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"Value-based payment"

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https://www.readbyqxmd.com/read/29338994/both-patients-and-maternity-care-providers-can-benefit-from-payment-reform-four-steps-to-prepare
#1
Malini A Nijagal, Neel T Shah, Jeff Levin-Scherz
Many Medicaid programs and private health plans are implementing new models of maternity care reimbursement, and clinicians face mounting pressure to demonstrate high quality care at lower cost. Clinicians will be better prepared to meet these challenges with a fuller understanding of new payment models and the opportunities they present. We describe the structure of maternity care "episode payments" and recommend four ways that clinicians can prepare for success as value-based payment models are implemented: identify opportunities to improve outcomes and experience, measure quality, reduce waste and work in teams across settings...
January 12, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29337604/the-current-status-of-outcomes-based-contracting-for-manufacturers-and-payers-an-amcp-membership-survey
#2
Amy Duhig, Soumi Saha, Stacie Smith, Stew Kaufman, Janet Hughes
BACKGROUND: As the United States health care system shifts from traditional volume-based payments to value-based payments, outcomes-based contracts (OBCs) are gaining popularity among payers and manufacturers as a mechanism for the shift toward value. Under this model, stakeholders hope to align drug payment and value to real-world performance metrics (e.g., biomarkers and health care resource utilization). OBJECTIVE: To understand the experiences, perceptions, and needs of payers and manufacturers related to OBCs...
December 22, 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29313756/data-needs-for-a-serious-illness-care-accountability-system-a-framework-and-recommendations
#3
Tom Valuck, Russ Montgomery
BACKGROUND: Successful implementation of a comprehensive accountability system for community-based serious illness care will require a robust data infrastructure. Data will be needed to support care delivery, quality measurement, value-based payment, and evaluation and monitoring. OBJECTIVE: The specific data needs in these areas need to be identified and understood, so that gaps in currently available data may be addressed. DESIGN: We developed a framework that includes the needed data and data infrastructure to support the features and characteristics of a serious illness care accountability system...
March 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29298402/public-reporting-of-primary-care-clinic-quality-accounting-for-sociodemographic-factors-in-risk-adjustment-and-performance-comparison
#4
Douglas R Wholey, Michael Finch, Rob Kreiger, David Reeves
Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control...
January 3, 2018: Population Health Management
https://www.readbyqxmd.com/read/29276761/creating-an-excellent-patient-experience-through-service-education-content-and-methods-for-engaging-and-motivating-front-line-staff
#5
Denise M Kennedy
Service quality and patient satisfaction affect an organization's value-based payments. This new value paradigm calls for a new approach to service education and training for front-line staff. Thoughtfully conceived, department-specific content, infused with patient feedback, value creation, and science of service quality principles, was developed to give front-line staff a deeper understanding of the impact of their performance on patient experience, value creation, and value-based revenue. Feedback from nearly 1500 trainees in 60 educational sessions delivered over 7 years indicates good understanding of the content and appreciation of the targeted approach...
December 2017: Journal of Patient Experience
https://www.readbyqxmd.com/read/29261816/improving-quality-of-care-for-seriously-ill-patients-opportunities-for-hospitalists
#6
Robin E Fail, Diane E Meier
As the shift to value-based payment accelerates, hospitals are under increasing pressure to deliver high-quality, efficient services. Palliative care approaches improve quality of life and family well-being, and in doing so, reduce resource utilization and costs. Hospitalists frequently provide palliative care interventions to their patients, including pain and symptom management and engaging in conversations with patients and families about the realities of their illness and treatment plans that align with their priorities...
December 20, 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29261249/real-world-economic-value-of-a-21-gene-assay-in-early-stage-breast-cancer
#7
Stanley E Waintraub, Donna McNamara, Deena Mary Atieh Graham, Andrew L Pecora, John Min, Tommy Wu, Hyun Gi Noh, Jacqueline Connors, Ruth Pe Benito, Kelly Choi, Eric Schultz, Stuart L Goldberg
OBJECTIVES: Value-based payment reforms shift cost-containment responsibilities to the physician. Although gene expression profiling (GEP) utilizing a 21-gene panel among patients with early-stage, axillary lymph node-negative, hormone receptor-positive, HER2/neu oncogene-negative breast cancer is able to identify a cohort that may achieve excellent outcomes without adjuvant chemotherapy, high up-front costs (list price, $4175) could dissuade usage. STUDY DESIGN: Retrospective review of consecutive patients with breast cancer treated at a single cancer center...
December 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29242239/defining-quality-in-cardiovascular-imaging-a-scientific-statement-from-the-american-heart-association
#8
REVIEW
Leslee J Shaw, Ron Blankstein, Jill E Jacobs, Jonathon A Leipsic, Raymond Y Kwong, Viviany R Taqueti, Rob S B Beanlands, Jennifer H Mieres, Scott D Flamm, Thomas C Gerber, John Spertus, Marcelo F Di Carli
The aims of the current statement are to refine the definition of quality in cardiovascular imaging and to propose novel methodological approaches to inform the demonstration of quality in imaging in future clinical trials and registries. We propose defining quality in cardiovascular imaging using an analytical framework put forth by the Institute of Medicine whereby quality was defined as testing being safe, effective, patient-centered, timely, equitable, and efficient. The implications of each of these components of quality health care are as essential for cardiovascular imaging as they are for other areas within health care...
December 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29226449/cms-demonstration-projects-and-the-future-of-value-based-payments
#9
Gail R Wilensky
No abstract text is available yet for this article.
December 2017: Milbank Quarterly
https://www.readbyqxmd.com/read/29200334/performance-and-participation-of-physicians-in-year-one-of-medicare-s-value-based-payment-modifier-program
#10
Karen E Joynt Maddox, Arnold M Epstein, Lok Wong Samson, Lena M Chen
In 2015 Medicare launched the Physician Value-Based Payment Modifier program, the largest US ambulatory care pay-for-performance program to date and a precursor to the forthcoming Merit-based Incentive Payment System. In its first year, the program included practices with a hundred or more clinicians. We found that 1,010 practices met this criterion, 899 of which had at least one attributed beneficiary. Of these latter practices, 263 (29.3 percent) failed to report performance data and received a 1 percent reporting-based penalty...
December 2017: Health Affairs
https://www.readbyqxmd.com/read/29195052/accountability-for-community-based-programs-for-the-seriously-ill
#11
Joan M Teno, Russ Montgomery, Tom Valuck, Janet Corrigan, Diane E Meier, Amy Kelley, J Randall Curtis, Ruth Engelberg
Innovation is needed to improve care of the seriously ill, and there are important opportunities as we transition from a volume- to value-based payment system. Not all seriously ill are dying; some recover, while others are persistently functionally impaired. While we innovate in service delivery and payment models for the seriously ill, it is important that we concurrently develop accountability that ensures a focus on high-quality care rather than narrowly focusing on cost containment. The Gordon and Betty Moore Foundation convened a meeting of 45 experts to arrive at guiding principles for measurement, create a starter measurement set, specify a proposed definition of the denominator and its refinement, and identify research priorities for future implementation of the accountability system...
December 1, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29189477/remaining-financially-viable-in-a-time-of-healthcare-transition
#12
Barry P Ronan
In an unstable healthcare environment, Western Maryland Health System has been demonstrating stability. We have responded to the many challenges that hospitals face and managed to thrive in the new, value-based world.We made the transition to value-based payment and care delivery models through innovations in Maryland's payment system. In 2010, we recognized that becoming a demonstration project for value-based care would benefit our health system as we dealt with an aging and shrinking regional population...
January 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/29182487/using-electronic-health-records-for-quality-measurement-and-accountability-in-care-of-the-seriously-ill-opportunities-and-challenges
#13
J Randall Curtis, Seelwan Sathitratanacheewin, Helene Starks, Robert Y Lee, Erin K Kross, Lois Downey, James Sibley, William Lober, Elizabeth T Loggers, James A Fausto, Charlotta Lindvall, Ruth A Engelberg
BACKGROUND: As our population ages and the burden of chronic illness rises, there is increasing need to implement quality metrics that measure and benchmark care of the seriously ill, including the delivery of both primary care and specialty palliative care. Such metrics can be used to drive quality improvement, value-based payment, and accountability for population-based outcomes. METHODS: In this article, we examine use of the electronic health record (EHR) as a tool to assess quality of serious illness care through narrative review and description of a palliative care quality metrics program in a large healthcare system...
November 28, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29181511/the-value-based-payment-modifier-program-outcomes-and-implications-for-disparities
#14
Eric T Roberts, Alan M Zaslavsky, J Michael McWilliams
Background: When risk adjustment is inadequate and incentives are weak, pay-for-performance programs, such as the Value-Based Payment Modifier (Value Modifier [VM]) implemented by the Centers for Medicare & Medicaid Services, may contribute to health care disparities without improving performance on average. Objective: To estimate the association between VM exposure and performance on quality and spending measures and to assess the effects of adjusting for additional patient characteristics on performance differences between practices serving higher-risk and those serving lower-risk patients...
November 28, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29147978/predictors-of-client-satisfaction-with-outpatient-mental-health-clinic-services-in-italy-and-new-york
#15
Luca Pauselli, Chiara Galletti, Norma Verdolini, Enrico Paolini, Daniela Gallucci, Pierfrancesco Maria Balducci, Francesco Bernardini, Jerome H Kogan, Ruth Shim, Patrizia Moretti, Michael T Compton
The aim of this cross-sectional study was to assess factors associated with client satisfaction in two mental health outpatient settings in Italy and the US. Sociodemographic and clinical variables, hope, and personality characteristics were evaluated in 18-65-year-old patients who had been receiving services for at least 2 months in one of two outpatient clinics, in Italy and the US. Patients were administered: the Healthy Days Core Module, the Kessler Screening Scale for Psychological Distress, the Verona Service Satisfaction Survey, the Client Satisfaction Inventory, the Health Service OutPatient Experience questionnaire, the Herth Hope Index, and the NEO Five-Factor Inventory-3...
November 17, 2017: Community Mental Health Journal
https://www.readbyqxmd.com/read/29132634/a-model-to-determine-payments-associated-with-radiology-procedures
#16
Thusitha Mabotuwana, Christopher S Hall, Shiby Thomas, Christoph Wald
OBJECTIVE: Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29091529/linking-quality-and-spending-to-measure-value-for-people-with-serious-illness
#17
Andrew M Ryan, Phillip E Rodgers
BACKGROUND: Healthcare payment is rapidly evolving to reward value by measuring and paying for quality and spending performance. Rewarding value for the care of seriously ill patients presents unique challenges. OBJECTIVE: To evaluate the state of current efforts to measure and reward value for the care of seriously ill patients. DESIGN: We performed a PubMed search of articles related to (1) measures of spending for people with serious illness and (2) linking spending and quality measures and rewarding performance for the care of people with serious illness...
November 1, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29090623/care-transformation-strategies-and-approaches-of-accountable-care-organizations
#18
Valerie A Lewis, Katherine I Tierney, Taressa Fraze, Genevra F Murray
Although accountable care organizations (ACOs) proliferate, little is known about the activities and strategies ACOs are pursuing to meet goals of reducing costs and improving quality. We use semistructured interviews with executives at 16 ACOs to understand ACO approaches. We identified two overarching ACO approaches to changing clinical care: a practice-based transformation approach, working to overhaul care processes and teams from the inside out; and an overlay approach, where ACO activities were centralized and delivered external to physician practices...
October 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29079401/implications-of-medicare-s-value-based-payment-initiative-for-specialty-health-systems
#19
EDITORIAL
Michael Hochman, Jehni Robinson, Kiran Dhanireddy
No abstract text is available yet for this article.
October 24, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/29068305/fee-for-service-is-dead-long-live-fee-for-service
#20
Jan Greene
The move to a value-based payment system was supposed to end perverse incentives that pay doctors more for delivering often unnecessary services. But things are changing slowly and the market is still 95% fee for service. There's talk of reworking the Medicare fee schedule so docs are paid more for the things that work, and less for those that don't.
September 2017: Managed Care
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