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outcomes based payment

Kirsten K Roessler, Rikke Holm Bramsen, Ajla Dervisevic, Randi Bilberg
Exercise based treatment for alcohol use disorders have shown an impact on mental health (e.g., depression or anxiety), and alcohol outcomes (e.g., craving or abstinence). However, there is a lack of information on the role of motivational aspects of participation in the process of designing exercise interventions for alcohol use disorder. This study aims to examine: (1) whether motivational aspects are taken into account when the type and delivery method of exercise interventions are chosen; (2) whether motivational aspects are taken into account post intervention; and (3) whether there are different traditions regarding payment for participants...
October 11, 2016: Scandinavian Journal of Psychology
Abdullah Alibrahim, Shinyi Wu
Accountable care organizations (ACO) in the United States show promise in controlling health care costs while preserving patients' choice of providers. Understanding the effects of patient choice is critical in novel payment and delivery models like ACO that depend on continuity of care and accountability. The financial, utilization, and behavioral implications associated with a patient's decision to forego local health care providers for more distant ones to access higher quality care remain unknown. To study this question, we used an agent-based simulation model of a health care market composed of providers able to form ACO serving patients and embedded it in a conditional logit decision model to examine patients capable of choosing their care providers...
October 4, 2016: Health Care Management Science
Bryan P Nowak
With the implementation of the Affordable Care Act (ACA) the US Government committed to a transition in payment policy for healthcare services linking reimbursement to improved health outcomes rather than the volume of services provided. To accomplish this goal the Department of Health and Human Services (HHS) is designing and implementing new payment models intended to improve the quality of healthcare while reducing its cost. Collectively these novel payment models and programs have been characterized under the moniker of Value-Based Purchasing (VBP) and while many of these models retain a fundamental fee-for-service (FFS) structure they are seen as essential tools in the evolution away from volume based healthcare financing towards a health system that provides "better care, smarter spending, and healthier people"...
September 30, 2016: Journal of Pain and Symptom Management
Michelle Tuten, Julia M Shadur, Maxine Stitzer, Hendrée E Jones
OBJECTIVES: Reinforcement-based treatment (RBT) plus recovery housing (RBT(RH)) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing. METHODS: We compared highly similar participants from a study of outpatient RBT (RBT, n=55) and the RBT(RH) (n=80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program...
September 10, 2016: Journal of Substance Abuse Treatment
Laxmaiah Manchikanti, Standiford Helm Ii, Ramsin M Benyamin, Joshua A Hirsch
UNLABELLED: The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score...
September 2016: Pain Physician
David J T Campbell, Marcello Tonelli, Brenda Hemmelgarn, Chad Mitchell, Ross Tsuyuki, Noah Ivers, Tavis Campbell, Raj Pannu, Eric Verkerke, Scott Klarenbach, Kathryn King-Shier, Peter Faris, Derek Exner, Vikas Chaubey, Braden Manns
BACKGROUND: Chronic diseases result in significant morbidity and costs. Although medications and lifestyle changes are effective for improving outcomes in chronic diseases, many patients do not receive these treatments, in part because of financial barriers, patient and provider-level knowledge gaps, and low patient motivation. The Assessing outcomes of enhanced chronic disease care through patient education and a value-based formulary study (ACCESS) will determine the impact of two interventions: (1) a value-based formulary which eliminates copayment for high-value preventive medications; and (2) a comprehensive self-management support program aimed at promoting health behavior change and medication adherence, combined with relay of information on medication use to healthcare providers, on cardiovascular events and/or mortality in low-income seniors with elevated cardiovascular risk...
September 26, 2016: Implementation Science: IS
Adam Lustig, Michael Ogden, Robert W Brenner, Jerry Penso, Kimberly D Westrich, Robert W Dubois
BACKGROUND: In 2013, it was reported that about 1 of every 3 U.S. adults has hypertension. Of these 70 million individuals, approximately 50% have their blood pressure under control. Achieving hypertension control, especially in at-risk populations, requires a multipronged approach that includes lifestyle modifications and pharmacological treatment. As provider groups, hospital systems, and integrated delivery networks optimize their care processes to promote population health activities in support of the accountable care organization (ACO) model of care, managing hypertension and other chronic diseases will be essential to their success...
October 2016: Journal of Managed Care & Specialty Pharmacy
Robert Rosenheck, Kim T Mueser, Kyaw Sint, Haiqun Lin, David W Lynde, Shirley M Glynn, Delbert G Robinson, Nina R Schooler, Patricia Marcy, Somaia Mohamed, John M Kane
BACKGROUND: Participation in work and school are central objectives for first episode psychosis (FEP) programs, but evidence effectiveness has been mixed in studies not focused exclusively on supported employment and education (SEE). Requirements for current motivation to work or go to school limit the generalizability of such studies. METHODS: FEP participants (N=404) at thirty-four community treatment clinics participated in a cluster randomized trial that compared usual Community Care (CC) to NAVIGATE, a comprehensive, team-based treatment program that included ≥5h of SEE services per week, , grounded in many of the principles of the Individual Placement and Support model of supported employment combined with supported education services...
September 22, 2016: Schizophrenia Research
Momotazur Rahman, Edward C Norton, David C Grabowski
As hospitals are increasingly held accountable for patients' post-discharge outcomes under new payment models, hospitals may choose to acquire skilled nursing facilities (SNFs) to better manage these outcomes. This raises the question of whether patients discharged to hospital-based SNFs have better outcomes. In unadjusted comparisons, hospital-based SNF patients have much lower Medicare utilization in the 180 days following discharge relative to freestanding SNF patients. We solved the problem of differential selection into hospital-based and freestanding SNFs by using differential distance from home to the nearest hospital with a SNF relative to the distance from home to the nearest hospital without a SNF as an instrument...
September 3, 2016: Journal of Health Economics
Pamela A Shaw, William S Yancy, Lisa Wesby, Victoria Ulrich, Andrea B Troxel, David Huffman, Gary D Foster, Kevin Volpp
BACKGROUND: Obesity continues to be a serious public health challenge. Rates are increasing worldwide, with nearly 70% of the US adults overweight or obese, leading to increased clinical and economic burden. While successful approaches for achieving weight loss have been identified, techniques for long-term maintenance of initial weight loss have largely been unsuccessful. Financial incentive interventions have been shown in several settings to be successful in motivating participants to adopt healthy behaviors...
September 19, 2016: Clinical Trials: Journal of the Society for Clinical Trials
Annabel Hickey, Jessica Suna, Louise Marquart, Charles Denaro, George Javorsky, Andrew Munns, Alison Mudge, John J Atherton
BACKGROUND: To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care. METHODS: This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments...
September 7, 2016: International Journal of Cardiology
Bijan J Borah, Yang Qiu, Nilay D Shah, Patrick P Gleason
BACKGROUND: The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence. METHODS: Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members...
September 2016: Healthcare
Tehsina F Devji, Arin L Madenci, Elizabeth Carpino, Izabela C Leahy, Mihail Samnaliev, Jennifer L Dearden, Brent R Weil, Christopher B Weldon, Joseph Cravero
PURPOSE: The current emphasis on fiscally responsible health spending in the era of the Affordable Care Act and other health care reform necessitates cost-conscious delivery of care. "Value" in health care is defined as the quality of care divided by the cost. As such, health systems optimize value by providing the most cost-effective care possible without sacrificing safety or outcomes. Elective, minimal risk surgical procedures in children may be value-enhanced by moving from an operating room (OR) to a more cost-efficient setting...
November 2016: Journal of Pediatric Surgery
Ali A Qureshi, Kristen Broderick, Susan Funk, Nancy Reaven, Marissa M Tenenbaum, Terence M Myckatyn
BACKGROUND: Current cost data on tissue expansion followed by exchange for permanent implant (TE/I) reconstruction lack a necessary assessment of the experience of a heterogenous breast cancer patient population and their multiple outcome pathways. We extend our previous analysis to that of direct hospital cost as bundling of payments is likely to follow the changing centralization of cancer care at the hospital level. METHODS: We performed a retrospective analysis (2003-2009) of TE/I reconstructions with or without an acellular dermal matrix (ADM), namely Alloderm RTM...
August 2016: Plastic and Reconstructive Surgery. Global Open
Marsha Gold, Catherine McLAUGHLIN
POLICY POINTS: The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain...
September 2016: Milbank Quarterly
Rebecca Bentley, Emma Baker, Tony Blakely
In this issue of the Journal, Reeves et al. (Am J Epidemiol. 2016;184(6):421-429) present the findings of a natural experiment analyzing the association between reduced housing affordability and mental ill health. Their difference-in-difference analysis of cross-sectional, quarterly population health surveys administered before and after implementation of a policy to reduce Housing Benefit payments in the United Kingdom in April 2011 represents an important way to assess the impact of a national housing policy shift on public health...
September 15, 2016: American Journal of Epidemiology
Carrie Hoover, Joy Plamann, Jean Beckel
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS XX contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo...
September 6, 2016: Journal of Gerontological Nursing
J Brian Cassel, Kathleen M Kerr, Donna K McClish, Nevena Skoro, Suzanne Johnson, Carol Wanke, Daniel Hoefer
OBJECTIVES: To evaluate the nonclinical outcomes of a proactive palliative care program funded and operated by a health system for Medicare Advantage plan beneficiaries. DESIGN: Observational, retrospective study using propensity-based matching. SETTING: A health system in southern California. PARTICIPANTS: Individuals who received the intervention between 2007 and 2014 (n = 368) were matched with 1,075 comparison individuals within each of four disease groups: cancer, chronic obstructive pulmonary disease, heart failure, and dementia...
September 2, 2016: Journal of the American Geriatrics Society
Ching-Heng Lin, Ying-Chih Lo, Pei-Yuan Hung, Der-Ming Liou
BACKGROUND: As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. OBJECTIVES: The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality...
September 2, 2016: Methods of Information in Medicine
Camille Haycock, Michelle L Edwards, Christopher S Stanley
The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that details a consolidated pay-for-performance provider payment system within the Medicare Access and CHIP Reauthorization Act. This proposed rule establishes policy for the new provider Merit-Based Incentive System and Alternative Payment Models. While the rule is extremely complex, and not yet finalized, there are significant implications for nursing and advanced practice providers. This proposed rule intends to drastically change the current provider payment system and reward providers who demonstrate better quality outcomes at a lower cost...
October 2016: Nursing Administration Quarterly
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