

Health Delivery Performance

Strategic Pillar Overview
How can firms and workers that operate within the health sector deliver the most health for the costs they incur? We address this question through interdisciplinary teams that consider management, operations, marketing, workforce optimization and the role of policy and payment in shaping the incentives that reward value and performance.
Highlights


Events
The Business of Caring for the Dying: A win-win? Or a moral hazard?
This panel explores the business models emerging around caring for the dying—from hospice to home-based care, Medicare Advantage innovations, and PACE programs—and asks whether private innovation can align with public values.
Events
Scaling Medical Education: Can New Schools Solve America's Doctor Shortage?
With physician shortages in the US, particularly in primary care and in underserved areas, this panel will explore the extent to which new medical schools may be effective or stymied in resolving shortages.

News
Conquering Cancer: 8 Expert Takeaways
Cancer represents one of medicine's most complex challenges. Within the umbrella of cancer are manifold diseases of abnormal growth, each with different causes, molecular mechanisms, and treatment approaches. Given the inherent complexity of addressing these many types of cancer, where does cancer detection, prevention, and treatment go from here?

Events
Medicare Advantage Supplemental Benefits: The Business of Caregiver Support
As Medicare Advantage plans expand their supplemental benefits to include caregiver support, this session will examine the emerging business models, implementation challenges, and the potential for meaningful impact on families navigating complex care needs.

News
Primary Care Reform: Aligning Payment, Policy, and Innovation
Hear from keynote speaker Sen. Sheldon Whitehouse and other panelists
Publication
The Innovation Imperative: Crossing the Valley of Death
Brian Miller for Social Science Research Network

Publication
Autonomous Artificial Intelligence for Diabetic Eye Disease Testing Improves Access and Equity in the Pediatric and Adult Populations: The Johns Hopkins Medicine Experience
Risa Wolf for Diabetes Spectrum

Publication
What Recent Changes In MA Mean For Affinity Plans And Supplemental Benefits
Andrew Anderson, Mark Meiselbach and Kali Thomas for Health Affairs Forefront
Publication
Population-Based Validation Results From the Drug Repurposing for Effective Alzheimer's Medicines (DREAM) Study
Jodi Segal for Clinical Pharmacology and Therapeutics
Publication
Immunogenic Profiling of Vancomycin: Detecting Vancomycin-Specific IgG in Patients With and Without Vancomycin Infusion Reactions
Santiago Alvarez Arango for Journal of Allergy and Clinical Immunology


Publication
Changes in US Primary Care Access and Capabilities During the COVID-19 Pandemic
Ellesse-Roselee Akré for JAMA Health Forum

Publication
Trends in mental health care and telehealth use across area deprivation: An analysis of electronic health records from 2016 to 2024
Catherine Ettman, Theodore J Iwashyna and Elizabeth Stuart for PNAS Nexus

Publication
Increases In Physician Professional Fees In Private Equity–Owned Gastroenterology Practices
Yashaswini Singh, and Daniel Polsky for Health Affairs

Publication
Exploring sociodemographic disparities in diagnostic problems and mistakes in the quest for diagnostic equity: insights from a national survey of patient experiences
Kathryn McDonald and Christina Yuan for Frontiers in Public Health

Publication
Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs
Katherine E M Miller, Ravi Gupta, and Daniel Polsky for Health Affairs Scholar

Publication
Paying for home care out-of-pocket is common and costly across the income spectrum among older adults
Karen Shen and Katharine Ornstein for Health Affairs Scholar

Publication
Addressing barriers to equitable telehealth for older adults
Bruce Leff for Frontiers Medicine

Publication
Adherence to FDA Guidance on Pulse Oximetry Testing Among Diverse Individuals, 1996-2024
Kadija Ferryman and Emmanuel Drabo for JAMA Network

Events
Primary Care Reform: Aligning Policy, Innovation, and Investment
How can innovation transform primary care delivery and financing? Join HBHI for an engaging event featuring expert panelists as they explore strategies to advance primary care.

News
Can Academic Health Systems be Learning Health Systems? 8 Expert Takeaways
Learning health systems center the patient experience as a critical component in the cycle of continuous improvement. How can academic health systems improve at delivering this kind of innovative performance?

Publication
Cost-effectiveness of AI for pediatric diabetic eye exams from a health system perspective
Tinglong Dai and Risa Wolf for NPJ Digital Medicine


Publication
How to Increase Living Kidney Donation—A Tale of Two Donors
Mario Macis for JAMA Network

Publication
Let Curves Speak: A Continuous Glucose Monitor based Large Sensor Foundation Model for Diabetes Management
Ritu Agarwal and Gordon Gao for arXiv

Publication
The CMS Sickle Cell Gene Therapy Access Model
Jeromie Ballreich and Mariana P. Socal for JAMA Pediatrics

Publication
Using AI as Gatekeeper or Second Opinion: Designing Patient Pathways for AI-Augmented Healthcare
Tinglong Dai for SSRN


Publication
Quality without harm: Keeping sight of patient safety
Albert Wu and Allen Kachalia for Journal of Patient Safety and Risk Management

Publication
Staggered Health Policy Adoption: Spillover Effects and Their Implications
Emilia Simeonova for Management Science

News
Prior Authorization and Trust in US Health Care
Expert panelists Ceci Connolly, CEO of Alliance of Community Health Plans; James P. Holland, President of Johns Hopkins Health Care; and Ravi Gupta, MD, PhD, Assistant Professor, Internist, and Prior Authorization Researcher, Division of General Internal Medicine.
Publication
Geriatric Home-Based Medical Care
Bruce Leff and colleagues provide a comprehensive resource for providers seeking to do house calls for older adults

Publication
Trends and Enrollment in Medicare Advantage “Affinity Plans”
Journal of General Internal Medicine

Publication
Reforming HSAs To Expand Gig Workers’ Access To Affordable Health Care
Ge Bai for Health Affairs Forefront

Publication
Characterizing patient portal use of people with cognitive impairment and potentially inappropriate medications
Jennifer Wolff and Casey Overby Taylor for Journal of American Geriatrics Society

Publication
Hearing Aid Use at the Intersection of Race, Ethnicity, and Socioeconomic Status
Ellesse-Roselee L. Akré and Nicholas S. Reed for JAMA Health Forum

Publication
Osteoporosis testing and treatment remain low in both Traditional Medicare and Medicare Advantage
Tej D. Azad, Rachel J. Wu, Kelly E. Anderson, Michael Darden & Amit Jain for Osteoporosis International

Publication
Development of a Diabetes Navigator Toolkit to Support Diabetes Technology Uptake: The IMPACT Toolkit
Risa Wolf for Clinical Diabetes

Publication
Single-encounter elicitation framework for diagnostic excellence patient-reported measures: SEE-Dx-PRM
Vadim Dukhanin and Kathryn McDonald for PEC Innovation

Publication
Beyond the Bottom Line: Assessing Charity Care, Community Benefits, and Tax Exemptions in Nonprofit Hospitals
Hossein Zare and Gerard Anderon for the Journal of Healthcare Management

Publication
Scenarios, not shortage forecasts, are key to better workforce policy
Melinda Buntin for Health Affairs Scholar

Publication
Higher Percentage of Virtual Primary Care Associated With Minimal Differences in Achievement of Quality Metrics
Jodi Segal, Maqbool Dada and K. Davina Frick for Medical Care

Publication
Categorizing Care Delays and Their Impact on Hospital Length of Stay
Shaker Eid for Quality Management in Health Care

Publication
How Artificial Intelligence is altering the nursing workforce
Olga Yakusheva for Nursing Outlook

Publication
US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care
Ge Bai for Health Affairs

Publication
Examining the use of telehealth to initiate buprenorphine for opioid use disorder treatment
Yimin Ge and Matthew Eisenberg for Health Affairs Scholar

Publication
De-risking Global Supply Chains: Looking Beyond Material Flows
Tinglong Dai for the National Bureau of Asian Research


Publication
State Full Practice Authority Regulations and Nurse Practitioner Practice Autonomy: Evidence From the 2018 National Sample Survey of Registered Nurses
Eric Slade and Laura Samuel for Medical Care Research and Review

News
AI for Medical Diagnosis and Prognosis: Reflections and Vision for 2025
Fireside chat between HBHI's Director and Bloomberg Distinguished Professor, Dan Polsky, PhD and Ziad Obermeyer, MD, Blue Cross of California Distinguished Associate Professor, Health Policy and Management, University of California, Berkeley

News
Organ Procurement in the U.S: Navigating Challenges & Shaping the Future
The panel, moderated by Mario Macis, PhD, Professor at Johns Hopkins University, included Andrew Cameron, MD, Director of Johns Hopkins School of Medicine Dept of Surgery; Alexandra Glazier, CEO, New England Donor Services; Jean Moody-Williams, RN, MPP, Deputy Center Director for CMS; Denis Wagner, MPA, Principal and Director of YES and Leadership, LLC

Research Project
2025 HBHI Pilot Grant Awardees
HBHI is pleased to announce our six pilot grant awardees for our 2025 cohort.

Publication
Chatting together: Using AI chatbots to improve diagnostic excellence
Albert Wu for Journal of Patient Safety and Risk Management


News
Exploring the Post-Election Healthcare Landscape
You’re invited to access this exclusive FMG Leading/Fierce Healthcare panel discussion featuring HBHI Director Dan Polsky to learn more.

News
Tailored Plan Design for Underserved Populations in Medicare Advantage: 8 Expert Takeaways
The panel, moderated by Andrew Anderson, PhD, Assistant Professor at Johns Hopkins University, included Andy Higgins, VP of Product Development at Clever Care; Sachin Jain, CEO of SCAN Group and SCAN Health Plan; Mark Meiselbach, Assistant Professor at Johns Hopkins University; and Casey Schwarz, Senior Counsel for Federal Policy.

Publication
The opioid industry's use of scientific evidence to advance claims about prescription opioid safety and effectiveness
Ravi Gupta and G Caleb Alexander for Health Affairs Scholar

Publication
Getting the diagnosis right: World Patient Safety Day 2024
Albert Wu and Kathryn McDonald in Journal of Patient Safety and Risk Management

Publication
Ethical Considerations in the Design and Conduct of Clinical Trials of Artificial Intelligence
Risa Wolf in JAMA Network Open

Publication
Macular Degeneration Drug Prescribing Patterns After Step Therapy Introduction in Medicare Advantage
Angela Liu Kelly E. Anderson, Joseph Levy, Daniel Polsky, and Gerard Anderson in JAMA Health Forum

News
Monthly AI Seminar Synopsis: Shaping the Responsible Use of AI
Featured speaker Dr. Nigam Shah from Stanford discussed the importance of aligning AI models with healthcare realities, particularly around capacity constraints and financial sustainability.

News
Creating and Scaling a Home-Based Care Ecosystem: 8 Expert Takeaways
The panel, moderated by Bruce Leff, MD, Professor of Medicine at Johns Hopkins, included Ali Khan, MD, MPP, FACP, Vice President and Chief Medical Officer – Aetna Medicare, Aetna/CVS Health Company; Eliza Pippa Shulman, DO, MPH, Chief Medical Officer at Medically Home; and Kristofer L. Smith, MD, MPP, Past-Chief Medical Officer at Optum at Home.

News
Cultivating Trust in Health Care: 8 Expert Takeaways
HBHI and the Center for Health Systems and Policy Models (CHSPM) invited a panel of three guests to discuss this issue: Senator Richard Burr, Chair of DLA Piper’s health policy strategic consulting service; Michael Darden, PhD, academic program director for the Master of Science in healthcare management at the Carey School of Business; and Lauren Taylor, professor in the Department of Population Health at NYU Grossman School of Medicine.
News
Addressing Healthcare's Carbon Footprint: 8 Expert Takeaways
HBHI convened an expert panel at the Hopkins Bloomberg Center in Washington, D.C. to discuss how the healthcare industry at large and providers at the grassroots level are working to bring about change.

News
HBHI Director Dan Polsky Leads National Academies Report to Expand Behavioral Health Provider Participation in Medicare and Medicaid
A new report by the National Academies of Sciences, Engineering, and Medicine examines the current challenges in increasing the behavioral health care workforce capacity to better meet the needs of publicly insured populations and proposes strategies to address those challenges.

Publication
Development of a hospital coding intensity measure based on sepsis diagnoses
Significant variation in coding intensity among hospitals has been observed and can lead to reimbursement inequities and inadequate risk adjustment for quality measures.

Publication
Valuing America's Health: Aligning Financing to Reward Better Health and Well-Being
The United States is experiencing a decline in life expectancy despite high health care spending due to a multitude of factors, including the COVID-19 pandemic, opioid epidemic, high burden of chronic disease, and systemic and structural inequities.

Publication
Overdiagnosis and Undertesting for Infectious Diseases
Congratulations to Johns Hopkins University Carey Business School Professors and HBHI Core Faculty members Shubhranshu Singh and Tinglong Dai on their recently accepted paper.

News
Can Americans Have Better and More Affordable Healthcare? 8 Expert Takeaways
The American healthcare system, an intricate web of providers, insurers, patients, and employers, has failed to improve meaningfully, despite decades of medical discovery and technological advancement, but has also become increasingly expensive. Why?

Events
Addressing Healthcare's Carbon Footprint
Featuring Expert Panelists Jeremey Greene, MD, PhD and Jodi Sherman, MD

Publication
The hospital at home in the USA: current status and future prospects
The annual cost of hospital care services in the US has risen to over $1 trillion despite relatively worse health outcomes compared to similar nations.

Publication
Algorithmic bias evaluation in 30-day hospital readmission models: A retrospective analysis of hospital discharges
The adoption of predictive algorithms in healthcare comes with the potential for algorithmic bias, which could exacerbate existing disparities.

Publication
Management of Patients with Complex Needs
Academic medical practices serve a valuable role in caring for patients with complex needs and training future internists in the many biopsychosocial components of patient care.

Publication
Randomized Experiments to Reduce Overuse of Health Care
Health care overuse is pervasive in countries with advanced health care delivery systems

Publication
Reducing Low-Value Health Care
The overuse of some medical services remains a chronic problem in the United States

News
Whose Business Is Health? Corporate Social Responsibility and the Health of Americans
Do companies have a responsibility for the health consequences of their products? Should those consequences drive how a company designs its product or service to be used by customers? What are the tradeoffs?

News
Blood Matters: Challenges and Opportunities in the Market for Blood and Blood Components
The goal of this webinar is to discuss the ecosystem of markets for blood and blood components in the US, the structure of the market ecosystem, the challenges faced, and the steps underway to address the challenges and ensure a stable supply of blood and blood components for patients in need.

News
Why Can't Americans Have Better and Cheaper Health Care? Exploring the Innovation Challenge
Why doesn't healthcare in the US improve in quality while becoming more affordable, as we see in other industries? Join us for an enlightening discussion with James (Jim) and Robert (Bob) Rebitzer, authors of "Why Not Better and Cheaper?"

Events
Hopkins Healthcare Business Conference
The Hopkins Healthcare Business Conference is a student produce event aiming to stimulate intellectual engagement, foster active participation, and provide robust networking opportunities for graduate students, academics, and industry leaders. The conference is centered on a commitment to multi-sectoral collaboration to support effective and equitable healthcare innovation.
March 7th and 8th

Publication
Trust and Health Care-Seeking Behavior
A unique feature of health care markets, recognized by Arrow (1963), is that a physician, the supplier of
medical services, is expected to act in the patient’s best interest.

Publication
Acute Hospital Care at Home in the United States: The Early National Experience
Hospitalization is the standard of care for acute illness, but hospital care is often expensive, unsafe, and uncomfortable (1).

Publication
Addressing the Drug-Shortage Crisis in Oncology
Patients with cancer face a crisis due to an ongoing shortage of essential chemotherapeutic drugs.

News
Psychedelics Treatment, Business, and Policy Futures: 8 Expert Takeaways
The application of psychedelic therapy for a range of mental and physical health issues is emerging as a transformative treatment method but federal policy has not kept pace with the industry’s rapid development. To understand the burgeoning business landscape surrounding this innovative therapy, the Hopkins Business of Health Initiative, in partnership with the Center for Mental Health and Addiction Policy, recently convened a panel of national experts to discuss the cutting-edge convergence of psychedelics, business, and policy.

News
AI and Healthcare Seminar Recap: Prof. Nicolson Price, University of Michigan Law School
Professor Nicholson Price, J.D., Ph.D., Professor of Health, University of Michigan Law School

News
AI and Healthcare Seminar Recap: Dr. Danton Char
Professor Danton Char, Stanford University School of Medicine; Faculty Affiliate, Institute for Human-Centered Artificial Intelligence (HAI)

Research Project
2024 Pilot Grants
HBHI is pleased to announce our five pilot grant awardees for our 2024 cohort.

Events
Why Can't Americans Have Better and Cheaper Health Care? Exploring the Innovation Challenge
Why doesn't healthcare in the US improve in quality while becoming more affordable, as we see in other industries? Join us for an enlightening discussion with James (Jim) and Robert (Bob) Rebitzer, authors of "Why Not Better and Cheaper?" We explored the unique challenges of healthcare innovation in the US, discussing why there's a lack of incentives for cost-reducing innovations and the ease of profiting from low-value innovations. The Rebitzers also shared their perspectives on directing healthcare innovation towards more efficient and cost-effective solutions. This is a crucial conversation for anyone interested in the future of American healthcare.

News
The Impact of Noncompetes on Healthcare: 7 Expert Takeaways
Non-compete agreements typically restrict employees from joining competitors or starting similar businesses within a given timeframe and geographical area after leaving their jobs. These kinds of covenants have become enormously widespread in the American economy, and even more so in the sector of health care.

Publication
Does Bad Medical News Reduce Preferences for Generic Drugs?
Policy makers and insurers promote the use of generic drugs because they can deliver large savings without sacrificing quality. But these efforts meet resistance from the public, who perceive generic drugs as inferior substitutes for brand name counterparts. Building on literature showing that negative emotions reduce risk-taking, the authors hypothesize that receiving bad medical news (i.e., negative information about one’s health) prompts patients to favor brand name over generic drugs as means to safeguard their health. The evidence exploits low-density lipoprotein cholesterol test results, where a discontinuity from clinical guidelines enables the authors to estimate the causal effect of bad medical news.

Publication
Impact of Physician Payment Scheme on Diagnostic Effort and Testing
Diagnostic effort, diagnostic testing, physician payment, healthcare operations management, artificial intelligence

Publication
Who Pays in Pay-for-Performance? Evidence from Hospital Prices and Financial Penalties
Public pay-for-performance (P4P) programs tie hospital payments to predetermined sets of quality measures and are intended to encourage or discourage certain outcomes

Publication
WHO Five Moments for Medication Safety: A time to organize?
Since the 2007 landmark report on Preventing Medication Errors from the US National Academy of Medicine, effective interventions have been developed to address medication errors.1 Despite this, medication errors persist as the most common source of harm for patients worldwide.2 In hospitals, adverse drug events are the most common adverse events, accounting in one large study for 39% of all events.3 Medication errors in ambulatory care settings are also an ongoing patient safety challenge.4

News
Digital Tools Are Putting Effective Behavioral Health Treatments in Patients' Pockets
It’s clear that changes in telehealth policy, mobile technology development, and consumer demand have fundamentally reshaped mental health treatment and substance use care in the US and around the world. What does this mean for people’s outcomes, specifically behavioral health care access, quality, and cost?

Publication
Workforce Composition In Private Equity–Acquired Versus Non–Private Equity–Acquired Physician Practices
Despite growth in private equity (PE) acquisitions of physician practices in the US, little is known about how changes in ownership influence workforce composition. Using clinician-level data linked to practice acquisition information, we estimated changes in clinician workforce composition in PE-acquired practice sites relative to non-PE-acquired independent practice sites for dermatology, ophthalmology, and gastroenterology specialties.

News
Incentive to Innovate: Corporate Solutions for America's Broken Health System
Around 150 million Americans rely on employers for access to health care. Can the companies who employ them help foster an affordable system that improves our health and doesn't drive us crazy in the process?

Publication
Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks
In this cohort study of nursing homes experiencing severe COVID-19 outbreaks, facilities experienced considerable staffing challenges during and after outbreaks. These results suggest the need for policy action to ensure facilities’ abilities to maintain adequate staffing levels during and after infectious disease outbreaks.

Publication
Association between Non-Profit Hospital Community Benefit Spending and Health Outcomes
Despite varying levels of non-profit hospital community benefit investment across counties, higher community benefit expenditures are not associated with an improvement in the selected health outcomes at the county level.

Publication
From COVID Vaccines to HIV Prevention: Pharmaceutical Financing and Distribution for the Public’s Health
The proposal for a national PrEP program applies some of the lessons of the national COVID vaccine campaign to HIV prevention.

Publication
Prioritising Surgical Cases Deferred by the COVID-19 Pandemic: An Ethics-Inspired Algorithmic Framework for Health Leaders
Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority?

Publication
Hopkins Study Links Fewer Primary Care Doctors, More Beds to Unnecessary Medical Care
Hospitals with a greater number of beds and fewer primary care physicians are more likely to provide unnecessary medical tests or treatments, according to a study led by researchers at the Johns Hopkins School of Medicine and Bloomberg School of Public Health