3.6 References & Attributions


Agarwal, R., Liao, J. M., Gupta, A., & Navathe, A. S. (2020). The Impact Of Bundled Payment On Health Care Spending, Utilization, And Qu A Systematic Review: A systematic review of the impact on spending, utilization, and quality outcomes from three Centers for Medicare and Medicaid Services bundled payment programs. Health Affairs, 39(1), 50-57. https://doi.org/10.1377/hlthaff.2019.00784

Agency for Healthcare Research and Quality. (2022). Defining the PCMH. https://www.ahrq.gov/ncepcr/research/care-coordination/pcmh/define.html

Appelbaum, P. S., & Parks, J. (2020). Holding insurers accountable for parity in coverage of mental health treatment. Psychiatric Services, 71(2), 202-204. https://doi.org/10.1176/appi.ps.201900513

Aroh, D., Colella, J., Douglas, C., & Eddings, A. (2015). An example of translating value-based purchasing into value-based care. Urologic Nursing35(2), 61. https://doi.org/10.7257/1053-816x.2015.35.2.61

Basu, S., Phillips, R. S., Song, Z., Landon, B. E., & Bitton, A. (2016). Effects of new funding models for patient-centered medical homes on primary care practice finances and services: Results of a microsimulation model. The Annals of Family Medicine, 14(5), 404-414. https://doi.org/10.1370/afm.1960

Bean, M., Erdil, M., Blink, R., McKinney, D., & Seidner, A. (2020). Utilization review in Workers’ Compensation: Review of current status and recommendations for future improvement. Journal of Occupational and Environmental Medicine, 62(6), e273-e286. https://doi.org/10.1097/jom.0000000000001893

Bell, N., Wilkerson, R., Mayfield-Smith, K., & Lòpez-De Fede, A. (2021). Community social determinants and health outcomes drive availability of patient-centered medical homes. Health & Place, 67, 102439. https://doi.org/10.1016/j.healthplace.2020.102439.

Benefits.gov. (n.d.). State Children’s Health Insurance Program. https://www.benefits.gov/benefit/607

Berwick, D. M. (2011). Launching accountable care organizations—the  proposed  rule  for  the  Medicare  Shared Savings Program. New England Journal of Medicine, 364(16), e32. https://doi.org/10.1056/nejmp1103602

Blavin, F., Garrett, B., Blumberg, L., Buettgens, M., Gadsden, S. M., & Rifkin, S. (2014). Monitoring the impact of the Affordable Care Act on employers. https://webarchive.urban.org/UploadedPDF/413273-Monitoring-the-Impact-of-the-Affordable-Care-Act-on-Employers.pdf

Bohan, J. G., Madaras-Kelly, K., Pontefract, B., Jones, M., Neuhauser, M. M., Goetz, M. B., Burke, M. & Cunningham, F. (2019). Evaluation of uncomplicated acute respiratory tract infection management in veterans: A national utilization review. Infection Control & Hospital Epidemiology, 40(4), 438-446. https://doi.org/10.1017/ice.2019.16

Bresnick, J. (2019, December 18). Breaking down the basics of the patient-centered medical home. https://healthitanalytics.com/features/breaking-down-the-basics-of-the-patient-centered-medical-home

Bureau of Labor Statistics. (n.d.) Definitions of health insurance terms. https://www.bls.gov/ncs/ebs/sp/healthterms.pdf

Bureau of Labor Statistics. (2021). Glossary of employee benefit terms. https://www.bls.gov/ebs/publications/glossary-for-health-plan-provisions-in-private-industry-2020.htm

Centers for Disease Control and Prevention. (2023). Correctional health is community health. https://www.cdc.gov/correctionalhealth/default.htm

Centers for Medicare and Medicaid Services. (n.d.-a). Design and development of the Diagnosis Related Group (DRG). https://www.cms.gov/icd10m/version37-fullcode-cms/fullcode_cms/Design_and_development_of_the_Diagnosis_Related_Group_(DRGs).pdf

Centers for Medicare and Medicaid Services. (n.d.-b). Custodial care vs. skilled care. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Downloads/infograph-CustodialCarevsSkilledCare-%5BMarch-2016%5D.pdf

Centers for Medicare and Medicaid Services. (2020a). People dually eligible for Medicare and Medicaid. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf

Centers for Medicare and Medicaid Services. (2020b). National healthcare expenditures. https://www.cms.gov/files/document/highlights.pdf

Centers for Medicare and Medicaid Services. (2021). Annual financial report fiscal year 2021. https://www.cms.gov/files/document/cms-financial-report-fiscal-year-2021.pdf

Centers for Medicare and Medicaid Services. (2022a). Medicare beneficiaries at a glance. https://data.cms.gov/infographic/medicare-beneficiaries-at-a-glance

Centers for Medicare and Medicaid Services. (2022b). Shared Savings Program fast facts. https://www.cms.gov/files/document/2022-shared-savings-program-fast-facts.pdf

Centers for Medicare and Medicaid Services. (2023). HCPCS – general information. https://www.cms.gov/medicare/coding/medhcpcsgeninfo

Cha, A. E., & Cohen, R. A. (2022). Demographic variation in health insurance coverage: United States, 2020. https://www.cdc.gov/nchs/data/nhsr/nhsr169.pdf

Craig, S. V., Ericson, K. M., & Starc, A. (2021). How important is price variation between health insurers? Journal of Health Economics, 77, 102423. https://doi.org/10.1016/j.jhealeco.2021.102423

Davis, K., Abrams, M., & Stremikis, K. (2011). How the Affordable Care Act will strengthen the nation’s primary care foundation. Journal of General Internal Medicine, 26(10), 1201-1203. https://doi.org/10.1007/s11606-011-1720-y

Falkson, S. R., & Srinivasan, V. N. (2022). Health maintenance organization. StatPearls Publishing LLC.

Giardino, A. P., & Wadhwa, R. (2022). Utilization management. StatPearls Publishing LLC.

Gold, M. (1999). Financial incentives: current realities and challenges for physicians. Journal of General Internal Medicine, 14(Suppl 1), S6-S12. https://doi.org/10.1046/j.1525-1497.1999.00260.x

H1. (2023). Five answers to questions about hospital DRG codes. https://h1.co/blog/5-answers-to-questions-about-hospital-drg-codes/

Hartman, M., Martin, A. B., Washington, B., Catlin, A., & National Health Expenditure Accounts Team. (2022). National health care spending in 2020: Growth driven by federal spending in response to the COVID-19 pandemic: National health expenditures study examines US health care spending in 2020. Health Affairs41(1), 13-25. https://doi.org/10.1377/hlthaff.2021.01763

HealthCare.gov. (n.d.-a). How to pick a health insurance plan. https://www.healthcare.gov/choose-a-plan/plan-types/

HealthCare.gov. (n.d.-b) Preauthorization. https://www.healthcare.gov/glossary/preauthorization/

Heaton, J., & Tadi, P. (2020). Managed care organization. StatPearls Publishing LLC.

Hong, Y. R., Huo, J., & Mainous, A. G. (2018). Care coordination management in patient-centered medical home: Analysis of the 2015 medical organizations survey. Journal of General Internal Medicine, 33(7), 1004-1006. https://doi.org/10.1007/s11606-018-4439-1

Institute for Healthcare Improvement. (n.d.). IHI triple aim initiative. https://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

Jacobson, G., Damico, A., Neuman, T., & Gold, M. (2017). Medicare Advantage 2017 spotlight: Enrollment market update. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update/

James, J. (2012). Pay-for-performance. Health Affairs Health Policy Brief. https://www.healthaffairs.org/do/10.1377/hpb20121011.90233/

Kaiser Family Foundation. (2015). Medicare timeline. https://www.kff.org/medicare/timeline/medicare-timeline/

Kaiser Family Foundation. (2019a). Data note: Changes in enrollment in the individual health insurance market through early 2019. https://www.kff.org/report-section/data-note-changes-in-enrollment-in-the-individual-health-insurance-market-through-early-2019-data-note/#endnote_link_419694-1

Kaiser Family Foundation. (2019b). An overview of Medicare. Issue Brief. https://files.kff.org/attachment/issue-brief-an-overview-of-medicare

Kaiser Family Foundation. (2021). 2021 Employer health benefits survey. https://www.kff.org/report-section/ehbs-2021-section-1-cost-of-health-insurance/

Kaiser Family Foundation. (2023). Status of state Medicaid expansion decisions: Interactive map. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

Keisler-Starkey, K., & Bunch, L. N. (2022). Health insurance coverage in the United States: 2021. Washington, DC: US Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278.pdf

Mass, S. (2016). Moral hazard and adverse selection in health insurance. National Bureau of Economic Research. Digest, 4. https://www.nber.org/digest/apr16/moral-hazard-and-adverse-selection-health-insurance

Medicaid.gov. (n.d.-a). Program history. https://www.medicaid.gov/about-us/program-history/index.html

Medicaid.gov. (n.d.-b). Benefits. https://www.medicaid.gov/chip/benefits/index.html

Medpac. (2021). Outpatient hospital services payment system. https://www.medpac.gov/wp-content/uploads/2021/11/medpac_payment_basics_21_opd_final_sec.pdf

Merriam-Webster. (2022). Risk definition. https://www.merriam-webster.com/dictionary/risk

Moy, H. P., Giardino, A. P., & Varacallo, M. (2022). Accountable care organization. StatPearls Publishing LLC.

Namburi, N. & Tadi, P. (2022). Managed care economics. StatPearls Publishing LLC.

National Association of ACOs. (n.d.). Home. National Association of ACOs. https://www.naacos.com/#:~:text=As%20of%20January%202022%2C%20there

National Cancer Institute. (2018). What is the ICD? https://training.seer.cancer.gov/icd10cm/intro.html

National Indian Health Board. (2015). The legal foundations for delivery of health care to American Indians and Alaska natives. https://www.nihb.org/docs/05202015/Foundations%20of%20Indian%20Health%20Care%20(March%202015).pdf 

Navathe, A. S., Dinh, C., Dykstra, S. E., Werner, R. M., & Liao, M. (2020). Overlap between Medicare’s voluntary bundled payment and accountable care organization programs. Journal of Hospital Medicine, 15(6), 356-359. https://doi.org/10.12788/jhm.3288

NEJM Catalyst. (2018). What is pay for performance in healthcare?. NEJM Catalyst4(2). https://catalyst.nejm.org/doi/full/10.1056/cat.18.0245

Norris, L. (2023). Who’s paying for the ACA’s Medicaid expansion? The federal government – or each state?  https://www.healthinsurance.org/faqs/ive-heard-the-federal-government-pays-for-the-medicaid-expansion-but-only-for-a-few-years-then-the-state-is-on-the-hook-for-costs/

Olakunle, O., Brown, I. L., & Williams, K. (2011). Concurrent utilization review: Getting it right. Physician Executive, 37(3), 50-54. https://www.proquest.com/openview/69a943ffbec3b8d44fbd60721bdceafd/1?pq-origsite=gscholar&cbl=36212

Physicians Advocacy Institute. (n.d.). Medicare Shared Savings Program overview. Medicare Quality Payment Program (QPP). http://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/Advanced-APM-Pathway/Medicare%20Shared%20Savings%20Program%20Overview.pdf

Primary Care Collaborative. (2022). What is a Patient-Centered Medical Home? https://www.pcpcc.org/sites/default/files/page-files/PCMH-PCPCC-Infographic.pdf

Rudowitz, R., Artiga, S., & Arguello, R. (2014). Children’s health coverage: Medicaid, CHIP and the ACA. Kaiser Family Foundation. https://www.kff.org/health-reform/issue-brief/childrens-health-coverage-medicaid-chip-and-the-aca/

Saynisch, P. A., David, G., Ukert, B., Agiro, A., Scholle, S. H., & Oberlander, T. (2021). Model homes: Evaluating approaches to patient-centered medical home implementation. Medical Care, 59(3), 206–212. https://doi.org/10.1097/MLR.0000000000001497

Schneider, E. C., Shah, A., Doty, M. M., Tikkanen, R., Fields, K., & Williams, R. D. (2021). Mirror mirror 2021 reflecting poorly: Health care in the US compared to other high-income countries. https://heatinformatics.com/sites/default/files/images- videosFileContent/Schneider_Mirror_Mirror_2021.pdf

Siyarsarai, P., Gholami, K., Nikfar, S., & Amini, S. (2020). Optimization of health transformation plan by drug utilization review strategy in a pediatric teaching hospital. International Journal of Pediatrics8(11), 12503-12515. https://13abanpharmacy.tums.ac.ir/uploads/162/2023/Feb/19/Optimization%20of%20Health%20Transformation%20Plan%20by%20Drug%20Utilization.pdf

Smith, T. E., Haselden, M., Corbeil, T., Tang, F., Radigan, M., Essock, S. M., … & Olfson, M. (2020). Relationship between continuity of care and discharge  planning after hospital psychiatric admission. Psychiatric Services, 71(1), 75-78. https://doi.org/10.1176/appi.ps.201900233

Swartz, K. (2006). Reinsuring health. New York: Russell Sage Foundation.

U.S. Government Accountability Office. (2006). Definitions of insurance and related information. https://www.gao.gov/assets/gao-06-424r.pdf

Whitmore, H., Gabel, J. R., Pickreign, J., & McDevitt, R. (2011). The individual insurance market before reform: low premiums and low benefits. Medical Care Research and Review68(5), 594-606. https://doi.org/10.1177/1077558711399767

Zitter, M. (1997). A new paradigm in health care delivery: disease management. Disease Management: A Systems Approach to Improving Patient Outcomes. Chicago, Ill: American Hospital Publishing, Inc, 1-25.


Selected content from:

  1. “Introduction to the U.S. Healthcare System” by Thomas A. Clobes is licensed under CC BY-NC-SA 4.0 by-nc-sa. Chapters 1, 6, 8. https://scholarworks.calstate.edu/concern/educational_resources/nk322m064?locale=en
  2. Reprinted from United States: Health System Review 2020 , Vol 22(4), Ewout van Ginneken (ed.), Health Systems in Transition / Chapter 3 (pgs. 119-120, 122, 131, 138- 139, 142)/ Copyright 2020. Accessed January 30, 2023. https://eurohealthobservatory.who.int/publications/i/united-states-health-system-review-2020
  3. Economics – Theory Through Applicationsby Saylor Academy is licensed under CC BY-NC-SA 3.0. by-nc-sa. Chapter 16. https://socialsci.libretexts.org/Bookshelves/Economics/Book%3A_Economics_-_Theory_Through_Applications/16%3A_A_Healthy_Economy/16.02%3A_Supply_and_Demand_in_Health-Care_Markets.

Click here to move on to Chapter 4: Access, Quality, & Cost.


Icon for the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License

Exploring the U.S. Healthcare System Copyright © 2023 by Karen Valaitis is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

Share This Book