ACO Contracts With Downside Financial Risk Growing, But Still In The Minority.
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ABSTRACT:
SUBMITTER: Peck KA
PROVIDER: S-EPMC8559781 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveThis study examined whether positive changes in social attitudes and policies surrounding sexual minority relationships have translated to diminished deleterious effects of minority stress on relationship quality.BackgroundSexual minority emerging adults now come of age at a time of greater equality and acceptance than previous generations. Research has demonstrated consistent negative effects of stigma-theorized as minority stress-on relationship quality for sexual minority individuals. However, given the improving social climate, questions remain regarding whether minority stress has the same deleterious effects on the romantic relationships of sexual minority emerging adults.MethodFive-hundred forty-nine individuals in relationships drawn from a US national probability sample completed a survey containing validated measures of minority stressors and relationship satisfaction. Responses from emerging adults (aged 18-25) were compared to two cohorts who came of age during the HIV/AIDS crisis (aged 34-41) and post Stonewall (aged 52-59).ResultsEmerging adults were more satisfied with their relationships than older cohorts. Experiences of everyday discrimination were associated with decreased relationship satisfaction for all cohorts; however, felt stigma, stigma concealment, and internalized stigma were associated with lower relationship satisfaction for older but not younger cohorts.ConclusionFindings illustrate the continued but shifting role of minority stress and provide the first evidence that social and policy changes may have translated into more positive relationship experiences for sexual minority emerging adults.
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Project description:Risk taking is central to human activity. Consequently, it lies at the focal point of behavioral sciences such as neuroscience, economics, and finance. Many influential models from these sciences assume that financial risk preferences form a stable trait. Is this assumption justified and, if not, what causes the appetite for risk to fluctuate? We have previously found that traders experience a sustained increase in the stress hormone cortisol when the amount of uncertainty, in the form of market volatility, increases. Here we ask whether these elevated cortisol levels shift risk preferences. Using a double-blind, placebo-controlled, cross-over protocol we raised cortisol levels in volunteers over 8 d to the same extent previously observed in traders. We then tested for the utility and probability weighting functions underlying their risk taking and found that participants became more risk-averse. We also observed that the weighting of probabilities became more distorted among men relative to women. These results suggest that risk preferences are highly dynamic. Specifically, the stress response calibrates risk taking to our circumstances, reducing it in times of prolonged uncertainty, such as a financial crisis. Physiology-induced shifts in risk preferences may thus be an underappreciated cause of market instability.
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Project description:The Medicare Shared Savings Program (MSSP) adjusts savings benchmarks by beneficiaries' baseline risk scores. To discourage increased coding intensity, the benchmark is not adjusted upward if beneficiaries' risk scores rise while in the MSSP. As a result, accountable care organizations (ACOs) have an incentive to avoid increasingly sick or expensive beneficiaries. We examined whether beneficiaries' exposure to the MSSP was associated with within-beneficiary changes in risk scores and whether risk scores were associated with entry to or exit from the MSSP. We found that the MSSP was not associated with consistent changes in within-beneficiary risk scores. Conversely, beneficiaries at the ninety-fifth percentile of risk score had a 21.6 percent chance of exiting the MSSP, compared to a 16.0 percent chance among beneficiaries at the fiftieth percentile. The decision not to upwardly adjust risk scores in the MSSP has successfully deterred coding increases but might discourage ACOs to care for high-risk beneficiaries in the MSSP .
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Project description:BackgroundHealth-related social needs (HRSN) are associated with higher chronic disease prevalence and healthcare utilization. Health systems increasingly screen for HRSN during routine care. In this study, we compare the differential prevalence of social risk factors and social needs in a Medicaid Accountable Care Organization (ACO) and identify the patient and practice characteristics associated with reporting social needs in a different domain from social risks.MethodsCross-sectional study of patient responses to HRSN screening February 2019-February 2020. HRSN screening occurred as part of routine primary care and assessed social risk factors in eight domains and social needs by requesting resources in these domains. Participants included adult and pediatric patients from 114 primary care practices. We measured patient-reported social risk factors and social needs from the HRSN screening, and performed multivariable regression to evaluate patient and practice characteristics associated with reporting social needs and concordance to social risks. Covariates included patient age, sex, race, ethnicity, language, and practice proportion of patients with Medicaid and/or Limited English Proficiency (LEP).ResultsTwenty-seven thousand four hundred thirteen individuals completed 30,703 screenings, including 15,205 (55.5%) caregivers of pediatric patients. Among completed screenings, 13,692 (44.6%) were positive for ≥ 1 social risk factor and 2,944 (9.6%) for ≥ 3 risks; 5,861 (19.1%) were positive for social needs and 4,848 (35.4%) for both. Notably, 1,013 (6.0%) were negative for social risks but positive for social needs. Patients who did not identify as non-Hispanic White or were in higher proportion LEP or Medicaid practices were more likely to report social needs, with or without social risks. Patients who were non-Hispanic Black, Hispanic, preferred non-English languages or were in higher LEP or Medicaid practices were more likely to report social needs without accompanying social risks.ConclusionsHalf of Medicaid ACO patients screened for HRSN reported social risk factors or social needs, with incomplete overlap between groups. Screening for both social risks and social needs can identify more individuals with HRSN and increase opportunities to mitigate negative health outcomes.
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Project description:Summary The shift to climate neutrality requires new process technologies for energy-intensive industries, such as steel, chemicals, or cement. A variety of technology options exist – but they face the challenges of (i) first-of-kind costs, (ii) higher operation and investment costs, and (iii) insufficient and uncertain carbon prices, which partly stem from political uncertainty. Existing innovation policy instruments and carbon policies such as price floors can only partly address these challenges. Project-based carbon contracts-for-difference (CCfDs) guarantee investors a fixed carbon price over the contract duration, thus de-risking such investments from political and market uncertainty, and allowing governments to set carbon prices above current levels. Here we show for a case study in the steel sector that carbon mitigation costs can be reduced by up to 27% and that owing to high incremental operation costs, price floors of 79% of the CCfD price would be needed for projects to achieve bankability. Graphical abstract Highlights • Low-carbon industry faces higher costs but low and uncertain carbon prices• Project-based carbon contracts-for-difference (CCfD) secure revenue from carbon savings• When incremental OPEX are high, high price floors needed to enable bankability• CCfDs lower carbon mitigation costs for steel by up to 27% compared to no policy Energy flexibility; Energy Modelling; Energy policy; Energy resources;
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