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"Value-based payment"

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https://www.readbyqxmd.com/read/29764166/chimeric-antigen-receptor-t-cells-a-savior-with-a-high-price
#1
Gilberto de Lima Lopes, George R Nahas
Chimeric antigen receptor (CAR) T cells represent a medical and scientific breakthrough that may represent a paradigm for the future of personalized medicine in the age of cancer immunotherapy. As with many new cancer agents, such novel and incredible results come with a high price. At the time of the writing of this article, there are two CAR T cells available, Kymriah, produced by Novrtis with a price tag of US$475,000 and Yescarta produced by Gilead Pharmaceuticals with a price tag of US$373,000, neither price including the required hospital admission in order to administer the agent in addition to potential treatment of side effects...
April 2018: Chinese Clinical Oncology
https://www.readbyqxmd.com/read/29759290/anesthesiology-s-future-with-specialists-in-population-health
#2
REVIEW
Mike Schweitzer
In population health medicine, often it is not primary care, but rather the specialists' care teams that are responsible for the most overall spending for health care. Engaging specialists in population health medicine is a prerequisite to be successful in improving the quality of care by reducing complications, unnecessary utilization, avoidable Emergency Department visits/readmissions, and total cost of care. Creating patient-centric, physician-lead, interdisciplinary care teams to redesign the delivery of care across the continuum of the episode of care (eg, shadow bundle) is a successful approach to commercial or Centers for Medicare and Medicaid Services value-based payments...
June 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29733731/assessing-medicare-s-approach-to-covering-new-drugs-in-bundled-payments-for-oncology
#3
L Daniel Muldoon, Pamela M Pelizzari, Kelsey A Lang, Joe Vandigo, Bruce S Pyenson
New oncology therapies can contribute to survival or quality of life, but payers and policy makers have raised concerns about the cost of these therapies. Similar concerns extend beyond cancer. In seeking a solution, payers are increasingly turning toward value-based payment models in which providers take financial risk for costs and outcomes. These models, including episode payment and bundled payment, create financial gains for providers who reduce cost, but they also create concerns about potential stinting on necessary treatments...
May 2018: Health Affairs
https://www.readbyqxmd.com/read/29710252/setting-achievable-benchmarks-for-value-based-payments-no-perfect-solution
#4
David W Baker, Susan Yendro
No abstract text is available yet for this article.
April 12, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29707957/a-health-plan-s-journey-to-identifying-meaningful-quality-measures
#5
Misty Roberts, Faith Green, Worthe Holt
The number of quality measures in health care is overwhelming, and reporting requirements are inconsistent. Value-based payments emphasize the need to prioritize quality measures and align across organizations. This article describes the process Humana undertook to reduce the quality measurement burden, refine measure consistency across the organization, ensure alignment with national standards, and relate quality measures to improved health outcomes within the health plan. Of the 1100 measures identified in use at Humana, 699 were duplicative or inconsistent...
April 1, 2018: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/29697778/quality-of-post-acute-care-in-skilled-nursing-facilities-that-disproportionately-serve-black-and-hispanic-patients
#6
Maricruz Rivera-Hernandez, Momotazur Rahman, Dana B Mukamel, Vincent Mor, Amal N Trivedi
Background: Understanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions. Methods: Our final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities...
April 25, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29624190/hospitalist-value-in-an-aco-world
#7
Jing Li, Mark J Williams
The accountable care organization (ACO) concept is advocated as a promising value-based payment model that could successfully realign the current payment system to financially reward improvements in quality and efficiency. Focusing on the care of hospitalized patients and controlling a substantive portion of variable hospital expenses, hospitalists are poised to play an essential role in system-level transformational change to achieve clinical integration. Especially through hospital and health system quality improvement (QI) initiatives, hospitalists can directly impact and share accountability for measures ranging from care coordination to implementation of evidence-based care and the patient and family caregiver experience...
April 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29618639/hospital-level-care-coordination-strategies-associated-with-better-patient-experience
#8
Jose F Figueroa, Yevgeniy Feyman, Xiner Zhou, Karen Joynt Maddox
BACKGROUND: Patient experience is a key measure of hospital quality and is increasingly contained in value-based payment programmes. Understanding whether strategies aimed at improving care transitions are associated with better patient experience could help clinical leaders and policymakers seeking to improve care across multiple dimensions. OBJECTIVE: To determine the association of specific hospital care coordination and transition strategies with patient experience...
April 4, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29608365/primary-care-practices-abilities-and-challenges-in-using-electronic-health-record-data-for-quality-improvement
#9
Deborah J Cohen, David A Dorr, Kyle Knierim, C Annette DuBard, Jennifer R Hemler, Jennifer D Hall, Miguel Marino, Leif I Solberg, K John McConnell, Len M Nichols, Donald E Nease, Samuel T Edwards, Winfred Y Wu, Hang Pham-Singer, Abel N Kho, Robert L Phillips, Luke V Rasmussen, F Daniel Duffy, Bijal A Balasubramanian
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives...
April 2018: Health Affairs
https://www.readbyqxmd.com/read/29553274/incorporating-value-into-physician-payment-and-patient-cost-sharing
#10
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/29541764/us-national-trends-in-mortality-from-acute-myocardial-infarction-and-heart-failure-policy-success-or-failure
#11
Paula Chatterjee, Karen E Joynt Maddox
Importance: Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas...
March 14, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29537242/diagnosis-coding-for-value-based-payment-a-quick-reference-tool
#12
Daniel Belatti, Megan Lykke
No abstract text is available yet for this article.
March 2018: Family Practice Management
https://www.readbyqxmd.com/read/29508113/legislative-and-policy-developments-and-imperatives-for-advancing-the-primary-care-behavioral-health-pcbh-model
#13
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/29505363/promoting-health-equity-and-eliminating-disparities-through-performance-measurement-and-payment
#14
Andrew C Anderson, Erin O'Rourke, Marshall H Chin, Ninez A Ponce, Susannah M Bernheim, Helen Burstin
Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity...
March 2018: Health Affairs
https://www.readbyqxmd.com/read/29496977/evolving-federal-and-state-health-care-policy-toward-a-more-integrated-and-comprehensive-care-delivery-system-for-children-with-medical-complexity
#15
Carolyn S Langer, Richard C Antonelli, Lisa Chamberlain, Richard J Pan, David Keller
Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health...
March 2018: Pediatrics
https://www.readbyqxmd.com/read/29482217/time-for-value-based-payment-models-to-adopt-a-disparities-sensitive-frame-shift
#16
Krisda H Chaiyachati, Jay Bhatt, Jane M Zhu
No abstract text is available yet for this article.
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29461992/healthcare-s-future-strategic-investment-in-technology
#17
Michael A Franklin
Recent and rapid advances in the implementation of technology have greatly affected the quality and efficiency of healthcare delivery in the United States. Simultaneously, diverse generational pressures-including the consumerism of millennials and unsustainable growth in the costs of care for baby boomers-have accelerated a revolution in healthcare delivery that was marked in 2010 by the passage of the Affordable Care Act.Against this backdrop, Maryland and the Centers for Medicare & Medicaid Services entered into a partnership in 2014 to modernize the Maryland All-Payer Model...
April 2018: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/29460679/amcp-partnership-forum-improving-quality-value-and-outcomes-with-patient-reported-outcomes
#18
(no author information available yet)
Patient-reported outcomes (PROs), which provide a direct measure of a patient's health status or treatment preferences, represent a key component of the shift toward patient-centered health care. PROs can measure the state of a patient's disease-specific and overall health throughout the care continuum, enabling them to have a variety of uses for key health care stakeholders. Currently, PROs are used in drug development, aligning patient and clinician goals in care, quality-of-care measures, and coverage and reimbursement decisions...
March 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29453504/financing-the-primary-care-behavioral-health-model
#19
Dennis S Freeman, Lesley Manson, Jeff Howard, Joel Hornberger
The PCBH model of integrated care blends behavioral health professionals into the primary care team, thereby enhancing the scope of primary care and expanding the range of services provided to the patient. Despite promising evidence in support of the model and a growing number of advocates and practitioners of PCBH integration, current reimbursement policies are not always favorable. As the nation's healthcare system transitions to value-based payment models, new financing strategies are emerging which will further support the viability of PCBH integration...
February 16, 2018: Journal of Clinical Psychology in Medical Settings
https://www.readbyqxmd.com/read/29419821/the-use-of-individual-provider-performance-reports-by-us-hospitals
#20
Joshua A Rolnick, Kira L Ryskina
Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential to improve clinical outcomes through social comparison, and isolated cases of clinical dashboard uses at specific institutions have been previously reported. However, little is known about overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. We used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles...
February 7, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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