Leonard Davis Institute for Health Economics
Since 1967, the Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to data-driven, policy-focused research that improves our nation’s health and health care. Originally founded to bridge the gap between scholars in business (Wharton) and medicine at the University of Pennsylvania, LDI now connects all of Penn’s schools and the Children’s Hospital of Philadelphia through its more than 240 Senior Fellows. LDI’s research focuses on the key themes of insurance reform, health care delivery, healthy behaviors, and vulnerable populations.
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Publication Paying for Value and Health Equity in Community Health Centers(Leonard Davis Institute, 2025-02-25) Paula Chatterjee, MD, MPH; Janet Weiner, PhD, MPH; Rachel M. Werner, MD, PhDCommunity health centers (CHCs) face substantial obstacles to participation in value-based payment models, in which payers reward performance on health outcomes. Further, these models rarely measure and reward efforts toward population health equity, a central CHC goal and outcome. In this issue brief, we recommend ways to promote and enhance CHC participation in value-based payment, and strategies to align these efforts with health equity goals. We base these recommendations on a series of focus groups and conversations with frontline CHC leaders, payers, and payment policy experts.Publication Simple Visual Aids Raise Awareness and Knowledge About HIV Treatment(Leonard Davis Institute, 2025-03-26) Aaron Richterman; Tamar Klaiman; Rebecca Connelly; Daniel Palma; Eric Ryu; Laura Schmucker; Katherine Villarin; Gabrielle Grosso; Kathleen A. Brady; Harsha Thirumurthy; Alison ButtenheimBottles filled with red and black beads representing the HIV virus among healthy cells improve understanding of terminology, attitudes toward living with HIV, and the intention to take medication to prevent transmission. People living with HIV in Philadelphia interacted with B-OK bottles (Figure 1) while a researcher explained that they show the amount of virus in the body when HIV is diagnosed, if HIV is untreated, and with daily antiretroviral therapy. B-OK increased understanding that medication prevents dying from HIV and reduces the risk of transmitting the virus to others. The bottles could support a U.S. initiative to cut new HIV diagnoses, currently stuck at 38,000 per year, by 90% by 2030.Publication Practice Specialization and Post-acute Outcomes of Patients with Dementia in Skilled Nursing Facilities(2025) Seiyoun Kim, PhD; Hye-Young Jung, PhD; Derek Lake, PhD; Rebecca T. Brown, MD, MPH; Rachel M. Werner, MD, PhD; Jason Karlawish, MD; Kira Ryskina, MDObjective: To evaluate the effects of physician and advanced practitioner specialization in skilled nursing facility (SNF)-based practice (SNFists) on the outcomes of patients with Alzheimer’s disease and related dementias (ADRD) admitted to SNF for post-acute care. Study Setting and Design: Taking advantage of the natural experiment provided by the growth of SNFists, we conducted a within-SNF differencein-differences analysis with cross-temporal matching. Our primary outcome was functional improvement at SNF discharge, measured using a validated activities of daily living (ADL) score. Secondary outcomes included unplanned rehospitalization, emergency department (ED) visits, observational stays within 30 days of SNF admission, successful discharge to the community, SNF length of stay, admission into long-term nursing home care within 6 months of SNF discharge, and 30- and 60-day Medicare payments for professional and facility services. Data Sources and Analytic Sample: Medicare facility and professional claims and Nursing Home Minimum Data Set (MDS) data from 2012 and 2019 were used. The study sample included 338,574 community dwelling fee-for-service Medicare beneficiaries with ADRD, age 65 or older, discharged from an acute care hospital to one of the 5,196 SNFs that experienced an increase in patients treated by SNFists. Principal Findings: We did not observe an association between SNFist care and patient post-acute care outcomes or costs. Conclusions: Specialization in SNF-based practice among physicians and advanced practitioners alone may not be an effective strategy to improve post-acute care outcomes or reduce costs to Medicare for patients with ADRDPublication Community Health Centers and Value-Based Payment(Leonard Davis Institute of Health Ecoomics, 2024-04-01) Weiner, JanetCommunity health centers (CHCs) are a bedrock of the social safety net in the United States, providing care to vulnerable people in their communities, often for little or no cost to them. CHCs operate through funding streams and reimbursement mechanisms that pose challenges to participating in newer forms of value-based payment. This issue brief provides a snapshot of CHCs and the people they serve, how they currently are funded and reimbursed, how they fit into the landscape of value-based payment, and how alternative payment policies can align with their mission and mandate.Publication Expiration of the USDA Supplemental Nutrition Assistance Program (SNAP) Emergency Allotments(Leonard Davis Institute of Health Ecoomics, 2023-08-31) Richterman, Aaron; Roberto, Christina; Thirumurthy, HarshaThe U.S. Department of Agriculture (USDA) Supplemental Nutrition Assistance Program (SNAP) is the nation’s largest federal nutrition assistance program, providing monthly benefits for food to more than 42 million low-income people.1 SNAP has been proven to lift families from poverty and reduce food insecurity–inconsistent access to an adequate, nutritious diet.2 The COVID-19 pandemic brought U.S. food insecurity to its highest levels in recent history,3 prompting Congress to pass legislation allowing temporary issuance of additional SNAP benefits, called Emergency Allotments, to SNAP recipients. Emergency Allotments increased SNAP benefits substantially, adding an average of $126 to the monthly benefit in the first year and $166 in subsequent years.4 Emergency Allotments ended in March 2023, but 18 states ended them early, when their state public health emergency expired.Publication Using Financial Incentives to Treat Stimulant Use Disorders(2024-01-18) Beatty, Benicio; Komaragir, Ameya; Weiner, JanetStimulants are playing a prominent role in the current U.S. overdose crisis. As stimulant use continues to mount, the need for evidence-based treatment grows more urgent. This brief highlights contingency management, the most effective treatment for stimulant use disorder, and reviews the current barriers to its widespread use along with practice and policy strategies for increasing implementation.Publication Medicare Payment Policy for Post-Acute Care in Nursing Homes(2023-09-14) Schotland, Samuel; Werner, Rachel M.; Janet WeinerThe costs and quality of post-acute care (PAC) have come under increasing scrutiny for the value they provide to the nearly 40% of patients receiving specialized nursing or rehabilitation after hospital discharge. Much of this scrutiny focuses on skilled nursing facilities (SNFs), which account for a disproportionate amount of spending. The stakes are high for Medicare, the primary payer of post-acute services, for the nursing home industry, which relies on these short-stay patients to subsidize long-term residents, and for patients and families themselves. This Issue Brief reviews Medicare coverage and payment policy around PAC, trends in utilization and costs in SNFs, and what we know about quality and outcomes. We recommend ways to improve the value of these services through payment policies that align incentives across payers and settings.Publication Does Schooling Improve Cognitive Abilities at Older Ages?(Leonard Davis Institute of Health Ecoomics, 2023-02-02) Tachibana, ChrisIn older U.S. adults, higher levels of education resulted in better performance on tests that assess cognitive function in a study using innovative methods that provided average causal effects of schooling on a broad population. Higher cognitive scores were most prominent among college-educated individuals compared to high school graduates: A college education led to the equivalent of a 1.4- to 5.4-point increase on a 100-point cognitive test.Publication To Protect and Serve(Leonard Davis Institute of Health Ecoomics, 2023-07-14) Weiss, Madison; Weiner, JanetLocal police officers and other external law enforcement officers are ubiquitous in emergency departments (EDs) across the country. But the job of law enforcement to protect public safety can sometimes conflict with clinicians’ dedication to patient care while putting patient privacy, autonomy, and trust at risk. This brief reviews published work examining ambiguities around the role of law enforcement in EDs.Publication Expanding Scope of Practice After COVID-19(2021-02-15) Weiner, JanetTo expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.