Tag Archives: redefining healthcare models

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 »

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 »