Innovative Payment Research Articles

Primary Care First Initiative: Impact on Care Delivery and Outcomes

Problem definition: The Centers for Medicare & Medicaid Services launched the Primary Care First (PCF) initiative in January 2021. The initiative builds upon prior innovative payment models and aims at incentivizing a redesign of primary care delivery, including new modes of delivery, such as remote care. To achieve this goal, the initiative blends capitation and fee-for-service (FFS) payments and includes performance-based adjustments linked to service quality and health outcomes. We analyze a model motivated by this new payment system, and its impact on the different stakeholders, and derive insights on how to design it to reach the best possible outcome. Methodology/results: We propose an analytical model that captures patient heterogeneity in terms of health complexity, provider choice of care-delivery mode (referral to a specialist, in-person visit, or remote care), and quality of service (health outcomes and wait time). We analyze the provider decision on the mode of care delivery under both FFS and PCF and study whether PCF can be designed to yield a socially optimal outcome. We characterize analytically when patients, payer, and providers are better off under PCF and show that, in many cases, PCF can be designed to yield a socially optimal outcome. We numerically calibrate our model for 14 states in the United States. We observe that the average health status in a state is a source of heterogeneity that crucially drives the performance of PCF. We find that the model motivated by the current PCF implementation results in too much adoption of referral care and too little adoption of remote care. In addition, states with poor average health status may use more in-person care than socially optimal under a baseline (low) level of capitation. Moreover, relying on high levels of capitation leads to low adoption of in-person care. Managerial implications: Our results have health policy implications by shedding light on how PCF might impact patients, payer, and providers. Under the current performance-based adjustments, low levels of capitation should be preferred. PCF has the potential to be designed to achieve socially optimal outcomes. However, the fee per visit may need to be tailored to the local population’s health status. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.1207 .

Does Central Bank Digital Currency (CBDC) Payment Create The Opportunity For the Tourism Industry?

This research investigated perceived risks associated with central bank digital currency (CBDC) payment innovations and their effect on travelers’ adoption behavior, considering personal and product characteristics. This quantitative study determined that perceived risks, including financial, performance, privacy, psychological, and time risks, have an adverse effect on attitudes toward CBDC payment, which, in turn, affects the intention to adopt. In addition, this study underlined the moderating roles of consumer innovativeness, previous experience, structural assurance, and media encouragement in the link between perceived risk and attitude. The results advanced the understanding of travelers’ intention to use CBDC to pay for tourism products and services.

Impacts of Outpatient Payment Reforms on Volume and Expenditures in Public Hospitals: Evidence from a Quasi-Experimental Analysis in Zhejiang, China.

China developed an innovative episode-based payment scheme for outpatient care, namely "Ambulatory Patient Groups (APGs) + capitation" payment, to constrain inflation in outpatient expenditures. This study aimed to assess the effects of this payment method on volume and expenditures in Chinese public hospitals. A quasi-experimental study was conducted with 7 municipal and 12 county hospitals from Jinhua as the intervention group and 15 municipal and 24 county hospitals from three neighbouring cities as the control group. The payment reform was introduced to municipal and county hospitals in the intervention group in January 2020 and January 2021, respectively. Monthly data on volumes and outpatient expenditures were collected from each hospital from January 2019 to December 2021. Controlled interrupted time-series analyses were performed to determine the effects of the funding reforms. Outpatient visits in municipal hospitals decreased by 1417.54 (p=0.048) per month on average compared with control ones after the reform was implemented, whilst that in county hospitals increased by 1058.04 (p=0.041) per month on average. The trend of drug expenditures (β 7=-1.41, p=0.019) in municipal hospitals dropped, which was accompanied by an immediate reduction in consumable expenditures (β 6 =-6.89, p=0.044). The funding reform also led to the significant declines in drug (β 6=-10.96, p=0.009) and consumable (β 6=-4.78, p=0.041) expenditures in county hospitals. Municipal hospitals experienced the drop in the trend of total outpatient expenditures (β 7=-3.99, p=0.018) over the same period. The strength of the "AGPs + capitation" payment for outpatient care lies in its ability to control the excessive growth of medical expenses through correcting inappropriate incentives. However, minimising potential cost-shifting and risk-shifting to uninsured service items should be given attention.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Modernizing payment to critical access hospitals: A proposal for the next iteration of the Flex Program.

Pay-for-performance and tools for quality assurance in health care

Ongoing health care reforms in the countries of Southeast Europe (SEE) to modernise and promote the health sector include the introduction of innovative payment methods for health care providers in hospitals and outpatient services. The idea of remunerating health workers according to the work they do and the results they achieve has been present in the countries of SEE for more than four decades. This includes the need to develop and implement objective measures and criteria to regulate the work of health facilities and health professionals. Implementing the "Pay-for-performance" (P4P) model is a major challenge with the risk of compromising the quality of health services in all countries, and positive experiences for quality assurance have been modest in many countries around the world. Standards and norms (S/N), clinical pathways (CPW) and checklists (CL) are necessary regulatory tools that complement each other to protect the quality of health services and implement the "Payment for success" (P4S) model. The absence of S/N, CPW and CL in the implementation of the P4P model leads to inefficiencies, inadequate/unrealistic numbers, and poor quality of health services, as well as more frequent medical errors. With the development, introduction and implementation of S/N, CPW and CL in the application of the P4S model, everyone benefits: patients, healthcare organisations and their employees, health insurance companies, ministries of health and the state.

A RACE pathway for inventing and sustaining mobile payment innovation - A case study of a leading Bank in Taiwan

This study aimed to propose a resource framework called RACE to demonstrate how a conventional financial service provider developed a defensive strategy to secure existing assets and dynamically evolved to enter new areas of competition and achieve offensive success. RACE stands for technology resources (R), strategic alliances (A), customers (C), and ecosystems (E), which represent the critical resources of a conventional bank for digital transforming in the mobile payment market. The study adopts an explorative single case study to analyze Inter-firms’ coopetition in the market and to explore how competitive advantages were developed through a critical path of RACE model. The revelatory case is a leading financial institute in Taiwan. A qualitative case analysis was conducted and the results revealed that through dynamic interplays of the proposed RACE model among the internal and external resources, a conventional enterprise can create new competition battleground and develop new types of coopetition. The innovative disruption in advancing mobile payment is not a straightforward process, the journey is full of challenges from defensive resource exploitation to offensive market acceleration. The Implications of the evolving path of the RACE model provide various avenues for further research on the dynamic capabilities, and the results are suggested for academics and practitioners in the era of digital disruption.

Medicaid best price reforms to enable innovative payment models for cell and gene therapies

ABSTRACT Background Cell and gene therapies promise durable benefits but face financial challenges from the uncertainty in their performance. Value-based purchasing arrangements (VBPAs) can address uncertainty but have been inhibited in the US by the Medicaid Drug Rebate Program (MDRP) approach to determining Medicaid Best Price (MBP) rebates. The likely effectiveness of MDRP reform proposals enabling VBPAs is examined in this study for durable cell and gene therapies. Methods Monte Carlo simulations examined three potential reforms (Multiple Best Prices, Bundled Sales, and National Pooling) to determine the impact on payment misalignment, the required payer size to participate, and the percentage of total lives covered by a VBPA. Results Simulation results suggest that 11% to 54% of commercial US lives would be feasibly covered by a VBPA depending on reform type and condition size. MPB reform achieved the highest commercial contracted percentage and lowest misalignment for commercial payers compared to National Pooling and Bundled Sales. State Medicaid plan results suggest lower extreme misalignment across all successfully contracted instances than commercial payers. Conclusions The Multiple Best Prices will likely enable VBPAs for many durable cell and gene therapies and larger payers. Further reforms may be needed to extend VBPAs to ultra-orphan conditions.

Promoting Access to Innovative Anticancer Medicines: A Review of Drug Price and National Reimbursement Negotiation in China.

Providing universal access to high-cost medications like anticancer drugs is not an easy feat. Although basic medical insurance has covered over 95% of China's population since 2012, reimbursement for high-priced medicines is limited. In 2015, the Chinese government proposed establishing an open and transparent price negotiation mechanism for some patented and expensive drugs, where oncology was among the prioritized areas. In 2016, three drugs (gefitinib, icotinib, and tenofovir disoprox) underwent negotiation with the government, eventually reducing their prices by over 50% so that they could be prioritized during reimbursement processes. Focusing on anticancer medicines, this study comprehensively summarizes the progress in drug price and national reimbursement negotiation in China. Furthermore, we investigated the changes and development regarding negotiated anticancer medicines from quantity negotiated, classification, indication coverage, utilization, and procurement spending. Our findings could provide a reference for follow-up negotiations and reimbursement policies for high-value anticancer medications in other countries. From 2016 to 2021, 82 anticancer medicines were newly incorporated into the national reimbursement drug list (NRDL) via 6 rounds of negotiation. The majority of these were innovative pharmaceutics (ie, protein kinase inhibitors (28) and monoclonal antibodies (13)). Drug pricing and national reimbursement negotiation led to a marked decrease in prices and a sharp increase in the utilization of negotiated anticancer medicines. Following negotiations, the defined daily doses (DDDs) of innovative anticancer medicines experienced remarkable growth. Their proportion in total anticancer drugs DDDs also increased from 3.4% in 2014 to 20.9% in 2019. However, although drug prices decreased substantially after the negotiations, insurance spending still showed an upward trend owing to the significant increase in utilization. This calls for the government to carefully monitor the rational use of these expensive medicines and explore innovative payment models.

When Reality Does Not Meet Expectations-Experiences and Perceived Attitudes of Dutch Stakeholders Regarding Payment and Reimbursement Models for High-Priced Hospital Drugs.

This study aimed to identify the current experiences with and future preferences for payment and reimbursement models for high-priced hospital therapies in the Netherlands, where the main barriers lie and assess how policy structures facilitate these models. A questionnaire was sent out to Dutch stakeholders (in)directly involved in payment and reimbursement agreements. The survey contained statements assessed with Likert scales, rankings and open questions. The results were analyzed using descriptive statistics. Thirty-nine stakeholders (out of 100) (in)directly involved with reimbursement decision-making completed the survey. Our inquiry showed that currently financial-based reimbursement models are applied most, especially discounts were perceived best due to their simplicity. For the future, outcome-based reimbursement models were preferred, particularly pay-for-outcome models. The main stated challenge for implementation was generating evidence in practice. According to the respondents, upfront payments are currently implemented most often, whereas delayed payment models are preferred to be applied more frequently in the future. Particularly payment-at-outcome-achieved models are preferred; however, they were stated as administratively challenging to arrange. The respondents were moderately satisfied with the payment and reimbursement system in the Netherlands, arguing that the transparency of the final agreements and mutual trust could be improved. These insights can provide stakeholders with future direction when negotiating and implementing innovative reimbursement and payment models. Attention should be paid to the main barriers that are currently perceived as hindering a more frequent implementation of the preferred models and how national policy structures can facilitate a successful implementation.

The development of digital payments – Past, present, and future – From the literature

We seek to deepen and increase knowledge on the evolution of scholarship regarding digital payments by highlighting the main interpretative strands in the literature and the changes, if any, in research approaches. Using bibliometric and scientometric measures, we explore research hotspots and developmental trends in digital payments to identify influential aspects of published contributions and research streams. Our sample consists of 723 articles published between 1985 and 2021 obtained from the Web of Science. The results show that the most investigated digital payments are mobile payments, with the main analysis methodologies typically linked to technology adoption models. This review, original in terms of sample size and methodology, advances knowledge on the evolution of innovative payments and guides scholars in visualising various research models.

Designing and implementing a local residential property tax from scratch: lessons from the Republic of Ireland

Assigning recurrent taxes on immovable property to cities, municipalities, and rural districts is a common practice around the world. The Republic of Ireland is no different, with its annual taxes on real property assigned to local government. Following the 2008 financial crisis and the austerity era that ensued, Ireland’s property taxes underwent major reform, most notably the design and implementation of a new residential property tax 35 years after abolition of the previous system of ‘rates’ on residential properties. In this paper the new or different features of Ireland’s residential property tax are outlined, including the use of self-assessment and valuation bands, innovative payment methods and also the multiple compliance mechanisms for taxpayers. While recognising the importance of country-specific and local circumstances in property tax design, the paper concludes that elements of Ireland’s new residential property tax have potential lessons for other jurisdictions contemplating similar tax reform. These relate to the key tax principles of simplicity and public acceptability, and on specific design features of assessment and valuation, and collection and compliance.

THE GROWTH TRAJECTORY OF UPI-BASED MOBILE PAYMENTS IN INDIA: ENABLERS AND INHIBITORS

"Unified Payments Interface" (UPI), an innovative mobile-based payment system, was introduced by the Government of India to support its digitization initiatives. Not just in India, UPI has expanded globally by being implemented in Bhutan and is on the verge of being launched in ten more countries in north and southeast Asia and, the UAE & Africa. Thus the study examines UPI's growth and significance to the transformation of India's mobile payment systems, its global reach and further expansion. The study consists of two parts, with an initial focus on scholarly literature published in the last five years since the UPI's inception in April 2016. Out of 177 papers, the method yielded 14 notable peer-reviewed publications. Other sources include government policy papers, news materials, and research undertaken by national or international organizations such as Kantar, Statista, ASSOCHAM, Deloitte, Nielson, Ericsson, etc. Despite its early launch, UPI swiftly outperformed all other digital payment methods in India, including mobile wallets. Google Pay, PhonePe and Paytm were early drivers of UPI payments. However, the government-backed Bharat Interface for Money application failed to achieve its potential. Moreover, the Covid-19 pandemic has little impacted the growth of UPI. Another major finding is that transaction failure, and cyber frauds must be addressed for improved UPI uptake, and a greater focus will be on credit and cash withdrawals via UPI. The study concluded that Near field communication-based UPI payments will revolutionize peer-to-merchant payments.

Payment Intermediary – Key Determinant Influencing Online Payment Intention on E-Commerce Platforms in Vietnam

E-commerce is a new, rising phenomenon in Southeast Asian countries, and online payment methods are becoming increasingly popular on e-commerce platforms. Despite increasing investments in e-commerce platforms' online payment systems, Vietnamese consumers are still doubtful about this innovative payment alternative. This research applied the Technology Acceptance Model (TAM) to analyze the variables affecting customers' intention to make online payments on e-commerce platforms in Vietnam, a potential Southeast Asian market. In addition, the research group expanded on the primary study by adding the variables of Subjective Norms, Trust, and Risk to validate the findings of the original work in the new context. A new factor suitable for Vietnamese conditions, Payment Intermediary, was included by the authors to better explain the consumers’ attitudes and intentions toward online payments. The surveys were carried out using two methods of basic random sampling: an offline approach at offices and schools, and an online approach using social media. 521 questionnaires were collected, and 448 were considered valid and met the requirements that were initially set. SPSS 26 was used to assess the consistency and validity of all variables and test the hypotheses using a regression model. The hypothesis model was verified. The results showed that the correlation between independent and dependent variables, namely Attitude toward Use and Intention to Use, is very clear. In consumers' use of e-commerce platforms, Payment Intermediary plays a crucial role in developing their online payment attitudes and intentions.

PP111 Reimbursement And Payment Models: A Survey Of Stakeholders’ Current Experiences And Future Outlook Within The Dutch Policy Setting

IntroductionThe constant evolution of high-priced hospital drugs with large uncertainties are increasingly challenging the sustainability of many healthcare reimbursement systems. Consequently, more attention is paid to exploring innovative payment and reimbursement models that may contribute to sustainable healthcare funding mechanisms yet still ensure timely patient access to health intervention. However, more insight is needed into the experiences of stakeholders involved in making payment and reimbursement arrangements as they may play an essential part in successfully implementing innovative reimbursement and payment models in the future.MethodsBetween May and July 2021, a survey was sent out to Dutch stakeholders directly or indirectly involved in payment and reimbursement agreements. The survey questioned the current use of and future preferences for reimbursement and payment models for high priced hospital drugs using Likert scales. Results were analyzed using descriptive statistics.ResultsOur inquiry shows that currently financial-based reimbursement models are applied most often, especially discounts due to their simplicity. In the future, outcome-based reimbursement models are preferred more, particularly pay-for-outcome. The main challenge for implementation is generating evidence in practice.Upfront payment is currently the most frequently applied payment model, according to the respondents, whereas delayed payment models are preferred to be applied more often. Particularly payment at outcome-achieved models are preferred but they can be administratively difficult to arrange.The respondents are moderately satisfied with the payment and reimbursing system in the Netherlands, arguing that especially transparency about the final agreement and mutual trust could be improved.ConclusionsDespite the preference healthcare payers have for using outcome-based reimbursement models and delayed payment models, currently they are rarely applied. The insights from our survey can provide Dutch stakeholders with future direction when implementing innovative reimbursement and payment models. Attention should be paid to which barriers are currently perceived and how policy structures can facilitate implementation. Further research should focus on exploring which combinations of reimbursement and payment models are most likely to be successful in the Netherlands.

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

Community mental health facilities often do not offer the full range of evidence-based clinical and support services for individuals with serious mental illness. This creates equity issues, particularly when low-income and minority communities have access to fewer facilities. Medicaid expansion might encourage facilities to offer these services. However, this decision may also be affected by facility ownership type or mediated by service cost structure, particularly in the absence of innovative payment mechanisms. In this study, we determine whether and how Medicaid expansion and facility ownership are associated with changes in specialty mental health service availability in organized settings over time. We estimated two-way fixed effects models using six cross-sections of the National Mental Health Services Survey and compared changes in facility-reported offering of seven services from 2010 to 2019 (54,885 facility years): psychotropic medication, case management, family psychoeducation, psychiatric emergency walk-in services, supported employment, assertive community treatment, illness management, and recovery services. We tested whether Medicaid expansion and facility ownership (private for-profit, private not-for-profit, public) were associated with differential changes in service availability from 2010 to 2019. Overall, facilities were no more likely to offer nearly all services in 2019 than 2010. We found smaller declines for psychotropic medication and psychiatric emergency walk-in services among facilities in Medicaid expansion states compared to declines in non-Medicaid expansion states (6.3 (95% CI 95% CI = 1.8-10.7) and 5.5 (95% CI = 0.2-10.8) percentage points respectively). For-profit facilities experienced the largest declines in availability from 2010 to 2019, while public facilities experienced the smallest declines and some increases in availability of select services. Specialty mental health services are still not widely offered in community outpatient settings despite significant investments in Medicaid, although Medicaid expansion was associated with slower declines in availability. New payment models that incentivize outpatient facilities to offer clinical and support services may be needed.

“Doulas shouldn’t be considered visitors, we should be considered a part of [the] team”: doula care in Georgia, USA during the COVID-19 pandemic

Doula support improves maternal-child health outcomes. However, during the COVID-19 pandemic, hospitals restricted the number of support people allowed during childbirth. An academic-community research team conducted 17 in-depth interviews and structured surveys with doulas in metro-Atlanta, Georgia, USA from November 2020 to January 2021. Surveys were analysed for descriptive statistics in Stata v. 14, and interviews were analysed in Dedoose using a codebook and memo-ing for thematic analysis. All 17 doulas reported COVID-19 changed their practices: most were unable to accompany clients to delivery (14), started using personal protective equipment (13), used virtual services (12), and had to limit the number of in-person prenatal/postpartum visits (11). Several attended more home births (6) because birthing people were afraid to have their babies in the hospital. Some stopped seeing clients altogether due to safety concerns (2). Many lost clientele who could no longer afford doula services, and some offered pro bono services. Most doulas pointed to restrictive hospital policies that excluded doulas and disallowed virtual support as they felt doulas should be considered a part of the team and clients should not be forced to decide between having their doula or their partner in the room. COVID-19 has severely impacted access to and provision of doula care, mostly due to economic hardship for clients and restrictive hospital policies. At the same time, doulas and their clients have been resourceful – using virtual technology, innovative payment models, and home births.

Implementation Of Gateway Technology (Go-Pay) In Increasing Transaction Efficiency In MSMEs Dapur Restu

The Go-Pay payment gateway, available in the GoJek application, has revolutionized the traditional business model by adopting digital methods and offering user-friendly functionalities. This study examined the impact of using Go-Pay and leveraging analytics to enhance small and medium enterprise (SME) financial performance. Through descriptive analysis, the research revealed a positive influence of Go-Pay/Go-food on the micro business, Kitchen Restu, highlighting the benefits of digital payments for both sellers and buyers in terms of effectiveness and convenience. The findings shed light on the evolving fintech landscape, emphasizing the significance of payment gateways like Go-Pay in driving SME financial growth. The user-friendly and effective nature of Go-Pay shapes individuals' attitudes and intentions towards technology adoption. These insights hold implications for businesses, particularly SMEs, aiming to improve their financial performance. By adopting innovative payment solutions such as Go-Pay, sellers and buyers can enhance efficiency and convenience in their digital transactions. As the fintech industry continues to evolve, future research can explore the determinants and outcomes of using payment gateways like Go-Pay, providing deeper insights into their role in driving financial innovation and fostering growth. Ultimately, this study contributes to understanding the transformative power of payment gateways and their potential to reshape the business landscape.

Smile to pay: predicting continuous usage intention toward contactless payment services in the post-COVID-19 era

PurposeFinancial technology (FinTech) is undergoing a transformation as a result of robotics and artificial intelligence. FinTech service providers are embracing contactless technology, including the development and widespread adoption of innovative payment service. Among the many types of contactless payment services, facial recognition payment (FRP) has gained in popularity. To capitalize on this rising popularity, comprehending the mechanisms underlying continuous usage intention toward FRP is essential. Drawing from the stimulus–organism–response (S-O-R) model, this study investigates how FRP attributes facilitate continuous usage intention.Design/methodology/approachIn total, 321 Chinese FRP users completed an online survey. Partial least squares structural equation modeling analyzed the results of the survey.FindingsThe results reveal that relative advantage and compatibility, user-interface attractiveness and perceived security (stimuli) promote performance expectancy, effort expectancy and positive emotion (organism), which in turn foster FRP continuous usage intention (response).Originality/valueThis research presents an S-O-R model that incorporates several attributes from DOI theory, the UTAUT model and the AIDUA framework to elucidate the antecedents of consumers' continuous usage intention toward FRP. The findings corroborate the significance of the S-O-R mechanism in FRP, setting the groundwork for the acceptance and development of biometric authentication technologies in service contacts and banks. In addition, the study highlights opportunities and essential aspects for FinTech service developers and providers to consider in terms of their practical significance.

Reimbursement and payment models in Central and Eastern European as well as Middle Eastern countries: A survey of their current use and future outlook

There is growing interest in innovative reimbursement and payment models in Central and Eastern European (CEE) and Middle Eastern (ME) countries. A questionnaire was sent to payers from CEE and ME countries regarding the current use of, future preferences for and perceived barriers with these models. Twenty-seven healthcare payers from 11 countries completed the survey. Results showed participants preferred using outcome-based reimbursement models and delayed payment models more often; however, currently they are rarely applied. Barriers hindering implementation were mostly related to IT and data infrastructure, measurement issues, transaction costs and the administrative burden. Given these barriers highlighted in our study, policymakers should focus on the development of an implementation framework with contract templates for the preferred reimbursement and payment schemes to aid the feasibility of a successful implementation.

The Impact of Payment Innovation on Narrowing the Urban-rural Gap

With the rapid development of fintech, mobile payments is rapidly being widely used in China. As a financial and economic connection point, vigorously developing the payment system is the inevitable choice to narrow the gap between urban and rural areas. Based on this, this study attempts to establish a random effect model in panel regression to analyse the impact of the development of third-party payment on the urban-rural income gap of 31 provinces and municipalities from 2013 to 2020 in China. The results show that the growth of third-party payment scale has a positive effect on narrowing the urban-rural income gap. Therefore, this paper suggests that increasing the construction of rural mobile payment is of great significance to improve farmers’ income. And finally puts forward the specific path of mobile payment construction.