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Sean Orzol, Rosalind Keith, Mynti Hossain, Michael Barna, G Greg Peterson, Timothy Day, Boyd Gilman, Laura Blue, Keith Kranker, Kate A Stewart, Sheila Hoag, Lorenzo Moreno
BACKGROUND: The Center for Medicare & Medicaid Innovation (CMMI) tests new models of paying for or delivering health care services and expands models that improve health outcomes while lowering medical spending. CMMI gave TransforMED, a national learning and dissemination contractor, a 3-year Health Care Innovation Award (HCIA) to integrate health information technology systems into physician practices. This paper estimates impacts of TransforMED's HCIA-funded program on patient outcomes and Medicare parts A and B spending...
April 2018: Medical Care
Rocco J Perla, Hoangmai Pham, Richard Gilfillan, Donald M Berwick, Richard J Baron, Peter Lee, C Joseph McCannon, Kevin Progar, William H Shrank
Congress established the Center for Medicare and Medicaid Innovation (CMMI) to design, test, and spread innovative payment and service delivery models that either reduce spending without reducing the quality of care or improve the quality of care without increasing spending. CMMI sought to leverage these models to foster market innovation and accelerate the transformation of payment and care delivery to achieve the Triple Aim of better health, better care, and lower cost. This article provides a perspective on the design and execution of CMMI's five initial models, the resulting outcomes and lessons, and how their core concepts evolved within and spread beyond CMMI...
February 2018: Health Affairs
Janet Bull, Arif H Kamal, Matthew Harker, Donald H Taylor, Lindsay Bonsignore, John Morris, Lisa Massie, Parampal Singh Bhullar, Mary Howell, Mark Hendrix, Deeana Bennett, Amy Abernethy
BACKGROUND: Although limited, the descriptions of Community-Based Palliative Care (CBPC) demonstrates variability in team structures, eligibility, and standardization across care settings. OBJECTIVE: In 2014, Four Seasons Compassion for Life, a nonprofit hospice and palliative care (PC) organization in Western North Carolina (WNC), was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing innovative model to implement, evaluate, and demonstrate CBPC in the United States...
November 2017: Journal of Palliative Medicine
Suzanne Morton, Tyler Oberlander, Sarah Hudson Scholle, Michael Barr
47 Background: Public and private payers are beginning to adopt alternative payment structures that call for greater attention to patient-centered care and quality improvement activities (CMMI 2015; MACRA 2015). The National Committee for Quality Assurance (NCQA) developed standards for Patient-Centered Specialty Practice based on American College of Physicians principles. The report describes achievement on the standards among an initial cohort of recognized physicians. METHODS: We analyzed practice characteristics and determined how practices performed on each of the 21 elements in the PCSP program by showing the percent of practices scoring less than 50% of points, or 100% of points (i...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Joshua A Hirsch, Andrew B Rosenkrantz, Sameer A Ansari, Laxmaiah Manchikanti, Gregory N Nicola
The annual cost of healthcare delivery in the USA now exceeds US$3 trillion. Fee for service methodology is often implicated as a cause of this exceedingly high figure. The Affordable Care Act created the Center for Medicare and Medicaid Innovation (CMMI) to pilot test value based alternative payments for reimbursing physician services. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed into law. MACRA has dramatic implications for all US based healthcare providers. MACRA permanently repealed the Medicare Sustainable Growth Rate so as to stabilize physician part B Medicare payments, consolidated pre-existing federal performance programs into the Merit based Incentive Payments System (MIPS), and legislatively mandated new approaches to paying clinicians...
July 2017: Journal of Neurointerventional Surgery
Laura Gottlieb, Jeffrey D Colvin, Eric Fleegler, Danielle Hessler, Arvin Garg, Nancy Adler
Despite substantial evidence documenting the social patterning of disease, relatively little information is available on how the health care system can best intervene on social determinants to impact individual and population health. Announced in January 2016, the Centers for Medicare and Medicaid Innovation's (CMMI) Accountable Health Communities (AHC) initiative provides an important opportunity to improve the evidence base around integrated social and medical care delivery. To maximize learning from this large-scale demonstration, comprehensive evaluation efforts should focus on effectiveness and implementation research by supporting local, regional, and national studies across a range of outcomes...
March 2017: Journal of General Internal Medicine
Matthew C Nattinger, Keith Mueller, Fred Ullrich, Xi Zhu
PURPOSE: The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. METHODS: We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan...
December 2018: Journal of Rural Health
Christian A Thomas, Jeffrey C Ward
Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost...
2016: American Society of Clinical Oncology Educational Book
Coleen Kivlahan, Janis M Orlowski, Jonathan Pearce, Jessica Walradt, Matthew Baker, Darrell G Kirch
The authors describe observations from the 27 teaching hospitals constituting the Association of American Medical Colleges (AAMC) cohort in the Center for Medicare and Medicaid Innovation (CMMI) Bundled Payments for Care Improvement (BPCI) initiative. CMMI introduced BPCI in August 2011 and selected the first set of participants in January 2013. BPCI participants enter into Medicare payment arrangements for episodes of care for which they take financial risk. The first round of participants entered risk agreements on October 1, 2013 and January 1, 2014...
July 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Lena M Chen, Ellen Meara, John D Birkmeyer
OBJECTIVES: Aiming to encourage care coordination and cost efficiency, the Center for Medicare and Medicaid Innovation (CMMI) launched the Bundled Payments for Care Improvement (BPCI) initiative in 2013. To help gauge the program's potential impact and generalizability, we describe early and current participants. STUDY DESIGN: We examined the cross-sectional association between BPCI participation and providers' structural and cost characteristics. METHODS: Using data from October 2013 and June 2014, we quantified changes in BPCI participation...
November 2015: American Journal of Managed Care
Tracy L Johnson, Daniel Brewer, Raymond Estacio, Tara Vlasimsky, Michael J Durfee, Kathy R Thompson, Rachel M Everhart, Deborath J Rinehart, Holly Batal
CONTEXT: The Center for Medicare and Medicaid Innovation (CMMI) awarded Denver Health's (DH) integrated, safety net health care system $19.8 million to implement a "population health" approach into the delivery of primary care. This major practice transformation builds on the Patient Centered Medical Home (PCMH) and Wagner's Chronic Care Model (CCM) to achieve the "Triple Aim": improved health for populations, care to individuals, and lower per capita costs. CASE DESCRIPTION: This paper presents a case study of how DH integrated published predictive models and front-line clinical judgment to implement a clinically actionable, risk stratification of patients...
2015: EGEMS
Helga Radner, Kazuki Yoshida, Michelle Frits, Christine Iannaccone, Nancy A Shadick, Michael Weinblatt, Josef S Smolen, Daniel H Solomon
OBJECTIVE: When treating RA patients, remission (REM) or at least low disease activity (LDA) is the ultimate therapeutic goal. The aim of this study was to assess the impact of multimorbidity on achieving REM or LDA. METHODS: In a prospective RA cohort, we identified patients initiating any DMARD with follow-up data 1 year after. Treatment effects were measured using the clinical disease activity index (CDAI) and the modified health assessment questionnaire (MHAQ); multimorbidity status was assessed using a counted multimorbidity index (cMMI)...
November 2015: Rheumatology
Helga Radner, Kazuki Yoshida, Ihsane Hmamouchi, Maxime Dougados, Josef S Smolen, Daniel H Solomon
OBJECTIVE: To describe the treatment profile of multimorbid patients with rheumatoid arthritis (RA) in contrast to patients with RA only. METHODS: COMORA (Comorbidities in Rheumatoid Arthritis) is a cross-sectional, international study assessing morbidities, outcomes, and treatment of patients with RA. Patients were grouped according to their multimorbidity profile assessed by a counted multimorbidity index (cMMI). Treatment for RA was categorized as use of biologic disease-modifying antirheumatic drugs (bDMARD), in particular tumor necrosis factor inhibitors (TNFi), synthetic DMARD (sDMARD) use only, nonsteroidal antiinflammatory drug (NSAID) use, and corticosteroid use...
July 2015: Journal of Rheumatology
Alan S Hilibrand, Kurt Spindler, Regis J O'Keefe
Orthopaedic surgery is expensive and will be carefully scrutinized in the U.S. under health-care reform. Unfortunately, although the orthopaedic literature is replete with clinical outcomes studies, there is still a paucity of meaningful clinical outcomes data that are free from bias. It is possible that orthopaedic procedures may be among the most cost-effective medical treatments for the aging population. However, it is only through the collection of patient-generated outcomes data in prospective randomized and observational studies that orthopaedic surgery can be shown to provide high value (defined as high-quality outcomes at a relatively low cost) to society...
April 1, 2015: Journal of Bone and Joint Surgery. American Volume
Bechara Choucair, Bechair Choucair, Jay D Bhatt
No abstract text is available yet for this article.
April 2015: American Journal of Public Health
Shang-Min Chou, Wan-Jung Lai, Tzu-Wen Hong, Jui-Ya Lai, Sheng-Hong Tsai, Yen-Hsun Chen, Sz-Hsien Yu, Cheng-Hsiang Kao, Richard Chu, Shih-Torng Ding, Tsai-Kun Li, Tang-Long Shen
Cordyceps militaris is a well-known Chinese traditional medicinal mushroom frequently used for tonics and recently of a potential interest for cancer intervention. Here, we explored the cancer cell killing activity of the hot water extracts of C. militaris cultured mycelia (CM(MY)) and cultivated fruiting bodies (CM(FB)). We found that CM(FB) exhibited a greater cytotoxic effect against various cancer cells over CM(MY). Apoptotic phenotypes including apoptotic body formation, DNA laddering, caspase 3 activation and cleavage of PARP proteins were induced by CM(FB) treatment but only slightly induced by same concentration of CM(MY) treatment in human HL-60 leukemia cells...
October 15, 2014: Phytomedicine: International Journal of Phytotherapy and Phytopharmacology
Wieland Voigt, Josef Hoellthaler, Tiziana Magnani, Vito Corrao, Riccardo Valdagni
BACKGROUND: Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders. OBJECTIVE: To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency...
2014: PloS One
Su-jin Choi, Dae-Kyoo Kim, Sooyong Park
Software process improvement aims at improving the development process of software systems. It is initiated by process assessment identifying strengths and weaknesses and based on the findings, improvement plans are developed. In general, a process reference model (e.g., CMMI) is used throughout the process of software process improvement as the base. CMMI defines a set of process areas involved in software development and what to be carried out in process areas in terms of goals and practices. Process areas and their elements (goals and practices) are often correlated due to the iterative nature of software development process...
2014: TheScientificWorldJournal
Rongfeng Li, Evan P Lloyd, Kristos A Moshos, Craig A Townsend
Nearly 50 naturally occurring carbapenem β-lactam antibiotics, most produced by Streptomyces, have been identified. The structural diversity of these compounds is limited to variance of the C-2 and C-6 side chains as well as the stereochemistry at C-5/C-6. These structural motifs are of interest both for their antibiotic effects and their biosynthesis. Although the thienamycin gene cluster is the only active gene cluster publically available in this group, more comparative information is needed to understand the genetic basis of these structural differences...
January 24, 2014: Chembiochem: a European Journal of Chemical Biology
Jui-Jen Chen, Wu-Chen Su, Pei-Wen Wang, Hung-Chi Yen
In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field...
2013: SpringerPlus
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