Tag Archives: redefining healthcare models

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 »

The Value of Nonprofit Hospitals

There has been a great deal of focus on whether nonprofit hospitals bring value to the communities they serve in proportion to their tax-exempt status. The argument is that the tax dollars are necessary and properly utilized for community benefit; therefore, a tax-exempt status requires community benefit in replacement of payments. The measure used as a metric for… 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 Deeper Look at Structural Racism in US Health Care Policy

Structural racism refers to, “The totality of ways societies foster racial discrimination through mutually reinforcing systems of housing, credit, media, health care, and criminal justice.” One of the leading structural components that has led to the inequitable distribution of health services is healthcare financing, i.e., insurance coverage. Inadequate health insurance coverage is one of the most prevalent barriers… Read More »

The Value of an intellectual vs Emotional Approach to the Root Causes of Health Inequities

As we focus on improving the care for all, with a lens toward health equity, it’s essential to examine the root causes of health inequities and their existence. And Racism is a contributing factor that has led to our present situation. To progress, we need to have an understanding and commonality of definitions. Referencing a recent article by… Read More »

A Look at the Progression of Value-Based Payment Models

For those in the value-based world, we have been on this journey for years. And we have witnessed and participated in CMS and CMMI creating and implementing various models.  Undoubtedly, some have been more successful than others, and there has been an ongoing debate concerning the impact on value-based payment models. Two of the major concerns that have… Read More »

Do We have the Definition of Diagnosis All Wrong?

Almost daily, there are articles addressing the need for healthcare to be more consumer centric. We envision the topic within the context of service, access, and affordability. Yet, there remains a component that encompasses how we engage those we serve from a clinical perspective. Diagnosing and treating has been the primary focus of clinicians’ training. But, as we… Read More »

How Can We Lower Administrative Costs?

As we continue to focus on healthcare affordability, the topic of administrative waste rises to the forefront of many discussions. These are the costs associated with the delivery of healthcare and its associated payment functions that do not directly impact the outcome of care. Furthermore, one can view these dollars as detrimental to care because they drive up… Read More »

Is Our Need for Choice Driving Up the Cost of Healthcare?

We are a country founded on individual rights. As a society, we have also decided that healthcare is a right of citizenship; we do not permit the denial of care based on one’s ability to pay. Unfortunately, the cost of the administrative components of the healthcare ecosystem is a burden on the overall cost of care. Many of… Read More »