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"Value-based payment"

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https://www.readbyqxmd.com/read/28895824/value-based-care-will-flop-without-clinical-integration
#1
Chad Johnson
Value-based payment is gaining traction and proving to be a major factor in health care reform. But the success of those value-based models will depend on true clinical integration of providers-not just lip service to coordination.
August 2017: Managed Care
https://www.readbyqxmd.com/read/28887347/pharmacists-supporting-population-health-in-patient-centered-medical-homes
#2
Antoinette B Coe, Hae Mi Choe
PURPOSE: The integral role of pharmacists in supporting population health initiatives in the patient-centered medical home (PCMH) model of care is described. SUMMARY: Population health initiatives focus on the health outcomes of a group of patients; in the PCMH model, such groups of patients, known as panels, may be defined as patients assigned to a care team or provider. The basic characteristics of the PCMH model include physician-led, team-based practice; coordinated and integrated care within the PCMH and in the patient's community; provision of safe, evidence-based, high-quality care; incorporation of health information technology and continuous quality improvement strategies into panel identification, documentation, and care processes; improved access to care (e...
September 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28874486/reducing-hospital-readmissions-through-preferred-networks-of-skilled-nursing-facilities
#3
John P McHugh, Andrew Foster, Vincent Mor, Renée R Shield, Amal N Trivedi, Terrie Wetle, Jacqueline S Zinn, Denise A Tyler
Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates...
September 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28829924/the-10-conditions-that-increased-vermont-s-readiness-to-implement-statewide-health-system-transformation
#4
David Grembowski, Miriam Marcus-Smith
Following an arduous, 6-year policy-making process, Vermont is the first state implementing a unified, statewide all-payer integrated delivery system with value-based payment, along with aligned medical and social service reforms, for almost all residents and providers in a state. Commercial, Medicare, and Medicaid value-based payment for most Vermonters will be administered through a new statewide accountable care organization in 2018-2022. The purpose of this article is to describe the 10 conditions that increased Vermont's readiness to implement statewide system transformation...
August 22, 2017: Population Health Management
https://www.readbyqxmd.com/read/28822499/countervailing-incentives-in-value-based-payment
#5
REVIEW
Daniel R Arnold
Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives...
September 2017: Healthcare
https://www.readbyqxmd.com/read/28767576/association-between-costs-and-quality-of-acute-myocardial-infarction-care-hospitals-under-the-korea-national-health-insurance-program
#6
Hee-Chung Kang, Jae-Seok Hong
If cost reductions produce a cost-quality trade-off, healthcare policy makers need to be more circumspect about the use of cost-effective initiatives. Additional empirical evidence about the relationship between cost and quality is needed to design a value-based payment system. We examined the association between cost and quality performances for acute myocardial infarction (AMI) care at the hospital level.In 2008, this cross-sectional study examined 69 hospitals with 6599 patients hospitalized under the Korea National Health Insurance (KNHI) program...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28763549/association-of-practice-level-social-and-medical-risk-with-performance-in-the-medicare-physician-value-based-payment-modifier-program
#7
Lena M Chen, Arnold M Epstein, E John Orav, Clara E Filice, Lok Wong Samson, Karen E Joynt Maddox
Importance: Medicare recently launched the Physician Value-Based Payment Modifier (PVBM) Program, a mandatory pay-for-performance program for physician practices. Little is known about performance by practices that serve socially or medically high-risk patients. Objective: To compare performance in the PVBM Program by practice characteristics. Design, Setting, and Participants: Cross-sectional observational study using PVBM Program data for payments made in 2015 based on performance of large US physician practices caring for fee-for-service Medicare beneficiaries in 2013...
August 1, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28748535/financial-incentives-and-physician-practice-participation-in-medicare-s-value-based-reforms
#8
Adam M Markovitz, Patricia P Ramsay, Stephen M Shortell, Andrew M Ryan
OBJECTIVES: To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. DATA SOURCES/STUDY SETTING: Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013)...
July 26, 2017: Health Services Research
https://www.readbyqxmd.com/read/28717900/elements-of-program-design-in-medicare-s-value-based-and-alternative-payment-models-a-narrative-review
#9
Karen E Joynt Maddox, Aditi P Sen, Lok Wong Samson, Rachael B Zuckerman, Nancy DeLew, Arnold M Epstein
Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context...
July 17, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28694275/the-chief-primary-care-medical-officer-restoring-continuity
#10
Noemi Doohan, Jennifer DeVoe
The year 2016 marked the 20th anniversary of the hospitalist profession, with more than 50,000 physicians identifying as hospitalists. The Achilles heel of hospitalist medicine, however, is discontinuity. Despite many current payment and delivery systems rewarding this discontinuity and severing long-term relationships between patient and primary care teams at the hospital door, primary care does not stop being important when a person is admitted to the hospital. The notion of a broken primary care continuum is not an academic construct, it causes real harm to patients...
July 2017: Annals of Family Medicine
https://www.readbyqxmd.com/read/28685850/return-on-investment-roi-analyses-of-an-inpatient-lay-health-worker-model-on-30-day-readmission-rates-in-a-rural-community-hospital
#11
Roberto Cardarelli, Gregory Bausch, Joan Murdock, Michelle Renee Chyatte
PURPOSE: The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. METHODS: The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs)...
July 7, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28673817/a-state-led-framework-for-value-based-purchasing-to-incent-integration
#12
Katherine Shea Barrett, Katherine L Record, Vivian Haime
Addressing healthcare costs requires incenting providers to address both physical and behavioral health conditions, as well as social determinants of health. The most complex, and expensive, patients are often those with comorbid mental illness and/or addiction, who are at higher risk for exposure to violence, food insecurity, unstable housing and other adversities that negatively affect health. Yet today's value-based payment models and associated quality measures do not incent providers to address patients' behavioral and social needs...
June 22, 2017: Healthcare
https://www.readbyqxmd.com/read/28671354/preparing-for-value-based-payment-five-essential-skills-for-success
#13
Arnold E Cuenca
No abstract text is available yet for this article.
May 2017: Family Practice Management
https://www.readbyqxmd.com/read/28669857/aggregation-to-promote-health-in-an-era-of-data-and-value-based-payment
#14
Winston Liaw, Andrew W Bazemore, Robert L Phillips
No abstract text is available yet for this article.
September 2017: Healthcare
https://www.readbyqxmd.com/read/28665677/value-based-payment-models-in-oncology-will-they-help-or-hinder-patient-access-to-new-treatments
#15
Sonal Shah, Greg Reh
No abstract text is available yet for this article.
April 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28652243/clinical-pathways-recommendations-for-putting-patients-at-the-center-of-value-based-care
#16
Edward Abrahams, Alan Balch, Patricia Goldsmith, Marcia Kean, Amy M Miller, Gilbert Omenn, Ellen Sonet, John Sprandio, Courtney Tyne, Kimberly Westrich
Two major trends that have been affecting the provision of oncology care in the United States are a shift from volume-based to value-based care and a push toward patient-centered healthcare. However, these two trends are not always completely aligned with each other. Value-based payment models, including clinical pathways, are one strategy being implemented by oncology stakeholders to help encourage the uptake of value-based oncology care. If structured with the patient in mind, they can improve quality of care for patients with cancer, decrease inappropriate care while enabling appropriate personalization of care, and constrain rising prices by demanding a stronger link between cost and value...
August 15, 2017: Clinical Cancer Research: An Official Journal of the American Association for Cancer Research
https://www.readbyqxmd.com/read/28651925/engaging-small-independent-practices-in-value-based-payment-building-aledade-s-medicare-acos
#17
Brian W Powers, Farzad Mostashari, Emily Maxson, Kimberly Lynch, Amol S Navathe
No abstract text is available yet for this article.
June 23, 2017: Healthcare
https://www.readbyqxmd.com/read/28648871/creation-of-an-open-framework-for-point-of-care-computer-assisted-reporting-and-decision-support-tools-for-radiologists
#18
Tarik K Alkasab, Bernardo C Bizzo, Lincoln L Berland, Sujith Nair, Pari V Pandharipande, H Benjamin Harvey
Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline...
June 22, 2017: Journal of the American College of Radiology: JACR
https://www.readbyqxmd.com/read/28633411/surgeon-level-variability-in-outcomes-cost-and-comorbidity-adjusted-cost-for-elective-lumbar-decompression-and-fusion
#19
Silky Chotai, Ahilan Sivaganesan, John A Sielatycki, Kristin R Archer, Richard Call, Matthew J McGirt, Clinton J Devin
BACKGROUND: The costs and outcomes following degenerative spine surgery may vary from surgeon to surgeon. Patient factors such as comorbidities may increase the health care cost. These variations are not well studied. OBJECTIVE: To understand the variation in outcomes, costs, and comorbidity-adjusted cost for surgeons performing lumbar laminectomy and fusions surgery. METHODS: A total of 752 patients undergoing laminectomy and fusion, performed by 7 surgeons, were analyzed...
June 14, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28631999/adapting-healthcare-quality-measures-to-transgender-individuals
#20
Landon D Hughes, Olivia K G Berzin, Musetta Leung, Catherine Hersey, Sarah Grallert
The healthcare system's rapid shift toward value-based payment poses unique quality measurement challenges and new foci for researchers and policy makers. Quality measures that use sex-specific criteria may inappropriately include or exclude transgender individuals. More large-scale studies must be conducted to incorporate transgender individuals into measures that use sex-specific criteria, and "measure stewards" should consider the existing clinical guidelines and recommendations regarding transgender individuals when developing measures...
August 2017: LGBT Health
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