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Devin V Williams, Tiffany C Liu, Michael G Zywiel, Miranda K Hoff, Lorrayne Ward, Kevin J Bozic, Karl M Koenig
BACKGROUND: Limited access to specialty care for uninsured and underinsured patients may be exacerbated by traditional fee-for-service approaches to care that incentivize volume and intensity of services over value of care. The purpose of this study was to determine the impact of a value-based integrated practice unit (IPU) on access to musculoskeletal care and surgical outcomes in a safety-net population. METHODS: A new IPU was implemented on 6/1/2016 at an established safety-net clinic providing musculoskeletal care in central Texas to supplement existing musculoskeletal care provided through a fee-for-service model...
October 31, 2018: Healthcare
Sanchay Gupta, Adam L Beckman
No abstract text is available yet for this article.
September 25, 2018: Healthcare
Sanchay Gupta, Adam L Beckman
No abstract text is available yet for this article.
September 11, 2018: Healthcare
Suhas Gondi, Adam L Beckman
No abstract text is available yet for this article.
September 7, 2018: Healthcare
Dori A Cross, Paige Nong, Christy Harris-Lemak, Genna R Cohen, Ariel Linden, Julia Adler-Milstein
BACKGROUND: Improving primary care for patients with chronic illness is critical to advancing healthcare quality and value. Yet, little is known about what strategies are successful in helping primary care practices deliver high-quality care for this population under value-based payment models. METHODS: Double-blind interviews in 14 primary care practices in the state of Michigan, stratified based on whether they did (n = 7) or did not (n = 7) demonstrate improvement in primary care outcomes for patients with at least one reported chronic disease between 2010 and 2013...
September 6, 2018: Healthcare
Adam L Beckman, Sanchay Gupta
No abstract text is available yet for this article.
August 31, 2018: Healthcare
Madeleine Ballard, Ryan Schwarz
No abstract text is available yet for this article.
August 23, 2018: Healthcare
Adam L Beckman, Sanchay Gupta
No abstract text is available yet for this article.
August 21, 2018: Healthcare
Kathryn Zager, Yhenneko J Taylor
Emergency department visits for non-urgent reasons contribute to overcrowding and higher healthcare costs. Routing patients to lower cost care settings may improve outcomes. The Discharge to Medical Home model is a new care delivery model that routes low-acuity, ambulatory, emergency department (ED) patients to an adjacent primary care clinic, which provides the opportunity for patients to establish a medical home. During clinic hours, walk-in patients presenting to the ED are screened and, if appropriate, scheduled for a same-day appointment with a primary care provider...
August 21, 2018: Healthcare
Kevin G Volpp, Amol Navathe, Emily Oshima Lee, Mark Mugishii, Andrea B Troxel, Kristen Caldarella, Amanda Hodlofski, Susannah Bernheim, Elizabeth Drye, Justin Yoshimoto, Kim Takata, Michael B Stollar, Ezekiel Emanuel
OBJECTIVES: To describe the process of developing a new physician payment system based on value and transitioning away from a fee-for-service payment system STUDY DESIGN: Descriptive. This paper describes a recent initiative involving redesign of primary care provider payment in the State of Hawaii. While there has been extensive discussion about switching payment from volume to value in recent years, much of this change has happened at the organizational level and this initiative focused on changing the incentives for individual providers...
September 2018: Healthcare
Sharief Hendricks, Nailah Conrad, Tania S Douglas, Tinashe Mutsvangwa
Increasing pressure to improve health outcomes of populations with limited resources has prompted an emphasis on innovation. Design thinking has been proposed as a systematic approach to innovation in health, owing to its human-centred methodology that prioritises deep empathy for the end-users' desires, needs and challenges, which results in a better understanding of the problem in order to develop more comprehensive and effective solutions. A key feature of design thinking is stakeholder participation. If design thinking is going to be used as an approach to design and implement effective, equitable and sustainable health solutions, assessing stakeholder participation should be integrated into the process...
September 2018: Healthcare
Abhishek Dalal
No abstract text is available yet for this article.
September 2018: Healthcare
David Citrin, Poshan Thapa, Isha Nirola, Sachit Pandey, Lal Bahadur Kunwar, Jasmine Tenpa, Bibhav Acharya, Hari Rayamazi, Aradhana Thapa, Sheela Maru, Anant Raut, Sanjaya Poudel, Diwash Timilsina, Santosh Kumar Dhungana, Mukesh Adhikari, Mukti Nath Khanal, Naresh Pratap Kc, Bhim Acharya, Khem Bahadur Karki, Dipendra Raman Singh, Alex Harsha Bangura, Jeremy Wacksman, Daniel Storisteanu, Scott Halliday, Ryan Schwarz, Dan Schwarz, Nandini Choudhury, Anirudh Kumar, Wan-Ju Wu, S P Kalaunee, Pushpa Chaudhari, Duncan Maru
Integrating care at the home and facility level is a critical yet neglected function of healthcare delivery systems. There are few examples in practice or in the academic literature of affordable, digitally-enabled integrated care approaches embedded within healthcare delivery systems in low- and middle-income countries. Simultaneous advances in affordable digital technologies and community healthcare workers offer an opportunity to address this challenge. We describe the development of an integrated care system involving community healthcare worker networks that utilize a home-to-facility electronic health record platform for rural municipalities in Nepal...
September 2018: Healthcare
Joshua M Liao, R Tamara Konetzka, Rachel M Werner
Improving the value of post-acute care at skilled nursing facilities (SNFs) has become a Medicare policy priority. Anecdotally, hospitals have responded by formally acquiring or pursuing tighter informal connections with SNFs. We evaluated the trend in connections between US acute care hospitals and Medicare-certified SNFs between 2000 and 2013 using vertical integration and two novel network-based measures (number of SNF partners, and discharge concentration). Among 4441 hospitals and 17,215 SNFs, hospitals with weaker connections with SNFs were more often non-profit, major teaching hospitals with a larger number of discharges and beds...
September 2018: Healthcare
Donna Keyser, Jane Kogan, Marion McGowan, Pamela Peele, Diane Holder, William Shrank
National-level demonstration projects and real-world studies continue to inform health care transformation efforts and catalyze implementation of value-based service delivery and payment models, though evidence generation and diffusion of learnings often occurs at a relatively slow pace. Rapid-cycle learning models, however, can help individual organizations to more quickly adapt health care innovations to meet the challenges and demands of a rapidly changing health care landscape. Integrated delivery and financing systems (IDFSs) offer a unique platform for rapid-cycle learning and innovation...
September 2018: Healthcare
Jennifer M Polinski, Linda M Harris, William H Shrank, Andrew Sussman, John Barron
BACKGROUND: We studied whether integrating the US Department of Health and Human Services' myHealthfinder tool, an interactive tool that recommends preventive services, into CVS Health's digital platforms could increase preventive service uptake at its retail clinic, MinuteClinic. METHODS: We used a quasi-experimental, pre-post, difference-in-differences design. In a web-based campaign, consumers in "exposed" states visiting CVS pharmacy and MinuteClinic websites could view and use the myHealthfinder tool...
September 2018: Healthcare
Randi Sokol, Jessica Early, Amanda Barner, Sarah Gottfried, Richard Gumpert, Lorky Libaridian, Virginia Morrison, Alexandra Santamaria, Linda Shipton
Hepatitis C virus (HCV) is the most common blood-borne virus in the U.S., and its incidence continues to rise. With approval of direct-acting antiviral medications, treatment for Chronic Hepatitis C (CHC) has become highly efficacious with a minimal side effect profile. Primary care physicians are well-positioned to address this increased demand, yet most do not feel comfortable treating CHC. In this case report, we describe implementation of a multidisciplinary team-based approach for treating CHC at multiple primary care sites across a large safety net health system...
September 2018: Healthcare
Sema K Sgaier, Aparajita Ramakrishnan, Alkesh Wadhwani, Aparajita Bhalla, Hari Menon, James Baer, Ashok Alexander
Numerous public-health interventions have demonstrated effectiveness in pilots or on a small scale, but have proven challenging to scale up for population-level impact. Avahan, the Bill & Melinda Gates Foundation's HIV prevention program in 6 states of India, confronted the challenge of rapidly scaling up services to reach 300,000 people most at risk of HIV. This meant working in diverse and complex environments with marginalized and largely hidden populations. This case report presents a number of business-management principles that the foundation drew upon to successfully scale up this public-health program: 1) strategy development through market segmentation and complexity analysis, 2) a dynamic and evolving strategy, 3) developing an implementation and management structure to match the strategy, 4) standardization with flexibility, 5) generating demand to balance supply, 6) a customer-centric approach, and 7) data-driven management...
September 2018: Healthcare
Edwin S Wong, Chuan-Fen Liu, Susan E Hernandez, Matthew R Augustine, Karin Nelson, Stephan D Fihn, Paul L Hebert
BACKGROUND: Improving access to the Veterans Health Administration (VHA) is a high priority, particularly given statutory mandates of the Veterans Access, Choice and Accountability Act. This study examined whether patient-reported wait times for VHA appointments were associated with future reliance on VHA primary care services. METHODS: This observational study examined 13,595 VHA patients dually enrolled in fee-for-service Medicare. Data sources included VHA administrative data, Medicare claims and the Survey of Healthcare Experiences of Patients (SHEP)...
September 2018: Healthcare
Gregory W Kurtzman, Megha A Keshav, Nikita P Satish, Mitesh S Patel
BACKGROUND: Digital platforms that allow patients to go online or use smartphone applications to view and schedule physician appointments have not been well evaluated. METHODS: We conducted systematic searches for primary care physician appointments in 20 cities using ZocDoc, an online appointment scheduling platform. Availability was determined for three insurance types (self-pay, Medicare, and Medicaid) in states with and without Medicaid expansion. We collected data on physician characteristics, number of appointments available, and distance to clinics...
September 2018: Healthcare
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