Tag Archives: redefining healthcare models

Considering the Value of Generative AI in Healthcare

Generative AI is sparking intriguing discussions in healthcare, particularly in its role within chatbots for diagnostic and decision-making purposes. The potential benefits are vast, but it’s essential to recognize and address the accompanying risks and complexities. Diagnostic accuracy and adherence to evidence-based medicine have been central issues in recent healthcare conversations. As we strive to enhance outcomes and… Read More »

Addressing the Growing Need for a Home Care Workforce

In the evolving healthcare landscape, delivering appropriate care at the right time and location is paramount. However, one important model of care, very often overlooked, is the home care workforce. With the increasing demand for home services, it’s essential to acknowledge the significance of caregivers who provide services in the home. While physicians, nurses, and professional clinicians receive… Read More »

The Sustainability of Medicare Advantage Benchmarks: Balancing Costs and Services

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 »

Evaluating Quality and Cost Between Medicare Advantage & Traditional Medicare

With enrollment in the Medicare Advantage (MA) program continuing to rise and nearly 50% of all Medicare eligible beneficiaries participating in an MA product, now is the time to evaluate the program’s benefits and possible unintended consequences. Why? A recent study by Landon et al., published in the Journal of the American Medical Association, compared the two programs… Read More »

Will Diagnostic Artificial Intelligence Ever Become a Real Thing?

The desire to improve diagnostic accuracy, efficiency, and safety is always on the minds of clinicians. Suddenly, artificial intelligence (AI) arrives, and everyone believes we have found nirvana and a solution to all problems. Unfortunately, despite multiple peaks of excitement, AI still has failed to meet our expectations. When we delve into the reasons concerning diagnostic accuracy, it’s… Read More »

Is it Time to Consider the Value of National Licensure?

In a manner that was not possible during “normal” times, the COVID crisis allowed us to implement much-needed changes and the expansion of virtual care is one of them. In addition to the growth of virtual care, increasing the healthcare workforce during a time of crisis was necessary. In all, 45 states extended licenses to out-of-state practitioners. Currently,… Read More »

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 »

Determining the Effectiveness of Diagnostic testing

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 »

Physician Practices with Robust Capabilities Spend Less on Medicare Beneficiaries

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 »

Understanding Why We Need Stratification of Hospitals for Readmission Penalties

There has been considerable debate concerning the value of the Medicare Hospital Readmissions Reduction Program. The program was designed to deduct up to 3% of Medicare payments for hospitals with higher-than-expected thirty-day all-cause readmission rates, after index admissions, for six conditions and procedures. One of the primary concerns regarding the program was the disproportionate impact on teaching and… Read More »