Treo Solutions’ Intelligent Healthcare Insights Blog provides the latest information on healthcare policy, administration, analytics and research to provide you with insight and information on the changes, challenges and opportunities presented by healthcare transformation.
Our authors provide perspective for providers, payers, intermediaries and patients on topics that include Total cost of care, population health management, meaningful use, predictive modeling, accountable care, ACOs and Medicaid and Medicare.
The concept that payment for health care should be based on quality and clinically meaningful outcomes is not new; but the current breadth, variety and rapid adoption of value-based models is unprecedented. Value-based payment models now include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), bundled and episode-based payments, and pay for performance structures.
Yes. To achieve real success in population health we need health care consumers to actively engage in the behaviors necessary to secure their health. “Patient” engagement is the holy grail of health care. However, despite decades of research into health behavior and ways to change it, we don’t seem to be any closer. I think that is about to change.
On June 12, Xerox Corporation and 3M Health Information Systems sponsored a full-day symposium to honor the 30th anniversary of the implementation of diagnosis related groups (DRGs) titled “DRGs at Age 30: Looking Back, Looking Forward.” In today’s America, it’s hard to imagine a government healthcare initiative that is supported by both Republicans and Democrats, saves billions of dollars, improves health care, and is adopted by payers throughout the country -- and then around the world.
Earlier this year, the Journal of the American Medical Association (JAMA) published a widely publicized but limited article on medical homes in Pennsylvania that found little improvements in quality and no improvements in costs or utilization associated with medical homes. The authors concluded medical homes may generally “need further refinement” -- a phrase that was taken by many in the press to mean that medical homes “don’t work.”
When a person fails to follow recommended treatment plans we might label them ‘”non-compliant” because we lack insight into the multiple other issues that get between people and the outcomes they want. Some of these issues include a lack of adequate finances, difficulty accessing care in a timely manner, not understanding instructions, and lacking confidence in the ability to self-manage.
If health care providers have a reliable way to unmask these issues it gives them powerful insight into opportunities to improve outcomes, for example:
The New York State (NYS) Medicaid program transitioned to a risk-adjusted inpatient payment system at the end of 2009, using All Patient Refined Diagnosis Related Groups (APR-DRGs). Treo Solutions supported the NYS Department of Health’s inpatient transformation and calculated the payment system metrics, including relative weights.
At the 2014 HFMA conference here in Las Vegas, Dr. Atul Gawande delivered the keynote address and outlined four emerging lessons about U.S. health care. They are:
So, what does this really mean and what is missing from this picture?
The Medicare Hospital Readmissions Reduction Program (HRRP), established under the Affordable Care Act (ACA), provides a financial incentive to hospitals to lower readmission rates. Beginning October 2012, the HRRP, which applies to all general hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS)1, imposed a financial penalty on hospitals with excess Medicare readmissions. Debate has followed around the appropriateness of adding socioeconomic status (SES) factors to clinical factors in risk-adjusting targeted readmission rates.