Effectiveness of a Bundled Payments for Care Improvement Program for Chronic Obstructive Pulmonary Disease.

Background: The Medicare Bundled Payments for Care Improvement (BPCI) program reimburses 90-day care episodes post-hospitalization. COPD is a leading cause of early readmissions making it a target for value-based payment reform.

Objective: Evaluate the financial impact of a COPD BPCI program.

Evaluation of a transitions clinic to bridge emergency department and primary care.

Background: Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care.

Objective: The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions.

Closing the loop with an enhanced referral management system.

Objective: To evaluate the impact of a referral manager tool on primary care practices.

Materials And Methods: We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n = 61) and follow-up (n = 35) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction.