An Approach to Integrate a Blockchain-Based Payment Model and Independent Secure Documentation for a Robot as a Service

Robots for hire instead of purchase are developing an increasing interest among customers. This article will present a concept developed at ZeMA for the integration of a blockchain-based payment module and manipulation-proof documentation of process-specific data. This should improve the business model of hiring robots not only in terms of technical components but also in terms of economic considerations. In this way, the billing process can be automated to a certain extent, and a legally secure basis with the manipulation-proof storage of process-specific data can be created. The advantages and disadvantages of blockchain, in relation to Robot as a Service, will be highlighted and it will be shown how the disadvantages can be negated. The current limits of blockchain will also be shown. The blockchain technology IOTA is used.

90-Day Bundled Payment Simulation, Health Care Utilization, and Complications following Craniopharyngioma Resection in Adult Patients

Context Bundled payment and health care utilization models inform cost optimization and surgical outcomes. Economic analysis of payment plans for craniopharyngioma resection is unknown. Objective This study aimed to identify impact of endocrine and nonendocrine complications (EC and NEC, respectively) on health care utilization and bundled payments following craniopharyngioma resection. Design This study is presented as a retrospective cohort analysis (2000–2016) with 2 years of follow-up. Setting The study included national inpatient hospitalization and outpatient visits. Patients Patients undergoing craniopharyngioma resection were divided into the following four groups: group 1, no complications (NC); group 2, only EC; group 3, NEC; and group 4, both endocrine and nonendocrine complications (ENEC). Interventions This study investigated transphenoidal or subfrontal approach for tumor resection. Main Outcome Hospital readmission, health care utilization up to 24 months following discharge, and 90-day bundled payment performances are primary outcomes of this study. Results Median index hospitalization payments were significantly lower for patients in NC cohort ($28,672) compared with those in EC ($32,847), NEC ($36,259), and ENEC ($32,596; p < 0.0001). Patients in ENEC incurred higher outpatient services and overall median payments at 6 months (NC: 38,268; EC: 49,844; NEC: 68,237; and ENEC: 81,053), 1 year (NC: 46,878; EC: 58,210; NEC: 81,043; and ENEC: 94,768), and 2 years (NC: 58,391; EC: 70,418; NEC: 98,838; and ENEC: 1,11,841; p < 0.0001). The 90-day median bundled payment was significantly different among the cohorts with the highest in ENEC ($60,728) and lowest in the NC ($33,089; p < 0.0001). Conclusion ENEC following surgery incurred almost two times the overall median payments at 90 days, 6 months, 1 year. and 2 years compared with those without complications. Bundled payment model may not be a feasible option in this patient population. Type of complications and readmission rates should be considered to optimize payment model prediction following craniopharyngioma resection.

SALES EXPERIMENT OF A NEWSPAPER PUBLISHER: "PAY WHAT YOU WANT"

Digitalization poses great challenges for companies and especially for newspaper publishers. Due to the large number of digital competitors on the advertising market, media companies are forced to proactively win customers. A major German media company has thus dared to experiment and put the question of pricing for booking newspaper advertising in the hands of its customers. With the so-called "pay what you want" (PWYW) payment model, customers can be won and additional budgets spent. This paper explores the question of whether PWYW is a suitable sales model for newspaper companies and which factors have an influence. The results of the interviews with those involved show solutions, opportunities, problems and that additional turnover can be generated.

Cost-benefit Analysis of the COPE Program for Persons Living With Dementia: Toward a Payment Model

Background and Objectives There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports non-pharmacologic programs which provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut’s home- and community-based services (HCBS), which are state and Medicaid funded. Research Design and Methods Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or HCBS alone. Cost measures included those relevant to HCBS decision-makers: intervention delivery, healthcare utilization, caregiver time, formal care, and social services. Data sources included care management records and caregiver report. Results Per-dyad mean cost savings at 12-months were $2,354 for those who received COPE with a mean difference in difference of - $6,667 versus HCBS alone (95% CI: $-15,473, $2,734; NSS). COPE costs would consume 5.6% to 11.3% of Connecticut’s HCBS annual spending limit, and HCBS cost sharing requirements align with participants’ willingness to pay for COPE. Discussion and Implications COPE represents a potentially cost-saving dementia care service that could be financed through existing Connecticut HCBS. HCBS programs represent an important, sustainable payment model for delivering non-pharmacological dementia interventions such as COPE.