Bundled Payment. Hospitals See the Advantages, But Face Challenges, Too. While most hospital leaders see the advantages of moving to bundled payments for an episode of care, many are unprepared either for the mindset or the mechanics required to implement the emerging reimbursement model. Here are the concerns and possible strategies you should consider.
Video Preview: Is Bundled Payment a Gift or Pandora’s Box? Editors at H&HN summarized my April cover story on how hospitals are preparing for bundled payment.
Cover story: Renewed Interest In Shared Decision Making. Twenty years after its the introduction of shared decision making (SDM), health plans are seizing on this strategy to help patients choose among a variety of treatment options. Seeking to counterbalance physicians’ preferences, health plans are increasing their efforts to get more patients involved in SDM. Electronic medical record systems alert physicians to offer tools to help patients make decisions about the best care. Often, patients choose less risky and less unpleasant options, and lower costs are a welcome extra. Federal regulations for accountable care organizations and for the meaningful use of electronic health record (EHR) systems promote SDM as a way to engage patients more fully in making care decisions.
Cover Story: This Year’s Model: Are We on the Way to a Real ‘Learning Health Care System’? The fact that we waste hundreds of billions a year is all the more infuriating because we have the ability right now to stop the hemorrhaging. The Institute of Medicine says the U.S. health care system wastes $750 billion each year. In a report published in September, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, the IOM detailed how this amount was wasted on unnecessary services and excessive administrative costs and by failing to eliminate fraud. It’s a staggering figure, but here’s perhaps a more staggering fact: We know how to eliminate this waste, says Brent C. James, MD, the chief quality officer and executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare in Salt Lake City.
Feature Article: Medical Homeless: Ophthalmology and the PCMH. The patient-centered medical home is evolving, but specialists are still looking for their place.
Feature Article: Medicare Advantage Loses Its Advantage. Seeking to increase competition among plans, CMS is eliminating extra payments of $1,200 per member per year.
Feature Article: What Works Best for Patients? PCORI Hopes to Provide Answers. Even today, studies show, only half of treatments are truly based on evidence. Here’s an organization looking to better that share, and it may behoove health plans to help.
Q&A: A Conversation With François de Brantes: Bundled Payment’s Many Challenges. Health plans are taking steps to implement this promising payment system, but so far it has not been easy.
Cover story: Is Bundled Payment an Idea Whose Time Has Come? For decades, managed care plans have sought to stop making fee for service payments. Now they’re trying bundled payments for episodes of care.
Cover story: The Next Move in Physician Compensation. Here’s how practices have tweaked their salary and benefits schemes in response to healthcare reform.
Feature Article: HPV Vaccine Goes Underused. Only about 35 percent of girls get the full three doses of the vaccine for the human papillomavirus, which causes most cervical cancers
Report on Process Improvement: Mayo’s Clinical Laboratory Science Program Uses Lean/Six Sigma to Speed Applicant Reviews and Rolling Admissions
Cover story: For Health Insurers, Retail Space Available. Under health reform, consumers will be the new buyers in public and private exchanges, meaning care management programs will need a sharper focus on return on investment
Cover story: The Next Frontier: Patient Engagement. Seeking the best return on shared-savings programs such as PCMHs and ACOs, health plans are investing cash and other resources to attract and hold patients’ attention.
Cover story: Reform Forces Health Insurers to Reinvent Themselves
To paraphrase Mark Twain, the death of the health insurance industry has been greatly exaggerated. Plans simply have to develop new business models.
- Herzlinger Predicts ACOs, PCMHs Will Fail
- Virtual vs. Actual Networks
- CEO Contends That Eliminating Financial Risk Allows Medicaid Plans To Focus On Management
- AHIP’s Karen Ignagni: Health Insurers Will Continue to Innovate
- Wendell Potter: Insurers Will Be Radically Different
Cover story: Narrow Networks Found To Yield Substantial Savings
An early managed care idea that the marketplace once rejected is now being embraced by employers and offered by health plans.
Cover story: Decision Support’s New Advocates