HCFO - Findings Brief

Variation in Quality of Care Among Virtual Urgent Care Providers

cticse — Thu, 15 Sep 2016 19:31:47 +0000

With the rise of technology in the 21st century, patients have been increasingly turning to telemedicine in response to their need for timely and easily accessible care. Commercial virtual visits, new methods by which patients can request live consultations with physicians over the Internet, have become increasingly popular, with one company noting a user base approaching 6 million.

Certain Organizational Characteristics Affect ACO Preventive Care Quality Performance

cticse — Thu, 09 Jun 2016 12:26:05 +0000

During the past decade, preventive care in medicine has become a national priority. Coverage of preventive services has gained traction, exemplified by the Affordable Care Act’s (ACA) elimination of cost-sharing for all preventive services; however, provider performance and quality of care vary widely. Accountable Care Organizations (ACO) emerged as a novel payment model to create a coordinated health system whereby providers contract together to take collective responsibility for managing the cost and quality of care for a population of patients.

The Association of State Rate Review Authority with Health Insurance Premiums

cticse — Mon, 05 Oct 2015 14:17:08 +0000

During the past decade, increases in health insurance premiums have exceeded the rate of inflation, particularly in the individual and small group markets, with significant variation among states. The federal rate review regulation in the Affordable Care Act (ACA) requires health insurance carriers to file and publicly justify proposed rate increases of 10 percent or more.

Achieving Medication Adherence through Value-Based Insurance Design

eblecker — Tue, 19 May 2015 20:46:42 +0000

Cost sharing, often seen in the form of copayments, coinsurance, and deductibles, is commonly used to reign in health care spending. While the intent of cost sharing is to promote greater patient engagement around value-based health care choices, it can lead to patients avoiding necessary medications or services. Value-based insurance design plans (VBID) plans reduce this effect by limiting or eliminating cost sharing for medications and services that offer patients a high value return on their health.

The Impact of the Early Introduction of Palliative Care on Patient Functioning

eblecker — Wed, 18 Feb 2015 15:27:27 +0000

Palliative care is typically associated with services provided to terminally ill cancer patients. Increasingly, however, palliative care is considered a treatment option for other life-limiting illnesses and for easing chronic pain. Even though palliative care encompasses hospice care toward the end of life, the introduction of palliative care treatments earlier in a patient’s disease course can benefit the patient. All hospice care is palliative, but all palliative care is not hospice care.

How Prevalent and Costly are Choosing Wisely Low-Value Services? Evidence from Medicare Beneficiaries

mcollado — Mon, 06 Oct 2014 19:22:38 +0000

In 2012, the ABIM Foundation announced the Choosing Wisely® initiative, which encourages physicians, patients, and other health care stakeholders to engage in conversations about medical tests and procedures that may be unnecessary and, in some instances, cause harm. Under the initiative, specialty societies developed lists of five evidence-based recommendations of tests and treatments that physicians and patients should question. The goal of the initiative is to encourage physicians to be responsible stewards of finite health care resources and to reduce low-value care.

The Impact of Tiered Physician Networks on Patient Choices

eblecker — Wed, 17 Sep 2014 14:40:07 +0000

Several factors influence a patient’s choice of health care providers, including cost and quality. Increasingly, health plans, employers, and other payers are creating tiered provider networks to help guide patients’ decisions about care providers. A tiered network ranks providers according to cost and quality performance. Patients have a financial incentive (lower costsharing) to see a top-ranked provider.

The Challenges in Achieving Successful P4P Programs

eblecker — Mon, 17 Mar 2014 19:41:08 +0000

Health care payment reform is becoming one of the most important issues debated by health care policymakers, payers, providers, and purchasers. Architects of new payment models point out that the traditional fee-for-service model encourages the use of unnecessary medications and procedures while capitation promotes stinting on care and poses financial challenges to smaller provider groups.

Reducing Inappropriate Emergency Department and Avoidable Hospitalization Rates: Assessing the Influence of Medical Group Practice Characteristics

eblecker — Tue, 18 Feb 2014 14:47:35 +0000

Concern is growing over escalation in the improper and avoidable use of emergency departments (ED) by patients who did not receive appropriate care from their physicians. In a HCFO-funded study, John Kralewski, Ph.D., M.H.A., University of Minnesota and Medica Research Institute, and colleagues examined a national sample of 212 medical group practices and documented the characteristics of practices that influence these rates.

What Happens When Medicare Cuts Hospital Prices? Assessing the Impact on Inpatient Discharges Among the Elderly

lradomski — Wed, 13 Nov 2013 21:24:52 +0000

Among the major provisions of the Patient Protection and Affordable Care Act (ACA) is the tightening of Medicare payment policy. Specifically, the ACA permanently lowers the default rate of growth in Medicare prices for hospitals and most other providers by applying a downward adjustment each year equal to the growth in productivity throughout the economy. This policy change is expected to reduce Medicare expenditures by $379 billion from 2012 through 2021, according to estimates by the Congressional Budget Office.