRE (Integrating Support Persons Into Recovery) is a novel approach to working with support persons of patients with OUD.”

  • The paper relies on this without support.

    INSPIRE has a specific focus on supporting retention in medication for OUD.

    “INSPIRE has a specific focus on supporting retention in medication for OUD”

  • The paper relies on this without support.

    It remains unclear what level of evidence justifies a given level of financial risk and who should bear that risk.

    “It remains unclear what level of evidence (e.g., from economic evaluations) justifies a given level of financial risk and who should bear that risk.”

  • The paper relies on this without support.

    Many financing strategies involve coordinating funds across multiple levels of the service system ecology and/or across multiple service systems.

    “Many financing strategies involve coordinating funds across multiple levels of the service system ecology (e.g., fiscal mapping of provider, clinic, and health system funding needs) and/or across multiple service systems (e.g., juvenile justice, behavioral health, and private investors in case #1).”

  • The paper relies on this without support.

    Payors will be most interested in whether the OCM encourages high-quality care while containing their own costs.

    “Payors will be most interested in whether the OCM encourages high-quality care while containing their own costs, but providers could experience substantial unreimbursed costs of implementing and sustaining EBPs [65].”
15 of 15

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Cites

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Research works printed but not linked: 1

  1. Roman J. Solving the wrong pockets problem: how pay for success promotes investment in evidence-based best practices. Washington, DC: Urban Institute; 2015.

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Authors
Dopp, A. R., Kerns, S. E. U., Panattoni, L., Ringel, J. S., Eisenberg, D., Powell, B. J., Low, R., & Raghavan, R.
Affiliations
  • RAND Corporation (US)
  • University of Denver (US)
  • Fred Hutch Cancer Center (US)
  • University of California, Los Angeles (US)
  • Washington University in St. Louis (US)
  • New York University (US)
Corresponding author
Dopp, Alex R.
ORCID
Venue
Implementation Science
Publisher
Springer Science and Business Media LLC
Published
2021-06-29
Volume
16
Issue
1
Pages
66-66
ISSN
1748-5908 (ISSN-L)
DOI
10.1186/s13012-021-01137-9
PMC
PMC8240424
OpenAlex
W3175586516
Semantic Scholar
fae181ad3a20015a01fd78f7356442aa5f53ff04
Cited by
52
References
78
Citations by year
2026: 7 · 2025: 8 · 2024: 20 · 2023: 9 · 2022: 7 · 2021: 1
FWCI
10.96
Type
journal article
Language
en
Open access
Licence
Locations
  • Implementation Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institute of Mental Health (5R25MH08091607, R21MH122889, K01MH113806)
  • Patient-Centered Outcomes Research Institute (OBOT-2018C2-1287)
  • State of Colorado (Colorado State Pay for Success Initiative (no grant number))
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
evidence-based practice implementation, pay for success, multisystemic therapy, alternative payment models, cancer care, opioid use disorder, family support interventions, health policy decision-making, stakeholder collaboration, implementation sustainment
MeSH terms
Aged, Cost-Benefit Analysis, Delivery of Health Care, Medicare, Humans, Opioid-Related Disorders, United States, Evidence-Based Practice

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