Payment & Delivery

How insurers and providers are organized and paid to deliver care. Research by LDI Senior Fellows examines the shift from fee-for-service payments to newer models of paying for and delivering value, such as Accountable Care Organizations and Patient-Centered Medical Homes.

Insourcing Innovation: Harnessing The strengths Within

May. 8, 2014

It’s not easy to make the case that health care innovation can come from within…from the physicians and nurses on the front lines of patient care. Clinically-trained, path-driven, and time-starved, these clinicians may not appear to be the best source of disruptive change in health care.

A ‘Quality Storm’ Brewing around NHS Nurses

May. 5, 2014

It seems that nurses are getting a lot of bad press in England lately, coming under fire recently for being “uncaring.” In an article published in Nursing Standard, Linda Aiken of Penn’s School of Nursing contends that this erosion of public trust is the result of high workloads and low investment in nursing education, rather than any attitudes held by English nurses.

The Exnovation Conundrum

Apr. 29, 2014

How do we get people and organizations to change, especially when what they are currently doing adds little value, is very costly, is perhaps outmoded, and may, at worst, be dangerous? This is the question Benjamin Roman and David Asch raise in their new Annals of Internal Medicine piece on "Faded Promises".

The Way Forward for Integrated Care

Mar. 31, 2014

As health care reform rolls out, there is a growing focus on restructuring the health service delivery system in the hope of improving health care quality and "bending the cost curve." A key part of this focus has been on physician organization and, in particular, moving toward large, multispecialty physician groups or hospital-physician systems that can provide integrated, coordinated patient care (e.g., through "Accountable Care Organizations").

Patient-Centered Medical Homes: The Next Generation

Mar. 3, 2014

The ugly truth is that health care is often inefficient, costly, and does not meet the needs of its principal constituent -- the patient. This realization has led many physicians and health systems to enthusiastically turn to a new model for delivering primary care, the patient-centered medical home. The patient-centered medical home is a simple idea. It reorganizes care around the needs of the patient, emphasizing coordinated, accessible, and efficient care. In short, it reimagines the health care delivery system in the best image of itself.

Staffing Up To Avoid Hospital Readmissions Penalties?

Oct. 11, 2013

The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries with acute myocardial infarction, heart failure, or pneumonia. In FY2013, the penalties reduced payments to hospitals by an estimated $280 million. The goal is to give hospitals a financial incentive to improve care and to curb the estimated $15 billion Medicare spends annually on these readmissions.

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