Health Affairs Journal Convenes Own National Council on Spending and Value
The Tension Between Care Coordination and Conflicts of Interest
Should providers participating in accountable care organizations (ACOs) be exempt from existing regulations that prevent financial conflicts of interest in physician referrals? On the one hand, these regulations, collectively known as the Stark Law, can impede efforts to coordinate care across providers and facilities. On the other hand, ACOs and other alternative payment and delivery models do not necessarily obviate the need for regulations that prohibit physician kickbacks or self-referrals.
Supporting Medicare's Value-Based Transformation
The Centers for Medicare and Medicaid Services (CMS) recently released results from year 1 of Medicare’s largest pay-for-performance program, the Merit-based Incentive Payment System (MIPS).
Improving End of Life Care – Ask the Nurses
Everyone wants a dignified death – yet few actually experience one. Despite preferring to remain at home, most older adults spend their final days in hospitals, where they often undergo medical care that neither improves survival, quality of life, nor satisfaction and is often incongruent with their wishes and goals. A new study in the Journal of the American Geriatrics Society describes these problems in end of life care in nearly 500 U.S.
Changes to Racial Disparities in Readmission Rates After Medicare’s Hospital Readmissions Reduction Program Within Safety-Net and Non-Safety-Net Hospitals
After the Medicare Hospital Readmissions Reduction Program began enforcing financial penalties, disparities in readmissions between white and black patients widened at safety-net hospitals for conditions not targeted by the program. Disparities were stable for conditions targeted by the program. At non-safety-net hospitals, disparities were unchanged for both targeted and non-targeted conditions.
Cost Impact of The Transitional Care Model for Hospitalized Cognitively Impaired Older Adults
Using advanced practice nurses to support high risk patients and their families to transition from hospital to home can reduce postacute care use and costs. A study comparing three evidence-based care management interventions for a population of hospitalized older adults with cognitive impairment found that the Transitional Care Model, which relies on advanced practice nurses to deliver services from hospital to home, was associated with lower postacute care costs when compared to two “hospital only” interventions.
Nurses' and Patients' Appraisals Show Patient Safety in Hospitals Remains a Concern
In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016.
Implications Of MIPS Scoring On Clinician Engagement In Value-Based Payments
[Reposted: Joshua M. Liao and Amol S.
MIPS APMs In The Quality Payment Program
[Reposted: Joshua M. Liao and Amol S.
The Real Opportunities of MIPS Payment Adjustments
[Reposted: Joshua M. Liao, Anders Chen, and Amol S.
How Important Is Price Variation Between Health Insurers?
Stuart V. Craig, Keith Marzilli Ericson, Amanda Starc
Abstract [from journal]
Prices negotiated between payers and providers affect a health insurance contract's value via enrollees' cost-sharing and self-insured employers' costs. However, price variation across payers is hard to observe. We measure negotiated prices for hospital-payer pairs in Massachusetts and characterize price variation. Between-payer price variation is similar in magnitude to between-hospital price variation. Administrative-services-only contracts, in which insurers do not bear risk, have higher prices. We model negotiation incentives and show that contractual...
Effect of Community Health Worker Support on Clinical Outcomes of Low-Income Patients Across Primary Care Facilities: A Randomized Clinical Trial
Shreya Kangovi, Nandita Mitra, Lindsey Norton, Rory Harte Xinyi Zhao, Tamala Carter, David Grande, Judith A. Long
Abstract [from journal]
Importance: Addressing the social determinants of health has been difficult for health systems to operationalize.
Objective: To assess a standardized intervention, Individualized Management for Patient-Centered Targets (IMPaCT), delivered by community health workers (CHWs) across 3 health systems.
Design, Setting, and Participants: This 2-armed, single-blind, multicenter randomized clinical trial recruited patients from 3 primary care facilities in Philadelphia, Pennsylvania,...
Do High-Deductible Health Plans Bend the Spending Curve?
We know that high deductibles have a significant effect on spending levels, but do they affect spending growth? In a recent National Bureau of Economic Research (NBER) working paper, LDI Associate Fellow Molly Frean and LDI Senior Fellow Mark Pauly found that spending growth was significantly lower in states where privately insured employees have higher deductibles.
Penn DC Forum Envisions the Future of Bundled Payments
Just as Medicare launched its new voluntary bundled payment program, LDI Senior Fellows Amol Navathe, MD, PhD, and Ezekiel Emanuel, MD, PhD, hosted a forum in Washington, DC to discuss current evidence and best practices around payment transformation.
Can We Afford to Cure Cancer?
Novel gene and cell therapies hold out the promise of a cure for previously incurable conditions, often at eye-popping prices. Last month, more than 75 health policy and biomedical researchers, federal and state regulators, and clinicians convened at the Cost of a Cure Conference at the University of Pennsylvania to discuss key political, economic, and clinical challenges to the future of gene and cell therapies.