This slide deck discusses some of the relevant factors that should be considered when designing financial incentives for providers of healthcare services.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Rising healthcare costs are a major concern for employers. Health care costs have increased steadily over the past decade at a rate around 7% per year. Several factors contribute to higher costs, including an aging workforce and population, increased chronic conditions among employees, new medical technologies, and increased drug spending. To control costs, employers are focusing on strategies like consumer-driven health plans, wellness programs, dependent eligibility audits, strategic vendor management, and long-term cost control solutions rather than short-term fixes. Prescription drugs also represent a large portion of spending, so employers are promoting generics and mail order drugs to reduce drug costs.
Clinical Transformation: Fundamentally Changing Clinical Processes to Achieve...Huron Consulting Group
The document discusses clinical transformation at Maine Medical Center through reducing variability in care for patients requiring mechanical ventilation and tracheostomies. A team was formed to standardize processes and reduce length of stay and costs for these patients. The team identified over 70 action items and set goals around reducing length of stay, increasing standardization and palliative care screening, improving patient satisfaction, and generating savings. Metrics were established and showed progress towards the goals over 12 months, including reduced length of stay, increased compliance with best practices, and over $1 million in savings.
This document discusses pay-for-performance (P4P) programs, which provide financial incentives to healthcare providers for meeting quality benchmarks. The key points are:
1. P4P programs adjust payments to providers like physicians and hospitals based on performance measures related to quality, cost efficiency, and outcomes. Measures include structure, process, and outcomes.
2. The goals are to improve quality of care and reduce costs long-term by incentivizing evidence-based practices.
3. Providers are incentivized to improve quality through financial rewards or penalties based on meeting targets. However, programs have narrow focus and lack coordination between payers.
How to design effective and efficient real world trials TB Evidence 2014 10.2...Todd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges in defining quality metrics, and strategies for improving performance within healthcare systems. The document provides information on pragmatic clinical trials and how real-world evidence could reduce costs compared to traditional clinical trials.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Rising healthcare costs are a major concern for employers. Health care costs have increased steadily over the past decade at a rate around 7% per year. Several factors contribute to higher costs, including an aging workforce and population, increased chronic conditions among employees, new medical technologies, and increased drug spending. To control costs, employers are focusing on strategies like consumer-driven health plans, wellness programs, dependent eligibility audits, strategic vendor management, and long-term cost control solutions rather than short-term fixes. Prescription drugs also represent a large portion of spending, so employers are promoting generics and mail order drugs to reduce drug costs.
Clinical Transformation: Fundamentally Changing Clinical Processes to Achieve...Huron Consulting Group
The document discusses clinical transformation at Maine Medical Center through reducing variability in care for patients requiring mechanical ventilation and tracheostomies. A team was formed to standardize processes and reduce length of stay and costs for these patients. The team identified over 70 action items and set goals around reducing length of stay, increasing standardization and palliative care screening, improving patient satisfaction, and generating savings. Metrics were established and showed progress towards the goals over 12 months, including reduced length of stay, increased compliance with best practices, and over $1 million in savings.
This document discusses pay-for-performance (P4P) programs, which provide financial incentives to healthcare providers for meeting quality benchmarks. The key points are:
1. P4P programs adjust payments to providers like physicians and hospitals based on performance measures related to quality, cost efficiency, and outcomes. Measures include structure, process, and outcomes.
2. The goals are to improve quality of care and reduce costs long-term by incentivizing evidence-based practices.
3. Providers are incentivized to improve quality through financial rewards or penalties based on meeting targets. However, programs have narrow focus and lack coordination between payers.
How to design effective and efficient real world trials TB Evidence 2014 10.2...Todd Berner MD
This document discusses strategies for designing effective and efficient real-world clinical trials. It covers topics such as using real-world evidence to inform clinical trial design, the differences between efficacy and effectiveness, challenges in defining quality metrics, and strategies for improving performance within healthcare systems. The document provides information on pragmatic clinical trials and how real-world evidence could reduce costs compared to traditional clinical trials.
Part of the "Fourth Annual Health Law Year in P/Review" held at Harvard Law School on January 29, 2016.
This symposium featured leading experts discussing major developments during 2015 and what to watch out for in 2016. The discussion covered hot topics in such areas as health insurance, health care systems, public health, innovation, and other issues facing clinicians and patients.
This year's Health Law Year in P/Review was sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, the New England Journal of Medicine, Health Affairs, the Hastings Center, Harvard Health Publications at Harvard Medical School, and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund at Harvard University.
Visit our website for more information: http://petrieflom.law.harvard.edu/events/details/fourth-annual-health-law-year-in-p-review.
The document discusses pilots that will test and evaluate new ways for Primary Care Trusts (PCTs) to commission more integrated services across primary, community, and secondary care working with local authorities and other sectors. The goals of the pilots are to build an evidence base that integrated care can improve health outcomes faster, learn how PCTs can commission integrated care, and understand how existing reforms need to adapt to incentivize integration. Potential national outcomes include improved quality of care, health equity, and cost effectiveness.
This document discusses care coordination and its value. It defines care coordination as promoting quality, safety and efficiency in care through improved healthcare outcomes using a holistic and patient-centered approach. Registered nurses are central to organizing patient-centered care and enhancing value through quality outcomes and efficiencies. Care coordination can reduce hospital-acquired conditions, readmissions, costs and improve patient satisfaction. The document outlines various strategies nurses can use to demonstrate the value of care coordination.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
This document discusses improvements made to cancer treatment timelines at Counties Manukau Health (CMH) in New Zealand over the past year. It summarizes that CMH was not meeting the Ministry of Health's target of treating 85% of cancer patients within 62 days of referral, performing at only 52%. A team was formed to improve the six largest cancer pathways. Their analysis found opportunities to speed up the time between a patient's first specialist appointment and multidisciplinary meeting. Changes such as standardizing meeting templates, earlier diagnostic scans, and improved handoffs have increased CMH's treatment rate to an average of 76.4% and reduced variability in wait times.
The document discusses challenges that health systems face in managing costs under new bundled payment programs and global budgets. It provides an example from a pilot program in Maryland where costs have been capped and prices set in an effort to cut Medicare spending. The document outlines some of the key areas health systems need to address in both acute and post-acute care settings, such as optimizing patient mix and readmission rates, in order to successfully meet budget targets and quality measures. It provides details on specific strategies used by one Maryland health system to improve performance, such as reducing readmission rates from over 23% to less than 7%.
This document summarizes a presentation given by Helen Burstin on quality measurement, past and future. Some key points include:
- NQF leads consensus-based standard setting to improve healthcare quality through measurement. It convenes stakeholders to reach agreement on complex issues.
- Recent legislation has increasingly tied payment to quality measurement to encourage value-based care. The MACRA law establishes two paths for physicians, one based on quality metrics and one through alternative payment models.
- Measurement is evolving to better assess outcomes, reduce disparities, and capture value by linking cost and quality. Challenges include measurement gaps, unintended consequences, risk adjustment, and advancing electronic capture of data.
- There is a need
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Employer Sponsored Medical Clinics white paperTom Pascuzzi
Employer-sponsored medical clinics have evolved from providing only basic convenience care to playing a larger role in actively managing chronic conditions to help control employers' health care costs. Successful clinics are integrated into the employer's data-driven health strategy and hold the clinic accountable for meeting cost and productivity goals. Different clinic models provide varying levels of services from basic care to full primary care management. For an on-site clinic to be effective, employers need to analyze their claims data to identify conditions driving costs and those amenable to improved management. The Affordable Care Act has prompted some employers to reconsider clinics to help manage costs and improve access to care.
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
Presentation on the literature review of interventions to improve health care...IDS
This presentation was given in a Future Health System Consortium organised session at the Global Symposium on Health Systems Research in November 2010. The author is Alex Rowe from the Centers for Disease Control and Prevention.
Generating Quality Data through Collaborative Research with an ACOTodd Berner MD
This document summarizes a presentation about generating quality data through collaborative research with an ACO. The number of public and private ACOs is growing rapidly, with over 250 CMS MSSP ACOs covering 4 million Medicare beneficiaries. The goal of the collaborative research is to disseminate valued information on effectiveness and costs of care to payers and policymakers. Real-world evidence studies can provide insights beyond randomized controlled trials by observing patient outcomes across delivery system models. Measuring quality requires considering multiple stakeholder perspectives to identify metrics that drive improvement and have utility.
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
An enhanced care management program achieved lower health care costs through broader outreach, personalized health coaching, and engagement of higher-risk populations. A randomized controlled trial of 175,000 individuals found that the enhanced program led to a $7.96 lower average monthly medical cost per member and over a 4:1 return on investment. Key aspects of the enhanced program included targeting a wider range of chronic and preference-sensitive conditions, more frequent outreach, and deeper health coaching relationships.
This document provides a summary of the plot and story of the movie "The Stoning of Soraya M." It discusses how the movie is based on a true story about an innocent woman in a village who is accused of adultery by her abusive husband so he can remarry. She is put on trial without evidence and convicted, then buried up to her waist and stoned to death by the villagers. The summary criticizes the religious extremism, gender discrimination, and lack of fair trials that allowed Soraya to be killed in this way.
Soraya Ghebleh - Improving Public Health Despite Constitutional ImpedimentsSoraya Ghebleh
This document outlines various public health issues addressed by state attorneys general, including obesity, gun violence, end-of-life care, infectious disease, prescription drug abuse, environmental toxins, food safety, mental health, and injury. For each issue, it provides data on scope, causes, and examples of how specific state attorneys general have taken action to effect change through legislation, regulations, enforcement, and coordinating stakeholders. The attorneys general employ a variety of legal strategies but also recognize the need for multidisciplinary solutions and navigation of constitutional issues.
Part of the "Fourth Annual Health Law Year in P/Review" held at Harvard Law School on January 29, 2016.
This symposium featured leading experts discussing major developments during 2015 and what to watch out for in 2016. The discussion covered hot topics in such areas as health insurance, health care systems, public health, innovation, and other issues facing clinicians and patients.
This year's Health Law Year in P/Review was sponsored by the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, the New England Journal of Medicine, Health Affairs, the Hastings Center, Harvard Health Publications at Harvard Medical School, and the Center for Bioethics at Harvard Medical School, with support from the Oswald DeN. Cammann Fund at Harvard University.
Visit our website for more information: http://petrieflom.law.harvard.edu/events/details/fourth-annual-health-law-year-in-p-review.
The document discusses pilots that will test and evaluate new ways for Primary Care Trusts (PCTs) to commission more integrated services across primary, community, and secondary care working with local authorities and other sectors. The goals of the pilots are to build an evidence base that integrated care can improve health outcomes faster, learn how PCTs can commission integrated care, and understand how existing reforms need to adapt to incentivize integration. Potential national outcomes include improved quality of care, health equity, and cost effectiveness.
This document discusses care coordination and its value. It defines care coordination as promoting quality, safety and efficiency in care through improved healthcare outcomes using a holistic and patient-centered approach. Registered nurses are central to organizing patient-centered care and enhancing value through quality outcomes and efficiencies. Care coordination can reduce hospital-acquired conditions, readmissions, costs and improve patient satisfaction. The document outlines various strategies nurses can use to demonstrate the value of care coordination.
The document discusses New York State's efforts to promote the patient-centered medical home model. It notes that while New York spends a lot on healthcare, the quality and health outcomes are only middle of the pack. The Commissioner of Health believes the PCMH model can help strengthen primary care, improve chronic care management, and reduce avoidable costs. New York has promoted multipayer PCMH initiatives through legislation and programs. Initial PCMH pilot programs showed promising results, and the state has seen significant uptake of PCMH recognition across practices. Evaluations are still early, but results so far are encouraging regarding patient experience and quality measures.
This document discusses improvements made to cancer treatment timelines at Counties Manukau Health (CMH) in New Zealand over the past year. It summarizes that CMH was not meeting the Ministry of Health's target of treating 85% of cancer patients within 62 days of referral, performing at only 52%. A team was formed to improve the six largest cancer pathways. Their analysis found opportunities to speed up the time between a patient's first specialist appointment and multidisciplinary meeting. Changes such as standardizing meeting templates, earlier diagnostic scans, and improved handoffs have increased CMH's treatment rate to an average of 76.4% and reduced variability in wait times.
The document discusses challenges that health systems face in managing costs under new bundled payment programs and global budgets. It provides an example from a pilot program in Maryland where costs have been capped and prices set in an effort to cut Medicare spending. The document outlines some of the key areas health systems need to address in both acute and post-acute care settings, such as optimizing patient mix and readmission rates, in order to successfully meet budget targets and quality measures. It provides details on specific strategies used by one Maryland health system to improve performance, such as reducing readmission rates from over 23% to less than 7%.
This document summarizes a presentation given by Helen Burstin on quality measurement, past and future. Some key points include:
- NQF leads consensus-based standard setting to improve healthcare quality through measurement. It convenes stakeholders to reach agreement on complex issues.
- Recent legislation has increasingly tied payment to quality measurement to encourage value-based care. The MACRA law establishes two paths for physicians, one based on quality metrics and one through alternative payment models.
- Measurement is evolving to better assess outcomes, reduce disparities, and capture value by linking cost and quality. Challenges include measurement gaps, unintended consequences, risk adjustment, and advancing electronic capture of data.
- There is a need
Policy Implications of Healthcare Associated InfectionsAlbert Domingo
On February 19, 2014 at the Ateneo School of Medicine and Public Health in Pasig City, Dr. Albert Domingo presented an introduction to the economic impact of healthcare associated infections (HAIs) as well as related concepts in health policy and management. The speaker discussed common approaches taken to ascertain the economic impact of HAIs, followed by factors/considerations in Philippine health policy and management that must be understood and adjusted in order to minimize HAIs.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Employer Sponsored Medical Clinics white paperTom Pascuzzi
Employer-sponsored medical clinics have evolved from providing only basic convenience care to playing a larger role in actively managing chronic conditions to help control employers' health care costs. Successful clinics are integrated into the employer's data-driven health strategy and hold the clinic accountable for meeting cost and productivity goals. Different clinic models provide varying levels of services from basic care to full primary care management. For an on-site clinic to be effective, employers need to analyze their claims data to identify conditions driving costs and those amenable to improved management. The Affordable Care Act has prompted some employers to reconsider clinics to help manage costs and improve access to care.
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
Presentation on the literature review of interventions to improve health care...IDS
This presentation was given in a Future Health System Consortium organised session at the Global Symposium on Health Systems Research in November 2010. The author is Alex Rowe from the Centers for Disease Control and Prevention.
Generating Quality Data through Collaborative Research with an ACOTodd Berner MD
This document summarizes a presentation about generating quality data through collaborative research with an ACO. The number of public and private ACOs is growing rapidly, with over 250 CMS MSSP ACOs covering 4 million Medicare beneficiaries. The goal of the collaborative research is to disseminate valued information on effectiveness and costs of care to payers and policymakers. Real-world evidence studies can provide insights beyond randomized controlled trials by observing patient outcomes across delivery system models. Measuring quality requires considering multiple stakeholder perspectives to identify metrics that drive improvement and have utility.
This document discusses team-based care in the context of the patient-centered medical home (PCMH) model. It outlines six key qualities of effective team-based care: 1) a physician servant leader, 2) a clear mission and goals, 3) defined roles, 4) strong communication, 5) optimized systems, and 6) enhanced training. The article then provides strategies for implementing team-based care in small practices, noting they have limited resources but are adaptable, and in larger practices with multiple locations. Overall, the document emphasizes that developing the right team is essential before practices can transform to the patient-centered medical home model.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
An enhanced care management program achieved lower health care costs through broader outreach, personalized health coaching, and engagement of higher-risk populations. A randomized controlled trial of 175,000 individuals found that the enhanced program led to a $7.96 lower average monthly medical cost per member and over a 4:1 return on investment. Key aspects of the enhanced program included targeting a wider range of chronic and preference-sensitive conditions, more frequent outreach, and deeper health coaching relationships.
This document provides a summary of the plot and story of the movie "The Stoning of Soraya M." It discusses how the movie is based on a true story about an innocent woman in a village who is accused of adultery by her abusive husband so he can remarry. She is put on trial without evidence and convicted, then buried up to her waist and stoned to death by the villagers. The summary criticizes the religious extremism, gender discrimination, and lack of fair trials that allowed Soraya to be killed in this way.
Soraya Ghebleh - Improving Public Health Despite Constitutional ImpedimentsSoraya Ghebleh
This document outlines various public health issues addressed by state attorneys general, including obesity, gun violence, end-of-life care, infectious disease, prescription drug abuse, environmental toxins, food safety, mental health, and injury. For each issue, it provides data on scope, causes, and examples of how specific state attorneys general have taken action to effect change through legislation, regulations, enforcement, and coordinating stakeholders. The attorneys general employ a variety of legal strategies but also recognize the need for multidisciplinary solutions and navigation of constitutional issues.
Stoning is an ancient form of execution where people throw stones at a person until they die. It is used to punish women accused of unlawful sexual acts in some countries in Africa, Asia, and the Middle East. The document discusses several cases of women who were sentenced to death by stoning, including Soraya Manutchehri in Iran whose husband accused her of adultery so he could marry a younger girl, Du'a Khalil Aswad in Iraq at age 17 for falling in love with a boy of another religion, and Solange Medina in Mexico at age 20. Each case raises questions about whether stoning as a form of punishment is a fair system.
Human rights, Islam, and Iran - Soraya GheblehSoraya Ghebleh
The document discusses human rights violations in Iran since the 1979 revolution. It notes that violations increase when the regime feels instability or there is a rise in radical Islamism. Currently, under President Ahmadinejad, both phenomena are present as he pursues radical policies while the regime's power wanes. However, the international community has focused on Iran's nuclear program rather than its human rights abuses. The document also discusses debates around whether Islam is compatible with universal human rights standards.
Soraya Ghebleh - Variation in Healthcare DeliverySoraya Ghebleh
This is a presentation by Soraya Ghebleh that discusses some of the main points in unwarranted variation in healthcare and strategies that can potentially reduce it.
In this August 15, 2012 webinar CMS Innovation Center staff provided additional information for states that are interested in applying for a Model Testing award. Governors' offices were strongly encouraged to onvite their health care innovation team, key stakeholders and appropriate State officials such as State health department directors, Medicaid directors, and insurance commissioners.
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http://innovations.cms.gov
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Main Value-Based Care Metrics for Healthcare PracticesPracticeBuilders2
In its essence, embracing value-based care requires a dedicated focus on carefully measuring and improving key performance metrics. By giving importance to healthcare performance measurement, physician performance metrics, and value-based care metrics, medical practices can pave the way for long-term excellence and innovation. https://www.practicebuilders.com/blog/value-based-metrics-for-healthcare-practices/
This document discusses pay for performance (P4P) and its implications for healthcare organizations. It explains that P4P aims to improve quality by directly incentivizing superior care delivery. The document outlines drivers of P4P like rising healthcare costs and quality issues. It also reviews current P4P programs and discusses strategies organizations can take to prepare, like integrating performance data and contracting approaches that reward quality and efficiency.
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
How can cost management and complete charge capture protect and enhance the margin?
In this webinar, we will look at 2024 margin pressures likely to impact your organization’s financial resiliency. This presentation will also share how organizations can move from Fee-for-Service to Value; bringing Cost to the forefront.
The document discusses transformational change in healthcare due to value-based reimbursement policies from the Centers for Medicare and Medicaid Services (CMS). It outlines CMS's transition from a passive payer of services to an active purchaser of value and quality. Key programs that incentivize quality and penalize costs are described, including the Physician Value-Based Payment Modifier program. The financial impacts of these programs on providers are summarized. Strategies for physicians to respond, such as reducing costs or improving quality metrics, are also presented.
The documents discuss changes in the US healthcare system focusing on quality improvement initiatives. It summarizes frameworks from the Institute for Clinical Systems Improvement (ICSI) and Regional Health Improvement Collaboratives (RHIC) that provide guidelines and coordinate multi-stakeholder efforts to reform payment systems, improve care delivery, and increase community health. It also describes the Quality Alliance Steering Committee's (QASC) work measuring healthcare quality nationally through organizations like MN Community Measurement. The overall goal is to shift focus from sickness to prevention by increasing access to high-quality, coordinated care.
Population Health Management: Enabling Accountable Care in Collaborative Prov...Salus One Ed
This document provides the reader information about population health management (PMH), how it relates to incentive payments for healthcare providers and their health insurance partners (commercial and government). See details about required transformation of care delivery methods, typical accountable care payment models, how to achieve incentives, partnerships between state government (public health) and community shared services needs and necessary technology and data to achieve it.
Todd Berner: Assessment of Payer ACOs: Industry's RoleTodd Berner MD
This document summarizes key points about payers' accountable care organizations (ACOs) and the industry's role in partnering with ACOs. It finds that ACOs with commercial contracts tend to be larger and more advanced. They have more experience with pay-for-performance initiatives and other reforms. The document also discusses various strategies for ACOs to better manage costs, such as considering drug acquisition costs, utilization management, and developing care coordination programs. It notes opportunities for specialty pharmaceutical companies to partner with ACOs in areas like managing high-cost conditions and supporting patient care.
The document discusses current industry trends in healthcare, including a shift from volume-based to value-based reimbursement and the development of accountable care organizations and population health management. It outlines two stages of integration for providers: strategic alignment and clinical integration. Stage I strategic alignment can be achieved through various models including joint ventures, clinical co-management agreements, and professional services agreements. Stage II clinical integration focuses on merging clinical and business models through accountable care organizations, clinically integrated networks, and quality collaboratives.
Introduces Value-based Healthcare, an important concept for transforming healthcare making it more cost-effective, sustainable, and patient-centered. Strategically, it makes the healthcare providers accountable to the desired patient and health system "valued" outcomes.
https://youtu.be/-oOuJfpRFpY
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
This document discusses how Medicaid waivers can expand whole-person care approaches. It provides examples of whole-person care pilots in California and Minnesota that integrate services across medical, behavioral health, and social services. These pilots aim to improve outcomes, patient experience, and lower costs. The document also discusses how care coordination platforms can help overcome challenges of data sharing, privacy, and interoperability across different provider types to better coordinate whole-person care.
How Providers Can Reshape their Operations to Master Value-Based ReimbursementsCognizant
Healthcare providers must make sweeping system, process and operational changes to thrive under the inevitable move to value-based payments. Here are our recommendations on how to get started.
In an article for Healthcare Executive, Don Seymour, Kevin Talbot, and Chad Stutelberg share their insight on developing compensation strategies that link executive and physician compensation models to acute care outcome-based payment methodologies.
Developing core metrics for employee health managementHealthFitness
There are currently few standards around how the health management industry discusses and measures effectiveness. However, this is about to change.
HealthFitness’ Ed Framer, Ph.D., director of health and behavioral sciences, is the co-leader of a collaborative project between the Care Continuum Alliance and the Health Enhancement Research Organization to develop standard metrics for employee health. At the World Congress Wellness & Prevention 3.0 Conference, May 8-9, 2013, he presented an update on the project and project scope.
Paying for Value in Medicaid: A Synthesis of Advanced Payment Models in Four ...soder145
1. The document analyzes Medicaid payment reform models in four states - Arkansas, Minnesota, Oregon, and Pennsylvania.
2. State budget pressures often provided the initial motivation for reform. States aim to improve outcomes while containing costs through payment incentives and care delivery changes.
3. The models vary significantly between states but commonly seek to link payments to quality and cost performance measures in order to influence provider behavior.
North highland himss_hardwiringclinicalfinancialperformance_041315North Highland
North Highland's Ricardo Martinez and Donna Houlne's presentation on "Hardwiring Clinical and Financial Performance Through Patient-Centered, Physician-Directed Transformation"
The Centers for Medicare and Medicaid Services (CMS) State Innovation Models Initiative provides funding to support states in developing and testing innovative healthcare payment and service delivery models. States can apply for one of two types of awards - planning grants of $1-3 million to support model design or testing grants of $20-60 million over 3 years to implement models. The goal is to engage multiple payers and stakeholders to transform healthcare delivery from a volume-based system to one that rewards better health outcomes at lower cost. States must demonstrate how their models will achieve improved health, care experience and affordability through payment and delivery system reform.
VBP, Delivery System Reform, and Health and Social ServicesAndré Thompson, MPA
This document discusses the transition from fee-for-service to value-based payment models in healthcare. It explains that fee-for-service results in poor outcomes and high costs. Value-based payment ties provider reimbursement to outcomes like quality and cost. The document outlines key components of value-based payment implementation including delivery system reform, payment reform, performance measurement, and population health management. It notes that social services organizations will need to demonstrate their value and be accountable for outcomes as the healthcare system shifts its focus to addressing social determinants of health.
- The document is a corporate presentation that provides an overview of Catasys, Inc., which combines predictive analytics and evidence-based treatment programs to improve outcomes and lower costs for health plans.
- Catasys' proprietary OnTrak program identifies high-cost patients with behavioral health and medical conditions, engages them in treatment, and provides a virtual 52-week care program, achieving a 50% reduction in costs on average.
- Catasys has national agreements with several leading health plans covering over 7.5 million lives initially, with plans to expand to more states and conditions. Clinical results show reductions in ER visits and hospitalizations along with 46% lower healthcare costs for enrolled members.
Similar to Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Making (20)
Soraya Ghebleh - Unwarranted Variation in HealthcareSoraya Ghebleh
Unwarranted variation in healthcare refers to differences in medical practice that cannot be explained by illness, need, or evidence. There are three main drivers of unwarranted variation: effective care, preference-sensitive care, and supply-sensitive care. Shared decision making has the potential to help reduce unwarranted variation related to preference-sensitive care by increasing patient education and involvement in healthcare decisions. Aligning financial incentives through payment models like accountable care organizations could also help by rewarding quality over quantity of services. Improving outcomes research and data sharing between providers may further address unwarranted variation by helping providers determine effective, necessary care based on evidence from different institutions and settings.
This is a presentation by Soraya Ghebleh that explains the major components of Medicare and the associated terms an individual would need to know to navigate the vast amount of information available on Medicare.
Soraya Ghebleh - Key Healthcare Statistics in the United StatesSoraya Ghebleh
The United States spends more on healthcare than any other developed nation yet lacks universal healthcare coverage. Healthcare spending has risen dramatically over time and now accounts for nearly 18% of the US economy. Chronic conditions that can often be prevented, like diabetes and heart disease, account for 75% of healthcare spending. While healthcare spending is high, key health outcomes and statistics like life expectancy rank the US lower than most other developed countries.
Soraya Ghebleh - Defining Disruptive Innovation in HealthcareSoraya Ghebleh
This is a presentation by Soraya Ghebleh that looks at disruptive innovation in healthcare, why it is important and relevant, and provides examples of different types of disruptive innovations.
Soraya Ghebleh - Strategies to Reduce Childhood ObesitySoraya Ghebleh
This is a presentation from Soraya Ghebleh that looks at the problem of childhood obesity in America and offers potential policy and strategy solutions.
Soraya Ghebleh - Iranian Land Reform and the 1979 RevolutionSoraya Ghebleh
This document provides background information on land reform in Iran prior to the 1979 revolution. It discusses the feudal land ownership system dominated by large landlords prior to 1962. Land reform laws were implemented between 1962-1971 to redistribute land from landlords to peasants. However, the results of land reform were mixed - while it achieved the political goal of weakening landlords, it failed to improve conditions for many peasants due to issues like land fragmentation and lack of infrastructure. Ultimately, land reform contributed to social and economic instability in rural areas that helped enable the 1979 revolution.
Soraya Ghebleh - Selected Theories in International RelationsSoraya Ghebleh
This presentation describes some of the major theories in international relations and their subsets including liberalism, realism, constructivism, and critical issues theories.
Mussolini wrote "What is Fascism?" in 1932 to both lay out the fundamental beliefs of fascism and justify his authoritarian leadership in Italy. He argues that fascism emphasizes service to the state over individualism and promotes nationalism, expansionism, and the glorification of war. While avoiding directly mentioning his own role, Mussolini positions the fascist state as having absolute power over individuals. Through dramatic rhetoric and references to ancient Rome, he presents fascism as the preeminent ideology of the era and justifies Italy's aggressive foreign policy under his rule. The article demonstrates how Mussolini used propaganda to consolidate totalitarian control in Italy and claim fascism as his political doctrine.
Soraya Ghebleh - Use of Financial Incentives PaperSoraya Ghebleh
This document discusses using financial incentives to influence clinical decision-making by healthcare providers. It notes that while incentives aim to improve quality and reduce costs, their effectiveness depends on many factors. The document examines key determinants like a provider's biology, behaviors, social environment and physical setting. It recommends incentives be used cautiously and only in defined settings, populations and problems where results can be clearly measured. Both small and large provider groups may respond to some incentives like those targeting directly measurable outcomes.
Increased incidence of valley fever in Arizona is a growing public health concern. The disease, caused by inhalation of fungal spores found in soil, has seen substantial increases in reported cases since 1997 when reporting became mandatory. While seasonal and climate factors influence rates, other risk factors like construction activities, increased at-risk populations, and delays in provider education have also contributed to rising incidence. Improved diagnostics, preventative measures, and development of a vaccine could help address the disease burden.
Soraya Ghebleh - Clinical Integration and Care CoordinationSoraya Ghebleh
Here is a simple slidedeck of research done that examined which systemic care coordination practices should be maximized according to the literature to improve clinical integration within and between healthcare organizations.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Top Effective Soaps for Fungal Skin Infections in India
Soraya Ghebleh - Using Financial Incentives to Influence Clinical Decision Making
1. USING FINANCIAL INCENTIVES TO
INFLUENCE CLINICAL DECISION MAKING
S O R AYA G H E B L E H , M P H
T H E D A R T M O U T H I N S T I T U T E F O R H E A LT H
P O L I C Y A N D C L I N I C A L P R A C T I C E
2. PROVIDER DECISION MAKING
- Providers are a major component influencing healthcare
outcomes and healthcare expenditures
- The most expensive item in healthcare is the “provider’s pen”
- Resource utilization is determined by provider decision making
- Under the existing Fee-for-service (FFS) in healthcare:
3. HEALTHCARE REFORM
- Healthcare reform aims to realign financial incentives with quality of care
- The Institute of Medicine’s six aims for improving quality in healthcare include
- Safety, Effective, Patient-Centered, Timely, Efficient, Equitable
Requires financial incentives to be tied to quality metrics
in order for providers to receive reimbursement for care
Incentives, however, need to be monitored and evaluated as prior attempts of
using financial incentives to influence clinical decision making have not always
been successful in improving quality for patients
4. WHAT ARE THE ISSUES?
(1) Fee-for-service drives high healthcare costs because providers are incentivized to
perform more services without necessarily improving quality of care
(2) Magnitude of financial incentives that can potentially be introduced makes
determining the appropriate incentive difficult
(3) Replication of successful results across the numerous settings available for
healthcare service delivery is not assured
(4) Applicability of incentives that may work in a large provider system may not translate
to a solo or small group practice
(5) Protecting practices that cannot transition towards integrated delivery that requires
high-start up capital and advanced healthcare technology
(6) Numerous stakeholders need to collaborate for successful incentive programs that
include providers, insurance companies, beneficiaries, and government agencies
5. WHY ARE FINANCIAL INCENTIVES IMPORTANT?
- Providers are the target population for financial incentive
models in healthcare
- Potential implications with regard to ethnicity, geographical
location, and cultural background of participating providers
- Distinctions between providers that work in self-owned
practices and small group practices compared to those in
large provider networks or accountable care organizations
7. KEY DETERMINANT - BIOLOGY
Biological makeup of providers varies widely and can directly affect how they
respond to financial incentives to deliver care
Specific indicators include:
• Age of the physician
• Where the physician went to school and trained
• Gender
• Religious Background and Upbringing
• Value System
• Ethnic Background
• Socioeconomic Status
• Personal Bias
8. KEY DETERMINANT - BEHAVIORS
Provider behaviors implicated in decision-making include:
• Prescribing habits
• Personal work ethic and the amount of preparation time
• Average number of tests physician typically orders
• Physician self-monitoring
• Personal spending habits
• Size of the workload the physician takes on
The target income level of the provider
will affect whether a financial
incentive will be an important factor,
tying into family financial obligations
Implicit assumption in medicine
that all providers practice in the
best interest of their patients
9. KEY DETERMINANT – SOCIAL ENVIRONMENT
Different Provider Settings
• Hospitals
• Clinics
• Ambulatory Care Centers
• Offices
• Nursing Homes
• Skilled Nursing Facilities
• Community Health
Centers
- Provider settings dictate the structure and
magnitude of incentive given to the provider
- Organizational structure and culture of the
provider setting can affect the success of
incentives
- The proportion of the group to which the
incentive is applied is relevant
10. KEY DETERMINANT – PHYSICAL ENVIRONMENT
- Provider access to necessary tools for quality
improvement is crucial
- Providers practicing in rural or impoverished areas may
have different responses to incentives compared to
providers practicing in urban or higher income locations
- Different geographic locations are tied with different
patient populations who have different diseases and can
determine the way providers react when providing care
11. KEY DETERMINANT – POLICES & INTERVENTIONS
Structure of the incentive affects provider participation
Government policy factors include government insurance reimbursements from
Medicare and Medicaid
Provider adherence to clinical guidelines set by academic institutions and what the
status quo of quality provision is among a provider community are indicators of the
likelihood of incentives working within that provider community
Healthcare reform will have huge implications for providers if methods of
reimbursement change and shared savings and accountable care models begin to
dominate the healthcare arena
12. KEY DETERMINANT – ACCESS TO QUALITY HEALTH CARE
Lack of reimbursement to providers and healthcare settings that
see patients who are underinsured or have no insurance often
leads to an increase in over-testing, over-prescribing, and over-
diagnosing of patients who have more reliable insurance or the
ability to pay. Providers don’t necessarily need incentives to
provide increased access to quality care but under current
reimbursement schemes, providers have more of an incentive
to increase quantity and this has increased the cost burden.
13. WHAT NOW?
Financial incentives should be used in defined settings for defined problems
within defined populations where measurable results can be produced
indicating a movement towards a desired improvement in
quality.
14. LARGE AND SMALL PROVIDER SETTINGS
Large Provider Settings
Can assume more
risk
Higher capabilities
for infrastructure and
technology
implementation
Larger pool to
measure
performance
improvement and
quality metrics
Provider buy-in and
active participation is
more likely in a larger
setting
Potential to
participate in shared
savings models and
accountable care
Large and Small Provider Settings
Absolute
threshold, directly
measurable
incentives
Vaccinations
Reduced repeat
unnecessary lab
tests
Increased
screenings and
preventative care
initiatives
15. CHARACTERISTICS TO CONSIDER
- Interventions of any kind should be explicitly described and known to
providers so they are aware of what entity is paying for the intervention
- Determining short-term goals compared to long-term goals is important when
coming up with metrics of success for the incentive
- Metrics to be considered for any incentive program should include the
provider population providing the data, percentage of patients being targeted
for the incentive, expected overall effects of the incentive, and the type of
feedback given
- Financial risks and penalties can be used to influence and change physician
behavior as well
- Organizational pressure can either increase or decrease intrinsic motivation
to perform depending on the environment, setting, and culture
16. CONCLUSIONS
Financial incentives are not going anywhere and will
continue to be implemented in a variety of healthcare
settings. In order for these incentives to be utilized
properly, the healthcare community needs to understand
that financial incentives and reimbursement strategies
are provider and setting specific and they must
implement incentives accordingly.