Category Archives: Payment Reform

Duke, Colorado Explore Innovative Payment Models for Specialty Care

By Khin-Kyemon Aung

???????????????????There’s no time like now to test new ways to pay for specialty care, and the federal government has offered immense support in this endeavor. Earlier this year, the Center for Medicare and Medicaid Innovation (CMMI) sought input from stakeholders to develop payment models for diseases cared for by specialists. CMMI is also in the midst of testing bundled payments for 48 different episodes of care, launching a new accountable care organization (ACO) model for patients with end-stage renal disease, and developing an episode-based payment model for oncology care. Additionally, through Health Care Innovation Awards and State Innovation Model funding, the Centers for Medicare and Medicaid Services is aiming to further drive innovation around how specialty care is delivered and paid for to incentivize improved outcomes and higher quality at lower costs.

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Health Wonk Review: Polar Vortex Edition, July 2014

Okay, so the vaunted summer polar vortex didn’t exactly bring the expected plummeting temperatures this week, but at least the oppressive humidity is lessened. Along with that refreshing change, some fresh thoughts from our Health Wonkers:

Over at InsureBlog, Henry Stern, LUTCF, CBC, kicks things off with a post on “SexistCare.” Stern reveals that the ACA mandates a whole raft of benefits specifically for women and children, but none for men. He wonders why mammograms are covered as preventive care, for example, but there are no corresponding provisions for prostate cancer screening. “Where’s the hue and cry?” he asks.

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WSJ Contributors Have It All Wrong About CMMI

By Coleen Kivlahan, MD

On April 23, 2014, an op-ed in the Wall Street Journal described the Center for Medicare and Medicaid Innovation (CMMI), one of the few bright spots on the health reform horizon in our country, as “a stealthy menace.” It was written by Lanhee Chen from the Hoover Institute (a scholar and attorney) and James Capretta from the American Enterprise Institute (a scholar and long term public policy government servant). The authors are not working in one of our nation’s health systems

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Rebooting Primary Care from the Bottom Up

Originally posted on April 16, 2014

Zubin DamaniaFor the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan…ford).

I used to play a game with the med students and housestaff: let’s estimate how many of our inpatients actually didn’t need hospitalization, had they simply received effective outpatient preventative care. Over the years, our totals were almost never less than 50%.

For my fellow math-challenged Americans: that’s ONE HALF! Clearly, if there were actually were any incentives to prevent disease, they sure as heck weren’t working.

In a country whose care pyramid is upside down—more specialists than primary care docs, really?—we’re squandering our physical, emotional, and economic health while spending more per capita than anyone else. Four percent of our healthcare dollars go towards primary care, with much of the remaining 95% paying for the failure of primary care. (The missing 1%? Doritos.)

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Connecting Physicians to Health Care Cost Transparency

teaching_values_projectBy François de Brantes, MS, MBA and Neel Shah, MD, MPP

We recently returned from the National Summit on Healthcare Price, Cost, and Quality Transparency, where leading thinkers convened to discuss next steps in a growing movement to hold caregivers accountable for delivering better care at lower costs. Traditionally quality, cost, and patient experiences remained locked inside black boxes of individual patient–physician encounters. However, at the cusp of 2014, the window of opportunity to shine a light on physician performance appears to be permanently jammed open by public demand, payer pressure, and a technology marketplace that is eager and capable of making it happen. Continue reading Connecting Physicians to Health Care Cost Transparency

Pay-for-Performance Programs Ignore True Human Motivators

brainstormsI often listen to books on CD during long trips in the car. They’re a great way to catch up on reading and provide the added bonus of letting me avoid the mind-numbing “hit list” of pop tunes on the radio.

After a trip that flew by while I laughed to Tina Fey’s Bossypants (worthy of a future post if I can figure out to link it to health care), I tried another nonfiction selection from my local library: Drive by Daniel Pink. Pink worked as an aide to Secretary of Labor Robert Reich, and from 1995 to 1997, he was chief speechwriter for VP Al Gore. He graduated from Yale Law School and has written five best-selling management books. His 2009 TED talk on “the puzzle of motivation” is one of the 10 most-watched.

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Yale’s I-CARE Engages Residents, Faculty on Costs in Friendly Competition

teaching_values_projectBy Robert Fogerty, MD

Residency is like the adolescence of medical training. Residents are testing boundaries, learning their limits, and developing their diagnostic and therapeutic skills. Much like a young bear learning to fish, residents learn by doing under the close supervision of a faculty physician. Mama bear won’t let her cub starve and faculty won’t let the residents cause harm. When given the chance, however, residents will push those boundaries to the limits in an attempt to best each other. They are, inherently, competitive creatures. Much like the proud bear with a big salmon, the resident with the rarest diagnosis or the most abnormal lab value becomes the alpha doctor. At Yale School of Medicine, we leverage this competitive atmosphere to engage residents in learning and education.

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Bundled Payments: Are You Ready for Change?

brainstormsBy Joanne Conroy, MD

No one really loves change. When the change has an unclear impact, we often resist because of the fear of the unknown. Our resistance runs the emotional gamut from “Life is complex enough; why change what is already working?” to feeling actively threatened from a personal security or financial perspective. We can manage the anxiety by educating ourselves and developing a change strategy to embrace the emotional and operational impact of the change. We do this all the time in our personal lives, yet, in our professional lives, we often adopt an “ostrich mentality.” Choosing not to prepare for change leads to greater uncertainty and fear.

For teaching hospitals, the case in point is the shift in payment models from fee-for-service to alternative or bundled payments.

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