Tag Archives: consumerism in healthcare

Understanding Primary Care & Specialty Care Value-Based Models, Is One Better than the other?

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 »

Do Value Based Payment Models Really Work?

For those in the value-based payment (VBP) world, we are constantly asking the question; “Is what we are doing impactful and adding value to quality, service, and costs, to those we serve?” A recent study in Health Affairs analyzed 20 years of commercial VBP studies and found mixed results. And from this information, it’s possible to formulate a… Read More »

A Bell-Shaped Curve and Healthcare Grading

Healthcare is brimming with competitive clinicians and administrators. CMS and other “grading” agencies pit us against each other concerning benchmarking, penalties, and value-based payments. But does this methodology promote better patient care? Most of our quality and experience metrics are “graded” on a bell-shaped curve; in other words, how we do, compared to others? This constant analysis leads… Read More »

Understanding Virtual Primary Care, And the Value It Brings

As we continue to identify the benefits of telehealth, we must delineate how this form of technology most efficiently impacts primary care services. One can view such digital interventions as either substitutive or additional. If one utilizes an electronic visit instead of an in-person visit, this is an example of substitution. We are now categorizing this modality as… Read More »

Considering Different Payment Models for Primary Care

As we continue to focus on value-based care, how we design our value-based payment models continues to be critical. Historically, we have oversimplified the polarity by placing a fee-for-service on one end of the spectrum and global capitation payments on the opposite side. Thus, creating the idea that these two payment mechanisms are counter to each other, and… Read More »

Do Value-Based Payments Align with Present Conditions?

Advanced payment models are designed to align reimbursement with the desired outcome of value (quality, service, and cost) for individuals. However, our current insurance models do not account for the desired short-term financial outcomes aligning with the much longer duration of care which is necessary to see clinical improvement. For example, to prevent heart disease, cholesterol management requires… Read More »

Where Do Conflicts of Interest Exist in the Medical Profession?

We hear about conflicts of interest on the news all the time. And in medicine, we have addressed this topic in relation to the pharmaceutical industry and its interactions with physicians. As a result, one can now review these connections as part of the ever-increasing desire for transparency. However, as technology progresses, we must also be attuned to… Read More »

Why Using Social Determinant Metrics in The Hospital Readmission Penalty Calculation Matters?

Currently, there is an ongoing debate whether Medicare readmission penalty policy is equitable to all hospitals. The greatest argument and concern is the lack of social determinants of health (SDOH) factors in the calculation. Many contend including SDOH is essential to create greater equality amongst the comparisons. In contrast, others do not believe they are impactful or state… Read More »

Can Social Media Increase Preventive Health Care?

According to the Center for Disease Control and Prevention, preventive care services can save 100,000 lives a year. Daily, healthcare systems and providers focus on how to deliver primary prevention services best and how to ensure that the coordination of the payment model is providing such care. However, for optimal success to occur, we need to expand our… Read More »

Are People Willing to Pay Extra for Quality?

There are several external rating agencies such as CMS STARS, Healthgrades, Leapfrog, and US News and World Report that inform the public concerning the quality of healthcare facilities and physicians. Unfortunately, many of these rating agencies rarely measure the same metrics, so it can be extremely confusing both for the provider and the consumer to decipher. And being… Read More »