Hospital-Skilled Nursing Facility Integration and Participation in a Bundled Payment Initiative.

Importance: Reduced institutional postacute care has been associated with savings in alternative payment models. However, organizations may avoid voluntary participation if participation could threaten their own revenues.

Objective: To characterize the association between hospital-skilled nursing facility (SNF) integration and participation in Medicare's Bundled Payments for Care Improvement Advanced (BPCI-A) program.

Medicare APMs at a crossroads.

Reaching the goals set by the Health Care Payment and Learning Action Network requires an unyielding and unrelenting focus on encouraging providers to adopt advanced alternative payment models (APMs). Many of these models will continue to be voluntary because they either are in early stages or have not yet proven their effectiveness. The models that have proven their effectiveness should become permanent, comprising the new way that providers are paid in the Medicare program.

U.S. Infant and Maternal Mortality Rates: Shamefully (and Unnecessarily) Bad and Getting Worse.

The U.S. rate is now higher than infant mortality rates in Antigua or Cuba.

An APM That Would Actually Work.

Think of this alternative payment model as a large set of event-driven care packages that get triggered by consumer-patients. Each care package can be priced and adjusted for the individual's medical history. Providers who want to bid for the care package can, and what they're offering will be available and comparable to other providers.

The Opaque Fight Against Price Transparency.

For those who doubt the importance of transparency in price and quality to free the market, you just have to look behind the public curtain and observe the fierceness with which the opponents of transparency are trying to keep consumers in the dark.

Health Care Needs the Real Triple Aim.

Price transparency, payment reform, and consumerism are needed to bring market forces to health care. Too many managed care organizations are comfortable with the status quo.

Occam's Razor, Health Care Costs, And Insurance Coverage.

It's no mystery why this country has both the highest per capita health care costs and the lowest overall percentage of people with coverage. The two are connected, but as if on a teeter-tooter: As one goes up, the other goes down.

Curing an ill healthcare system: transparent multilateral benefits, cost, and quality.

A transparent, smart, multilateral benefits system can lead the way to healthcare reform with health and economic benefits for all based on: Provider competition guided by quality measurements, clinical nuance, and price competition. Shared risk among consumers, employers, and plans. Economic incentives for all parties.

Episode of care analysis reveals sources of variations in costs.

Objectives: To understand and reveal the underlying sources of inter- and intraplan variation in a selected number of chronic and procedural episodes.

Study Design: Analysis of allowed claims from 9 regional health plans covering commercially insured populations in different areas of the United States.

Methods: Use of the PROMETHEUS Evidence-Informed Case Rates analytics to 1) calculate total plan costs and cost of specific episodes, 2) create price and severity adjustments, and 3) determine coefficients of variation.

Bending the curve through health reform implementation.

In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans.

Reducing potentially avoidable complications in patients with chronic diseases: the Prometheus Payment approach.

Unlabelled: OBJECTIVE (OR STUDY QUESTION): To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness.

Data Sources/study Setting: A claims database of 3.5 million commercially insured members under age 65.

Prometheus payment model: application to hip and knee replacement surgery.

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs.

Should health care come with a warranty?

How health care providers get paid has implications for the delivery of care and cost control; the topic is especially important during an economic downturn with persistent growth in health spending. Adding "warranties" to care is an innovation that transfers risk to providers, because payment includes allowances for defects. How do such warranties affect patient care and bottom lines? We examine a proposed payment model to illustrate the role of warranties in health care and their potential impact on providers' behavior and profitability.

Physicians respond to pay-for-performance incentives: larger incentives yield greater participation.

Objective: To determine the extent to which the size of the available financial incentive influences a physician's decision to participate in a pay-for-performance (P4P) program.

Study Design: Statistical analysis of historical data from Bridges to Excellence (BTE).

Methods: Setting available financial incentives as the independent variable and physician participation rates as the dependent variable, we applied regression analysis to BTE's data from selected sites to explore the relationship of fixed bonus-based incentive programs to physician participation rates in those programs.

Motivating public use of physician-level performance data: an experiment on the effects of message and mode.

Despite widening efforts to publicly report health care quality data, patients appear to make little use of these data. Several studies indicate patients' interest in physician-level information, but actual use of physician-level data remains unestablished. Using a randomized experimental design, this study evaluates the extent to which use of a Web site offering physician-level data is affected by three parameters: invitation mode (mail vs.

Bridges to Excellence--recognizing high-quality care: analysis of physician quality and resource use.

Objective: To examine whether physicians who sought and received Bridges to Excellence (BTE) recognition performed better than similar physicians on a standardized set of population-based performance measures.

Study Design: Cross-sectional comparison of performance data.

Methods: Using a claims dataset of all commercially insured members from 6 health plans in Massachusetts, we examined population-based measures of quality and resource use for physicians recognized by the BTE programs Physician Office Link and Diabetes Care Link, compared with nonrecognized physicians in the same specialties.

Evidence-informed case rates: paying for safer, more reliable care.

There is widespread dissatisfaction with the current modes of paying for health care. Created by Prometheus Payment, evidence-informed case rates (ECRs) are designed to create fair payments for all providers delivering care to a patient for a particular condition. ECRs would combine global fees with an allowance for complications and performance incentives.

The value of ambulatory care measures: a review of clinical and financial impact from an employer/payer perspective.

To understand the value for payers and purchasers of primary care quality measures in an insured population, we conducted a 2-part analysis. In the first part, we reviewed the economic and clinical literature supporting 62 quality metrics spanning primary care that had been proposed for use in a physician recertification program and in a pay-for-performance program. We then ranked these metrics by both economic and clinical evidence of effectiveness.

The potential of HIEs as infomediaries.

For more than 40 years, various health services researchers have noted the many distortions in the American healthcare economy that produce massive information assymetries and almost near opacity in the medical services delivery market. This paper comments on the potential of health information exchanges (HIE) to address many of these deeply embedded structural issues. Although hundreds of HIEs are emerging across the nation and the value of moving to a fully interoperable digital healthcare system has been widely recognized, the economic sustainability of HIEs remains a vexing matter While most of these organizations rely on a transaction- or production efficiency-based model, the authors conclude this model has economic limits and their future viability may rest upon HIEs becoming public utility infomediaries.