I have referenced, over the years, one way to measure value for those we serve. As we continue our journey, being able to quantify what we do is critical to our success. Attached is a link to an article published by the Advisory Board that goes into greater detail on the equation I have discussed. How Sentara measures… Read More »
Recently, a colleague shared an article with me, “The Two Words That Can Make Health Care a Nightmare,” by Chris Stranton, highlighting the challenges posed by prior authorizations (PAs) in healthcare. While I agree that PAs can be problematic, it’s crucial to delve deeper, and consider the broader context surrounding their use. Prior authorizations have long been a… Read More »
Since its inception, more than 50 years ago, Medicare Advantage (MA) has experienced significant growth, surpassing the number of beneficiaries in traditional Medicare. This situation has sparked a debate regarding the sustainability of MA benchmarks and their impact on the Medicare Trust Fund. There are two schools of thought regarding the purpose of MA. The first suggests… Read More »
As we continue to address health inequities, understanding how algorithms impact races differently is important. One of these inequities revolves around the racial disparities in kidney disease, with Black individuals experiencing a 2-to-4-fold higher incidence of kidney failure than White individuals. Moreover, Black individuals have faced lower referral rates for pre-dialysis transplant evaluation, post-kidney failure transplants, and placement… Read More »
As we continue to focus on delivering health in a manner that is equitable, we have come to realize the importance of social drivers of health, known as those diseases of life, that occur outside of the physiologic realm and impact an individual’s health and wellness. Presently, investments in methodologies that address these conditions have revolved around governmental… Read More »
As we begin to reflect on policy changes and how they impacted people during covid, It’s of utmost importance that we assess what enhanced our wellbeing and what did not. We know that a significant determinant of health, especially in children, is access to healthy food and permanent food security. One of the many policies during Covid was… Read More »
Currently, a significant portion of value-based care payments has focused on primary care-based models. Whether Medicare Advantage, Medicare Shared Savings Programs, Direct Primary Care, or other value-based programs, they all center on primary care clinicians and services. Though there are a few unique specialty-based models such as BPCI, the vast majority are not. These models have had a… Read More »
There is considerable discussion regarding aligning incentives to lower the total cost of care, and even more specifically, on the importance of diagnostic testing, the value it might bring, its accuracy, and the shared decision-making when ordering tests. Therefore, aligning incentives around appropriate diagnostic testing is critical to both diagnostic excellence and affordability of healthcare. Additionally, an important… Read More »
As clinicians, we spend a significant amount of our time attempting to diagnose what is ailing those we treat. And we have an armament of tests to select from and an extensive list of differential diagnoses, ranging from the probable, to the extremely rare yet, potentially fatal. Understanding the effectiveness of our diagnostic tests is important from multiple… Read More »
As consolidation and integration of physician practices occur, especially within organizations that can wrap capabilities around ambulatory clinical care, we must examine the potential benefit to those we serve. This ideal is also the premise for a clinically integrated network where payment models are designed to allow for enhanced capabilities available to smaller groups of clinicians. These enhanced… Read More »