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This study describes monthly test, test positivity, and case rates for coronavirus disease 2019 (COVID-19) among individuals detained by US Immigration and Customs Enforcement (ICE) between April and August 2020.

Medicare's Bundled Payments for Care Improvement (BPCI) program, which ran from 2013 to 2018, was an important experiment in physician-focused alternative payment models. However, little is known about whether the program was associated with better quality or outcomes or lower costs.To determine whether participation in BPCI among physician group practices was associated with advantageous or deleterious changes in costs or patient outcomes.This cross-sectional study used 2013 to 2017 Medicare files and difference-in-differences (DID) models to compare the change over time in Medicare payments, patient selection, and clinical outcomes between 91 orthopedic groups in BPCI Model 2 and 169 propensity-matched controls for patients undergoing joint replacement. Analyses were performed between December 2019 and February 2021.Voluntary participation in BPCI.The primary outcome was 90-day Medicare payments; secondary outcomes were patient selection (volume, comorbidities) and clinical outcomes (30-day and 90-day emergency department visits, readmissions, mortality, and healthy days at home).There were 74 343 patient episodes in the baseline period and 102 790 during the intervention in BPCI practices, and 88 147 patient episodes in the baseline period and 120 253 during the intervention in control practices; 291 214 of 461 598 (63.1%) patients were women, and 419 619 (90.9%) were White. At baseline, mean episode payments among BPCI-participating practices were $18 257, which decreased to $15 320 during the intervention, while control practices decreased from $17 927 to $16 170 (DID, -$1180; 95% CI, -$1565 to -$795;Group practice participation in BPCI for joint replacement was associated with reduced Medicare payments and improvements in clinical outcomes.

This study uses Medicare data to compare the characteristics of hospitals that did vs did not realize episodes savings under the Centers for Medicare & Medicaid Services’ Comprehensive Care for Joint Replacement program, which bundled payments for hip and knee surgery and paid bonuses to hospitals that exceeded quality and cost benchmarks.

Cancer care is expensive, and like other chronic illnesses, is prone to waste both through overuse of low-value services and underuse of evidence-based approaches.1 The fee-for-service model has been cited as a major factor, creating perverse incentives to provide high-cost, low-value care without sufficiently monitoring quality.2 Alternative models have been proposed as a means to both control costs and improve quality in oncology, including accountable care organizations, bundled episode-based payment models, and patient-centered medical homes.

To enable improved cost control, quality, and access, US health care delivery is moving from fragmented fee-for-service delivery into various innovative integrated models, including accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundles, defined as a coordinated group of services for a specific need, administered over a predefined period. These innovations hold promise for patients whose complex care requirements account for the bulk of health care costs and who would reap the most benefit from a coalesced network of care.