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https://www.readbyqxmd.com/read/29792460/the-complexity-diversity-and-science-of-primary-care-teams
#1
Kevin Fiscella, Susan H McDaniel
This article examines the past, present and future of primary care and teamwork. It begins with a definition and description of primary care-its uniqueness, diversity and complexity, including the historical role of teams within primary care. The article then reviews the emergence of innovative primary care teams, including those grounded in new processes such as the Patient-Centered Medical Home and interprofessional teams that include new types of health professionals, particularly psychologists and other integrated behavioral health clinicians...
May 2018: American Psychologist
https://www.readbyqxmd.com/read/29743214/advancing-primary-care-through-alternative-payment-models-lessons-from-the-united-states-canada
#2
Andrew Bazemore, Robert L Phillips, Richard Glazier, Joshua Tepper
The United States and Canada share high costs, poor health system performance, and challenges to the transformation of primary care, in part due to the limitations of their fee-for-service payment models. Rapidly advancing alternative payment models (APMs) in both countries promise better support for the essential tasks of primary care. These include interdisciplinary teams, care coordination, self-management support, and ongoing communication. This article reviews learnings from a 2017 binational symposium of 150 experts in policy and research that included a discussion of ongoing APM experiments in the United States and Canada...
May 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29735000/value-and-payment-in-sleep-medicine
#3
Emerson M Wickwire, Tilak Verma
Value, like beauty, exists in the eye of the beholder. This article places the value of clinical sleep medicine services in historical context and presents a vision for the value-based sleep of the future. First, the history of value and payment in sleep medicine is reviewed from the early days of the field, to innovative disruption, to the widespread adoption of home sleep apnea testing. Next, the importance of economic perspective is discussed, with emphasis on cost containment and cost-shifting between payers, employers, providers, and patients...
April 30, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
https://www.readbyqxmd.com/read/29699427/promoting-a-culture-of-health-through-cross-sector-collaborations
#4
Grant R Martsolf, Jennifer Sloan, Antonia Villarruel, Diana Mason, Cheryl Sullivan
In this study, we explore the experiences of innovative nurses who have developed cross-sector collaborations toward promoting a culture of health, with the aim of identifying lessons that can inform similar efforts of other health care professionals. We used a mixed-methods approach based on data from both an online survey and telephone interviews. A majority of the participants had significant collaborations with health care providers and non-health care providers. Strong partners included mental health providers, specialists, and primary care providers on the health side, and for non-health partners, the strongest collaborations were with community leaders, research institutions, and local businesses...
April 1, 2018: Health Promotion Practice
https://www.readbyqxmd.com/read/29697473/we-do-not-know-what-we-do-not-know-innovative-approaches-to-value-measurement
#5
Aaron A Laviana, Matthew J Resnick
PURPOSE OF REVIEW: Over the past several years, there has been an increasing focus on improving the 'value' of healthcare delivered, defined as the ratio of clinical outcomes to the costs incurred to achieve them. The former U.S. Secretary of Health and Human Services Sylvia Burwell announced in 2015 that the majority of healthcare payments in the Medicare and Medicaid programmes will align with value by 2018. Although this has yet to fully mature, numerous health systems have restructured with a goal of improving the value of care delivered to their populations...
April 24, 2018: Current Opinion in Urology
https://www.readbyqxmd.com/read/29697433/ensuring-access-to-quality-health-care-in-vulnerable-communities
#6
Jay Bhatt, Priya Bathija
For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed...
April 24, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29680407/accelerating-alzheimer-s-disease-drug-innovations-from-the-research-pipeline-to-patients
#7
Dana P Goldman, Howard Fillit, Peter Neumann
In June 2017, a diverse group of experts in Alzheimer's disease convened to discuss how to accelerate getting new drugs to patients to both prevent and treat the disease. Participants concluded that we need a more robust, diversified drug development pipeline. Strategic policy measures can help keep new Alzheimer's disease therapies (whether to treat symptoms, prevent onset, or cure) affordable for patients while supporting innovation and facilitating greater information sharing among payers, providers, researchers, and the public, including a postmarket surveillance study system, disease registries, innovative payment approaches, harmonizing federal agency review requirements, allowing conditional coverage for promising therapeutics and technology while additional data are collected, and opening up channels for drug companies to communicate with payers (and each other) about data and outcomes...
March 23, 2018: Alzheimer's & Dementia: the Journal of the Alzheimer's Association
https://www.readbyqxmd.com/read/29611068/global-budgets-in-maryland-early-evidence-on-revenues-expenses-and-margins-in-regulated-and-unregulated-services
#8
Margit Malmmose, Karoline Mortensen, Claus Holm
Maryland implemented one of the most aggressive payment innovations the nation has seen in several decades when it introduced global budgets in all its acute care hospitals in 2014. Prior to this, a pilot program, total patient revenue (TPR), was established for 8 rural hospitals in 2010. Using financial hospital report data from the Health Services Cost Review Commission from 2007 to 2013, we examined the hospitals' financial results including revenue, costs, and profit/loss margins to explore the impact of the adoption of the TPR pilot global budget program relative to the remaining hospitals in the state...
April 2, 2018: International Journal of Health Economics and Management
https://www.readbyqxmd.com/read/29610050/upmc-s-blueprint-for-building-a-high-value-health-care-system
#9
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...
March 30, 2018: Healthcare
https://www.readbyqxmd.com/read/29609611/association-between-industry-payments-and-prescribing-costly-medications-an-observational-study-using-open-payments-and-medicare-part-d-data
#10
Manvi Sharma, Aisha Vadhariya, Michael L Johnson, Zachary A Marcum, Holly M Holmes
BACKGROUND: While many new medications may offer advantages over existing drugs, some newer drugs are reformulations of existing products that provide little innovation or incremental benefit while driving up drug costs. Despite the lack of benefit of these medications, prescribers may be motivated by payments made by the pharmaceutical industry. The objective of the study was to determine the association between payments made to physicians by the pharmaceutical industry and prescriptions for certain selected costly brand name drugs...
April 2, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29607051/comprehensive-home-based-care-coordination-for-vulnerable-elders-with-dementia-maximizing-independence-at-home-plus-study-protocol
#11
Quincy M Samus, Karen Davis, Amber Willink, Betty S Black, Melissa Reuland, Jeannie Leoutsakos, David L Roth, Jennifer Wolff, Laura N Gitlin, Constantine G Lyketsos, Deirdre Johnston
Introduction: Despite availability of effective care strategies for dementia, most health care systems are not yet organized or equipped to provide comprehensive family-centered dementia care management. Maximizing Independence at Home-Plus is a promising new model of dementia care coordination being tested in the U.S. through a Health Care Innovation Award funded by the Centers for Medicare and Medicaid Services that may serve as a model to address these delivery gaps, improve outcomes, and lower costs...
December 2017: International Journal of Care Coordination
https://www.readbyqxmd.com/read/29595465/a-conversation-with-mai-pham-md-payment-innovation-at-anthem-downside-risk-will-be-rewarded
#12
Peter Wehrwein
The insurer's vice president of provider alignment solutions says: "We're going to start to signal to providers that if you are going to stay an upside-only arrangement, we're not going to give you free money forever in the form of the care-coordination fees that we've been paying out. They're not an entitlement."
March 2018: Managed Care
https://www.readbyqxmd.com/read/29566833/paying-for-cures-perspectives-on-solutions-to-the-affordability-issue
#13
REVIEW
Sarah Karlsberg Schaffer, Donna Messner, Jorge Mestre-Ferrandiz, Ellen Tambor, Adrian Towse
Curative therapies and other medicines considered "game-changing" in terms of health gain can be accompanied by high demand and high list prices that pose budget challenges to public and private payers and health systems-the so-called affordability issue. These challenges are exacerbated when longer term effectiveness, and thus value for money, is uncertain, but they can arise even when treatments are proven to be highly cost-effective at the time of launch. This commentary reviews innovative payment solutions proposed in the literature to address the affordability issue, including the use of credit markets and of staged payments linked to patient outcomes, and draws on discussions with payers in the United States and Europe on the feasibility or desirability of operationalizing any of the alternative financing and payment strategies that appear in the literature...
March 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/29553274/incorporating-value-into-physician-payment-and-patient-cost-sharing
#14
Zirui Song, Amol S Navathe, Ezekiel J Emanuel, Kevin G Volpp
The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29549075/medication-adherence-apps-review-and-content-analysis
#15
REVIEW
Imran Ahmed, Niall Safir Ahmad, Shahnaz Ali, Shair Ali, Anju George, Hiba Saleem Danish, Encarl Uppal, James Soo, Mohammad H Mobasheri, Dominic King, Benita Cox, Ara Darzi
BACKGROUND: Medication adherence is an expensive and damaging problem for patients and health care providers. Patients adhere to only 50% of drugs prescribed for chronic diseases in developed nations. Digital health has paved the way for innovative smartphone solutions to tackle this challenge. However, despite numerous apps available claiming to improve adherence, a thorough review of adherence apps has not been carried out to date. OBJECTIVE: The aims of this study were to (1) review medication adherence apps available in app repositories in terms of their evidence base, medical professional involvement in development, and strategies used to facilitate behavior change and improve adherence and (2) provide a system of classification for these apps...
March 16, 2018: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/29534061/socioeconomic-benefit-to-individuals-of-achieving-2020-targets-for-four-neglected-tropical-diseases-controlled-eliminated-by-innovative-and-intensified-disease-management-human-african-trypanosomiasis-leprosy-visceral-leishmaniasis-chagas-disease
#16
Edeltraud J Lenk, William K Redekop, Marianne Luyendijk, Christopher Fitzpatrick, Louis Niessen, Wilma A Stolk, Fabrizio Tediosi, Adriana J Rijnsburger, Roel Bakker, Jan A C Hontelez, Jan H Richardus, Julie Jacobson, Epke A Le Rutte, Sake J de Vlas, Johan L Severens
BACKGROUND: The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). METHODS: A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030...
March 2018: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/29508113/legislative-and-policy-developments-and-imperatives-for-advancing-the-primary-care-behavioral-health-pcbh-model
#17
Dennis S Freeman, Cathy Hudgins, Joel Hornberger
The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model...
March 5, 2018: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/29478461/a-public-health-perspective-on-paying-for-dentistry-the-affordable-care-act-and-looking-to-the-future
#18
REVIEW
Burton L Edelstein
Health care costs have traditionally been provider generated whereas payment has been split between public and private sources. There has been little pressure on health care providers to demonstrate value. The quest for value in health care financing is now widely evident as demonstrated by governmental and private sector pursuits of a 3-part aim: better health outcomes at lower cost with improved patient and population experience. Value-based approaches involve payment innovation with its attendant constraints and opportunities for innovation...
April 2018: Dental Clinics of North America
https://www.readbyqxmd.com/read/29452560/health-care-efficiencies-consolidation-and-alternative-models-vs-health-care-and-antitrust-regulation-irreconcilable-differences
#19
Michael W King
Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation...
November 2017: American Journal of Law & Medicine
https://www.readbyqxmd.com/read/29414261/the-affordable-care-act-what-s-next
#20
Mark McClellan, Mark Japinga
The postelection efforts to repeal, replace, or modify the Affordable Care Act (ACA) suggest that the debate over healthcare coverage will remain contentious, particularly because of the high and rising cost of health care. Feasible, potentially bipartisan approaches to improving access to coverage should emphasize reforming health care to achieve higher quality at a lower cost. In the individual market, where many enrollees face limited options and rising premiums, a combination of high-risk pools, reinsurance, and risk adjustment could improve coverage options while encouraging innovations in care for the highest-risk patients...
January 29, 2018: Annual Review of Medicine
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