Finance

Medicare Payments, Health Care Services Use, and Telemedicine Implementation Cost in Randomized Trial Comparing Telemedicine Case Management With Usual Care in Medically Underserved Patients With Diabetes Mellitus

Medicare Payments, Health Care Services Use, and Telemedicine Implementation Cost in Randomized Trial Comparing Telemedicine Case Management With Usual Care in Medically Underserved Patients With Diabetes Mellitus
Journal of the American Medical Informatics Association

Palmas, W., Shea, S., Starren, J., Teresi, J.E., Ganz, M.L., Burton, T.M., Pashos, C.L., Blustein, J., Field, L., Morin, P.C., Izquierdo, R.E., Silver, S., Eimicke, J.P., Langiua, R.A. & Weinstock, S.
03/01/2010

Objective
To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.
Design
We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State.
Measurements
We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006).
Results
Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month.
Conclusion
Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.

Take-Up

Take-Up
Financial Access Initiative Framing Note. February 2010.

Jonathan Morduch, Dean Karlan and Sendhil Mullainathan
02/01/2010

Brandraising: How Nonprofits Raise Visibility and Money Through Smart Communications

Brandraising: How Nonprofits Raise Visibility and Money Through Smart Communications

Durham, Sarah
01/01/2010

In the current economic climate, nonprofits need to focus on ways to stand out from the crowd, win charitable dollars, and survive the downturn. Effective, mission-focused communications can help organizations build strong identities, heightened reputations, and increased fundraising capability. Brandraising outlines a mission-driven approach to communications and marketing, specifically designed to boost fundraising efforts. This book provides tools and guidance for nonprofits seeking to transform their communications and marketing through smart positioning, branding, campaigns, and materials that leverage solid strategy and great creative, with a unique focus on the intersection of communications and fundraising.

New York City Quarterly Housing Update 2010: 3rd Quarter

New York City Quarterly Housing Update 2010: 3rd Quarter

Furman Center for Real Estate and Urban Policy.
01/01/2010

After analyzing six key indicators of housing market performance for the third quarter of 2010, NYU's Furman Center finds that New York City home prices are stabilizing, but still remain 22% below peak. The report also finds that a decrease in third-quarter foreclosure filings compared to last year may point to a slowdown in the foreclosure crisis. The Quarterly Housing Update incorporates sales data, development indicators and foreclosures, and presents a repeat sales index for each borough to capture price appreciation while controlling for housing quality.

Pension Obligation Bonds: Financial Crisis Exposes Risks (Brief Number 9 in State and Local Pension Plans Series ed.)

Pension Obligation Bonds: Financial Crisis Exposes Risks (Brief Number 9 in State and Local Pension Plans Series ed.)
Center for Retirement Research at Boston College

Munnell, A., Calabrese, T., Monk, A., Aubry, J.-P
01/01/2010

The brief’s key findings are:

  • Some state and local governments issue Pension Obligation Bonds (POBs) to raise cash to cover their required pension contributions.
  • POBs allow governments to avoid increasing taxes in bad times and could reduce pension costs, but they pose considerable risks.
  • Those who issue POBs are often fiscally stressed and not well-positioned to handle the investment risk.

Transportation Recovery in an Age of Disasters

Transportation Recovery in an Age of Disasters
Proceedings of the Transportation Research Board 89th Annual Meeting, Washington, DC

Zimmerman, R.
01/01/2010

Disasters from terrorism, natural hazards and accidents are now becoming commonplace and may be increasing as a major threat against the viability of transportation infrastructure and the invaluable social services it provides. The paper first sets forth the nature of the threats and hazards transportation infrastructure faces. This provides the foundation for understanding the need to develop an integrated and common set of solutions that incorporates co-benefits to solve more than one problem at the same time, that is, simultaneously for different kinds of hazards, different types of infrastructures, and infrastructures that affect or have interdependencies with transportation. Types of funding sources and innovative technologies that are becoming available to support protection and recovery are discussed in terms of their ability to integrate multiple hazards and address areas of need.

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites

Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites
Journal of Immigrant and Minority Health 2010.  DOI: 10.1007/s10903-010-9410-0

Silver D, J Blustein, BC Weitzman.
01/01/2010

Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending

The High Cost of Segregation: The Relationship Between Racial Segregation and Subprime Lending
November 2009

Furman Center for Real Estate & Urban Policy
11/18/2009

This study examines whether the likelihood that borrowers of different races received a subprime loan varied depending on the level of racial segregation where they live. It looks both at the role of racial segregation in metropolitan areas across the country and at the role that neighborhood demographics within communities in New York City played.

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