Tag Archives: redefining healthcare models

Providing Resources for those Caring for our Elderly with Dementia

As we live longer, certain disease states will continue to become more prevalent in the elderly, such as dementia. Unfortunately, our health care system is focused on episodic care versus the needs of those with chronic conditions, especially when they need long-term services outside of a care setting. The question arises concerning who delivers such care, are they… Read More »

Should Physician Offices Be Bill Collectors?

In our present financial models of healthcare reimbursement, the setup frequently places the physician and their practice staff in a real predicament. Consumers request that they deliver care during their time of need in a reverent and life-giving manner.  Additionally, they are required to collect your co-pay and/or co-insurance while simultaneously understanding your benefit plan, including how much… Read More »

Healthy Equity is A Critical Part of Value-Based Payment Models

As value-based payment models have continued to expand, this expansion has occurred in the more affluent communities. Additionally, communities with more socioeconomically vulnerable individuals were less likely to be selected for joint replacement bundles, another form of a value-based payment. A big reason for this lack of equitable distribution of value-based care, can be linked to the absence… Read More »

CMS STARS ratings – It’s Time for a Change

In 2016, the Centers for Medicare and Medicaid Services (CMS) introduced the Overall Hospital Quality Star Rating Program to create transparency on hospitals’ quality, by summarizing dozens of metrics on the Hospital Compare website. There was considerable consternation over the validity of the data. In addition to comparing all hospitals to each other, regardless of unique dynamics, all… Read More »

Understanding the Design Characteristics of Primary Care Capitation

Capitation, as a value-based payment model, has been around for decades. Many of us have experimented with variations of capitation, ranging from full capitation for all healthcare services to specialist capitation, to primary care (PCP) capitation. Currently, Primary Care Clinicians are much more comfortable with the nuances of these models because of the expansion of Medicare Advantage. This… Read More »

Taking a Closer Look at Capitation for Value-Based Care

As we focus on delivering value-based care; higher quality at a more affordable price, the conversation concerning payment models rapidly pivots to global capitation for a population of lives. The opposite payment model is a fee-for-service model, and currently, there is a belief that service-based fees lead to an over-utilization of services. Consequently, many believe the only possible… Read More »

Addressing Societal Health Issues at a Root Cause Level

As we continue to grapple with various disease states like obesity and diabetes, which impact a significant number of people, our ability to change human behaviors is minimal. We continuously design interventions that include education and behavioral modification with limited results. In essence, we appear to be attempting to prevent water from streaming out of the hose by… Read More »

If We Invest in Social Needs, There Can Be a Great Return

Recently, there is a tremendous amount of focus on the value of social interventions and healthcare costs. To be of optimal help to the greater society, it is important for us to thoroughly understand how to investigate the value of such interventions. In the journal, Health Affairs, a recent study by Kangovi et al. investigates the return on… Read More »

Preconceived Ideas Don’t Always Lead to What We Expect

A commonly held premise of shared decision-making is that the healthcare profession neither adequately gives specific treatment options nor discusses the trade-offs of surgical intervention. Predominantly, the thought is that if more in-depth conversations were to occur concerning the trade-offs, and there is more appropriate management of expectations, the chosen solution would be the more conservative approach. With… Read More »