Volatility and Persistence of Value-Based Purchasing Adjustments: A Challenge to Integrating Population Health and Community Benefit Into Business Operations.

With the passage of the Deficit Reduction Act of 2005 and the Patient Protection and Affordable Care Act in 2010, Medicare's Inpatient Prospective Payment System (IPPS) began a transition to value-based purchasing (VBP) that rewards or penalizes hospitals based on patient satisfaction, clinical processes of care, outcomes, and efficiency metrics. However, hospital-level volatility vs. persistence in value-based payments year-over-year could result in unpredictable cash flows that negatively influence investment behavior, drive underinvestment in community benefit/population health management initiatives, and make management of the factors that drive the VBP adjustment more challenging.

Primary Care Practice Redesign: Challenges in Improving Behavioral Health Care for a Vulnerable Patient Population.

This study examined a program focused on integrating mental health in a family medicine practice in an economically challenged urban setting. The program included using a behavioral health technology platform, a behavioral health collaborative composed of community mental health agencies, and a community health worker (CHW). Of the 202 patients screened, 196 were used for analysis; 56% were positive for anxiety, 38% had scores consistent with moderate to severe depression, and 34% were positive for post-traumatic stress disorder.

Complexities of Addressing Food Insecurity in an Urban Population.

There is an association between food insecurity, poor health outcomes, and increased health care spending. The Temple Food Insecurity Program was initiated to screen patients for food insecurity as part of the post Temple University Hospital discharge process. The community is economically challenged and food insecurity is a significant problem.

Aligning House Staff Performance Improvement Projects With Hospital Priorities: An Innovative Approach.

Background: As hospital leaders work to meet national performance improvement (PI) priorities and provide high-value healthcare, aligning house staff goals with those of the hospital organization becomes necessary. A hospital leadership goal is to achieve the Institute for Healthcare Improvement (IHI) Triple Aim with the delivery and measurement of high-value care through various PI frameworks, including the domains of the University HealthSystem Consortium (UHC), now Vizient. However, most house staff develop PI projects within their departments, and these projects do not always align with hospital priorities.

Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.

Background: Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs.