Soleil Shah

All Publications

• Strengthening the Center for Medicare and Medicaid Innovation's Approach to Constructing Alternative Payment Models. The Milbank quarterly Kannarkat, J. T., Shah, S., Parekh, N., Crosson, F. J. 2023

  Abstract

  The Center for Medicare and Medicaid Innovation (CMMI) seeks to develop evidence-based alternative payment models (APM) to improve health care quality and reduce costs, but its performance in achieving these goals has been mixed. In October 2021, CMMI released its Innovation Strategy Refresh to highlight challenges faced by payment models and suggest new strategic approaches for the upcoming decade. While a welcome recast of organizational goals, the Refresh leaves space for how CMMI will address persistent issues. These include how CMMI can best engage physicians and patients in APMs, minimize conflicting incentives among APMs, reduce selection bias in model participation, and, ultimately, transition away from the fee-for-service framework that underlies much of Medicare reimbursement. This article provides guidance to CMMI's vision by examining challenges within CMMI's strategy for model building and offering solutions to mitigate these issues. These strategies include engaging beneficiaries in APM incentives, expanding operational flexibility to improve clinical behaviors (e.g., waivers), rectifying issues with conflicting model incentives, building voluntary short-term and mandatory long-term incentives to mitigate selection bias, and transitioning to an overriding population-based model to constrain net costs. Policy Points The Center for Medicare and Medicaid Innovation (CMMI) seeks to develop evidence-based alternative payment models (APM) to improve care quality and reduce health care cost, but its performance in achieving these goals has been mixed. In October 2021, CMMI released a "strategic refresh" of its goals but left space for how persistent issues to model development would be addressed. We propose strategies to engage physicians and patients in APMs, minimize conflicting incentives among APMs, reduce selection bias in model participation, and, ultimately, transition away from the fee-for-service framework that underlies much of Medicare reimbursement.

  View details for DOI 10.1111/1468-0009.12597

  View details for PubMedID 36708247

• Corporate Investors in Primary Care - Profits, Progress, and Pitfalls. The New England journal of medicine Shah, S., Rooke-Ley, H., Fuse Brown, E. C. 2023

  View details for DOI 10.1056/NEJMp2212841

  View details for PubMedID 36617356

• Prospective Pilot Study Evaluating SARS-CoV-2 Transmission-Limiting Measures in an On-Site School ACADEMIC PEDIATRICS Jani, S. G., Ma, J., Pulendran, U., Hsing, J. C., Altamirano, J., Shah, S., Toomarian, E. Y., Maldonado, Y., Wang, C. 2022; 22 (4): 671-679

  View details for Web of Science ID 000832839400022

• Factors influencing care-seeking behaviour for mental illness in India: a situational analysis in Tamil Nadu. Journal of public health (Oxford, England) Jani, A., Ravishankar, S., Kumar, N., Vimitha, J., Shah, S., Pari, A., Ramasubramaniam, C. 2021; 43 (Supplement_2): ii10-ii16

  Abstract

  BACKGROUND: The contribution of mental illness to the total burden of disease in India nearly doubled from 1990 to 2017, increasing from 2.5% of the total disability-adjusted life years in 1990 to 4.7% in 2017. Despite efforts by the Indian government, a treatment gap of 75-85%, with heterogeneity across multiple dimensions, exists across India. We conducted a qualitative study in Tamil Nadu, India, to better understand the contextual factors affecting the care-seeking behaviour for mental illness.METHODS: Qualitative methods, including semi-structured interviews and focus groups (FGs), were conducted with stakeholders involved in the mental health care pathway in Tamil Nadu. Ten semi-structured interviews and five FGs were conducted and analysed using an inductive approach to identify codes, using Dedoose v7, related to the emerging themes and categories.RESULTS: Our analyses identified three key areas that influence care-seeking: views on what causes and/or constitutes mental illness, stigma and discrimination associated with mental illness and broader factors influencing decision-making.CONCLUSIONS: The specific contextual factors identified by our study can be used to design and implement approaches that can help to address some of the issues that influence the care-seeking behaviour and manifest in the treatment gaps seen in Tamil Nadu and in India, more generally.

  View details for DOI 10.1093/pubmed/fdab131

  View details for PubMedID 34622288

• Strategies to Overcome the Market Dominance of Hospitals-Reply. JAMA Shah, S., Navathe, A. S., Kocher, R. P. 2021; 326 (3): 278-279

  View details for DOI 10.1001/jama.2021.6895

  View details for PubMedID 34283186

• Association between the Number of Prescribers of Concurrent Opioid and Benzodiazepine Medications and the Risk of Overdose: A Retrospective Analysis Rishel, C. A., Shah, S., Zhang, Y., Darnall, B., Sun, E. LIPPINCOTT WILLIAMS & WILKINS. 2021: 643-644

  View details for Web of Science ID 000752526600281

• COVID-19 vaccine challenges: What have we learned so far and what remains to be done? Health policy (Amsterdam, Netherlands) Forman, R., Shah, S., Jeurissen, P., Jit, M., Mossialos, E. 2021

  Abstract

  Developing and distributing a safe and effective SARS-CoV-2 (COVID-19) vaccine has garnered immense global interest. Less than a year after COVID-19 was declared a pandemic, several vaccine candidates had received emergency use authorization across a range of countries. Despite this scientific breakthrough, the journey from vaccine discovery to global herd immunity against COVID-19 continues to present significant policy challenges that require a collaborative, global response. We offer a framework for understanding remaining and new policy challenges for successful global vaccine campaigns against COVID-19 as well as potential solutions to address them. Decision-makers must be aware of these challenges and strategize solutions that can be implemented at scale. These include challenges around maintaining R&D incentives, running clinical trials, authorizations, post-market surveillance, manufacturing and supply, global dissemination, allocation, uptake, and clinical system adaption. Alongside these challenges, financial and ethical concerns must also be addressed.

  View details for DOI 10.1016/j.healthpol.2021.03.013

  View details for PubMedID 33820678

• Overcoming the Market Dominance of Hospitals. JAMA Kocher, R. P., Shah, S. n., Navathe, A. S. 2021

  View details for DOI 10.1001/jama.2021.0079

  View details for PubMedID 33605976

• Prospective Pilot Study Evaluating SARS-CoV-2 Transmission-Limiting Measures in an On-Site School. Academic pediatrics Jani, S. G., Ma, J., Pulendran, U., Hsing, J. C., Altamirano, J., Shah, S., Toomarian, E. Y., Maldonado, Y., Wang, C. J. 2021

  Abstract

  The purpose of our study is to evaluate the feasibility and reliability of a comprehensive set of preventive measures in limiting secondary transmission of COVID-19 in schools.A prospective cohort study was conducted to evaluate SARS-CoV-2 transmission in an independent K-8 school in San Mateo County, California. The research was conducted between September 14, 2020 through March 22, 2021 and consisted of: (1) demographic and epidemiological questionnaires; (2) daily symptom reporting; (3) weekly RT-PCR testing; and (4) periodic on-site qualitative observations.180 (79%) students and 63 (74%) on-site staff/contractors were enrolled. Participants reported symptoms in 144 (<1%) daily surveys of the 19,409 collected. Among those who reported symptoms and exposures, none tested positive during the 22-week study period. Of all participants, a total of 6 tested positive for SARS-CoV-2 at least once by RT-PCR; all were asymptomatic at time of testing. No in-school transmission occurred. Mask adherence was high among all grades, and incidents of improper mask use mostly occurred during non-instruction time. Physical distancing was well-enforced during class time and snack breaks, although adherence during non-instruction time waned as the school year progressed.Our comprehensive, prospective study following COVID-19 transmission over 22 weeks in a K-8 school demonstrates that: (1) surveillance testing is important for detecting asymptomatic infections in schools; (2) monitoring symptoms may not be necessary and/or sufficient for COVID-19; and (3) younger children can adhere to key mitigation measures (e.g., masking) which have the potential to limit transmission.

  View details for DOI 10.1016/j.acap.2021.11.019

  View details for PubMedID 34896273

• Public Benefit Corporations: A Third Option For Health Care Delivery? Health Affairs Shah, S., Qian, J., Navathe , A., Shah, N. 2021
• Rating The Medicare Advantage Star Ratings—Improving The Status Quo Health Affairs Shah, S., Sun, E. 2021
• The Economic Footprint of Interventional Radiology in the United States: Implications for Systems Development. Journal of the American College of Radiology : JACR Shah, S. S., Tennakoon, L., O'Beirne, E., Staudenmayer, K. L., Kothary, N. 2020

  Abstract

  PURPOSE: Despite the growing presence of interventional radiology (IR) in inpatient care, its global impact on the health care system remains uncharacterized. The aim of this study was to quantitate the use of IR services rendered to hospitalized patients in the United States and the impact on cost.METHODS: The National Inpatient Sample 2016 was queried. Using the International Classification of Diseases, tenth rev, Clinical Modification/Procedure Classification System, adult inpatients who underwent routine IR procedures were identified. Unadjusted and adjusted analyses were performed. Weighted patient data are presented to provide national estimates.RESULTS: Of the 29.7 million inpatient admissions in 2016, 2.3 million (7.8%) had at least one IR procedure. Patients who needed IR were older (62.8 vs 57.1 years, P < .001), were sicker on the basis of the All Patient Refined Diagnosis Related Groups (27% major or extreme vs 14% for non-IR, P < .001), and had higher inpatient mortality (8.2% vs 1.7%, P < .001). While representing 7.8% of all admissions, this cohort accounted for 18.4% ($68.4 billion) of adult inpatient health care costs and about 3 times higher mean hospitalization cost compared with other inpatients ($29,402 vs $11,062, P < .001), which remained significant even after controlling for age and All Patient Refined Diagnosis Related Group.CONCLUSIONS: Approximately 1 in 10 US inpatients are treated with IR during their hospitalizations. These patients are sicker, with about 4 times higher mortality and 2.5 times greater length of stay, accounting for almost one-fifth of all health care costs. These findings suggest that IR should have a voice in discussions of means to save costs and improve patient outcomes in the United States.

  View details for DOI 10.1016/j.jacr.2020.07.038

  View details for PubMedID 32918863

• The Case for Independent Centers for Disease Control and Prevention-Protecting Public Health from Politics. JAMA health forum Shah, S., Forman, H. 2020; 1 (9): e201139

  View details for DOI 10.1001/jamahealthforum.2020.1139

  View details for PubMedID 36218741

• How To Ensure COVID-19 Doesn’t Delay Value-Based Care Health Affairs Shah, S., Kocher, B. 2020
• What If We Gave Hospitals Real Incentives To Prepare For The Next Pandemic? Health Affairs Shah, S., Kocher, B. 2020
• MACRA and Medicare's Elusive Quest for Fairness and Value with Physician Payment Policy: Speeding up the Transition to Big Med Saint Louis University Journal of Health Law & Policy Mayes, R., Shah, S. 2018; 11 (2): 235-248
• A molecular dynamics study of the binary complexes of APP, JIP1, and the cargo binding domain of KLC PROTEINS-STRUCTURE FUNCTION AND BIOINFORMATICS Taylor, C. A., Miller, B. R., Shah, S. S., Parish, C. A. 2017; 85 (2): 221–34

  Abstract

  Mutations in the amyloid precursor protein (APP) are responsible for the formation of amyloid-β peptides. These peptides play a role in Alzheimer's and other dementia-related diseases. The cargo binding domain of the kinesin-1 light chain motor protein (KLC1) may be responsible for transporting APP either directly or via interaction with C-jun N-terminal kinase-interacting protein 1 (JIP1). However, to date there has been no direct experimental or computational assessment of such binding at the atomistic level. We used molecular dynamics and free energy estimations to gauge the affinity for the binary complexes of KLC1, APP, and JIP1. We find that all binary complexes (KLC1:APP, KLC1:JIP1, and APP:JIP1) contain conformations with favorable binding free energies. For KLC1:APP the inclusion of approximate entropies reduces the favorability. This is likely due to the flexibility of the 42-residue APP protein. In all cases we analyze atomistic/residue driving forces for favorable interactions. Proteins 2017; 85:221-234. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/prot.25208

  View details for Web of Science ID 000394519300003

  View details for PubMedID 27891669