Decision Sciences Theses and Dissertations

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Browsing Decision Sciences Theses and Dissertations by Subject "Dialysis"

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    Patient-Centric Innovation in Service Modalities for End-Stage Renal Disease
    (University of Oregon, 2021-11-23) Jabbari, Mona; Murthy, Nagesh
    The purpose of this study is to examine the feasibility of introducing innovative dialysis delivery methods. In the first essay, advised by Prof. Nagesh Murthy and Dr. Eren Cil, we study a new and non-traditional dialysis service modality, called a mobile dialysis clinic, that can reduce the travel burden for ESRD patients, resulting in a reduction in hospitalization costs undertaken by Medicare.To this end, we develop a framework to consider the strategic interaction between Medicare and a dialysis service provider and examine the potential benefit to Medicare for considering a “shared-savings payment policy.” Specifically, our proposed incentive payment structure features “reward rate” as the percentage of hospitalization cost savings that the provider receives as a bonus payment for offering coverage using a mobile dialysis clinic. We first establish that the provider undertakes the additional costs of a new modality only when the reward rate offered by Medicare exceeds a critical level. We, then, show that once offering the new modality becomes viable, the provider serves more patients with the new modality and consequently decreases the hospitalization costs for Medicare as the reward rate increases. Despite the favorable effects of the new modality on the total hospitalization costs, Medicare faces a trade-off between lowering the hospitalization cost and the sharing cost savings with the provider. Hence, we find that Medicare does not always optimally offer enough compensation to the provider to justify offering the new service modality. However, we also identify certain conditions under which Medicare, interestingly, finds it optimal to increase the reward rate to incentivize the provider to offer a mobile clinic even when this increased reward rate results in a drastic improvement in provider’s profit with only a marginal reduction in Medicare’s cost. We discuss the prospect of offering assisted home dialysis in the second essay to overcome the barriers to home dialysis. The second essay is advised by Prof. Nagesh Murthy and Dr. Eren Cil. Assisted home dialysis can be provided in-home or via telemedicine by a nurse. We develop a mathematical model to examine the implications of an optimal integration of new modalities, i.e., satellite clinics and nurse assisted home-dialysis into the existing dialysis network on the provider's profit and Medicare's costs. We analyze these implications under a variety of scenarios that reflect geographic dispersion of patients from the existing main clinic, patient preferences, and hospitalization cost attributed to recurring distance traveled. Our findings can help policymakers for Medicare design new policies that motivate providers to introduce new and innovative ways of offering dialysis to patients.