101
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Affiliation(s)
- Hugh Alderwick
- Center for Health and Community, University of California, San Francisco, CA, USA
| | | | - Adam D M Briggs
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA
| | - Elliott S Fisher
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH, USA
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102
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Abstract
The Affordable Care Act (ACA) has reformed US health care delivery through insurance coverage expansion, experiments in payment design, and funding for patient-centered clinical and health care delivery research. The impact on cancer care specifically has been far reaching, with new ACA-related programs that encourage coordinated, patient-centered, cost-effective care. Insurance expansions through private exchanges and Medicaid, along with preexisting condition clauses, have helped more than 20 million Americans gain health care coverage. Accountable care organizations, oncology patient-centered medical homes, and the Oncology Care Model-all implemented through the Center for Medicare & Medicaid Innovation-have initiated an accelerating shift toward value-based cancer care. Concurrently, evidence for better cancer outcomes and improved quality of cancer care is starting to accrue in the wake of ACA implementation.
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Affiliation(s)
- Gabriel A Brooks
- From the *Dartmouth-Hitchcock Medical Center, Lebanon, NH; †The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; ‡Texas Oncology, Dallas, TX; and §The US Oncology Network, The Woodlands, TX
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103
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Berlin J. The Edge of Success. Tex Med 2018; 114:10. [PMID: 30625235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Make it through the challenges of forming an accountable care organization (ACO) for just a couple of years, and the money your groups save can be spectacular - into the millions under the right circumstances.
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104
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Corder JC. Population Health Management and ACOs: Will They Achieve Their Goals of Better Health and Lower Costs? Mo Med 2018; 115:7-10. [PMID: 30228668 PMCID: PMC6139785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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105
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Seiler LW. Long-Term Care: Funding of Long-Term Care. Issue Brief Health Policy Track Serv 2017; 2017:1-81. [PMID: 29360305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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106
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Thomson Reuters Accelus. Healthcare Reform: Payment Reform. Issue Brief Health Policy Track Serv 2017; 2017:1-42. [PMID: 29360300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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107
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Raduege TJ. Healthcare facilities. Issue Brief Health Policy Track Serv 2017; 2017:1-61. [PMID: 29359902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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108
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Raduege TJ. Medicaid Restructuring. Issue Brief Health Policy Track Serv 2017; 2017:1-72. [PMID: 29361655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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109
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Raduege TJ. Healthcare Reform: Delivery Reform. Issue Brief Health Policy Track Serv 2017; 2017:1-71. [PMID: 29360298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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110
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Affiliation(s)
- Bruce E Landon
- From the Department of Health Care Policy, Harvard Medical School, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston (B.E.L.), and the Heller School for Social Policy and Management, Brandeis University, Waltham (R.E.M.) - both in Massachusetts
| | - Robert E Mechanic
- From the Department of Health Care Policy, Harvard Medical School, and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston (B.E.L.), and the Heller School for Social Policy and Management, Brandeis University, Waltham (R.E.M.) - both in Massachusetts
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111
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112
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Calandra R. ACOs Sit Like Gibraltar in Rough Seas of Change. Manag Care 2017; 26:28-30. [PMID: 28895821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ACO, a creature of the ACA that often gets confused with its progenitor, seems like it will survive-and maybe even thrive-in whatever healthscape emerges from the Republican anti-ACA push. But just what will happen to the various forms of the ACO that are now in place?
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113
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114
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Abstract
Purpose - The purpose of this paper is to describe the current landscape of health information technology (HIT) in early accountable care organizations (ACOs), the different strategies ACOs are using to develop HIT-based capabilities, and how ACOs are using these capabilities within their care management processes to advance health outcomes for their patient population. Design/methodology/approach - Mixed methods study pairing data from a cross-sectional National Survey of ACOs with in-depth, semi-structured interviews with leaders from 11 ACOs (both completed in 2013). Findings - Early ACOs vary widely in their electronic health record, data integration, and analytic capabilities. The most common HIT capability was drug-drug and drug-allergy interaction checks, with 53.2 percent of respondents reporting that the ACO possessed the capability to a high degree. Outpatient and inpatient data integration was the least common HIT capability (8.1 percent). In the interviews, ACO leaders commented on different HIT development strategies to gain a more comprehensive picture of patient needs and service utilization. ACOs realize the necessity for robust data analytics, and are exploring a variety of approaches to achieve it. Research limitations/implications - Data are self-reported. The qualitative portion was based on interviews with 11 ACOs, limiting generalizability to the universe of ACOs but allowing for a range of responses. Practical implications - ACOs are challenged with the development of sophisticated HIT infrastructure. They may benefit from targeted assistance and incentives to implement health information exchanges with other providers to promote more coordinated care management for their patient population. Originality/value - Using new empirical data, this study increases understanding of the extent of ACOs' current and developing HIT capabilities to support ongoing care management.
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Affiliation(s)
- Frances M Wu
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Menlo Park, California, USA
| | - Thomas G Rundall
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Stephen M Shortell
- Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Joan R Bloom
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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115
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Caron MA. Value-based care is here to stay. Health Manag Technol 2017; 38:19. [PMID: 29474042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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116
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Whitman E. A tale of two ACOs. Mod Healthc 2017; 47:20-22. [PMID: 30715812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hospital systems and physician practices setting up accountable care organizations are generating mixed results. Whether you profit from shared savings will often depend on where you start--and that's a problem.
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117
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Largest accountable care organizations Ranked by estimated Medicare lives. Mod Healthc 2017; 47:34. [PMID: 30715817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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118
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Hill D, Feldman SR. Cost of diagnosing psoriasis and rosacea for dermatologists versus primary care physicians. Cutis 2017; 99:134-136. [PMID: 28319619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Growing incentives to control health care costs may cause accountable care organizations (ACOs) to reconsider how skin disease is best managed. Limited data have suggested that disease management by a primary care physician (PCP) may be less costly than seeing a specialist, though it is not clear if the same is true for the management of skin disease. This study assessed the cost of seeing a dermatologist versus a PCP for diagnosis of psoriasis and rosacea.
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Affiliation(s)
- Dane Hill
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R Feldman
- Center for Dermatology Research, Departments of Dermatology, Pathology, and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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119
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Affiliation(s)
- Jerry Avorn
- Harvard Medical School; and Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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120
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Fragmentation in the Delivery of Health Care. Natl Bur Econ Res Bull Aging Health 2017;:3. [PMID: 28591977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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121
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Haugen MB, Dascher P, Manor B. Uniting HIM and IT. J AHIMA 2017; 88:24-27. [PMID: 29400933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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122
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Bridger CM, Smith SE, Saunders ST. Saving Lives and Saving Money: The Role of North Carolina Health Departments in Medicaid Managed Care. N C Med J 2017; 78:55-57. [PMID: 28115569 DOI: 10.18043/ncm.78.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A new Medicaid system is emerging in North Carolina in which accountable care organizations will aim to improve both the quality and value of health care. We explore how local health departments can apply their expertise in population health to help achieve these goals.
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Affiliation(s)
- Colleen M Bridger
- director, Orange County Health Department, Hillsborough, North Carolina; adjunct clinical professor, Department of Maternal and Child Health; adjunct assistant professor, Department of Health Policy and Management; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven E Smith
- director, Henderson County Health Department, Hendersonville, North Carolina
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123
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Raduege TJ. Medicaid Restructuring. Issue Brief Health Policy Track Serv 2016; 2016:1-67. [PMID: 28248069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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124
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Raduege TJ. Healthcare Facilities. Issue Brief Health Policy Track Serv 2016; 2016:1-75. [PMID: 28248465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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125
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Rothenberg IZ. As ACOs evolve, the clinical lab's role grows. MLO Med Lab Obs 2016; 48:32-33. [PMID: 30047667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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126
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Huaiquil A. ACOs Bring Assisted Living Into The Fold. Provider 2016; 42:18-26. [PMID: 29601688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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127
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Reinke T. Joint Venture Health Plans May Give ACOs a Run for Their Money. Manag Care 2016; 25:35-37. [PMID: 28121562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Joint venture plans are starting to demonstrate their ability to implement clinical management and financial management reforms. A JV health plan replaces the offloading of financial risk by health plans to ill-equipped providers with an executive-level cost management committee stated jointly by the hospital and payer.
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128
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Herman B. With Wellcare deal, future looks bright for Medicare Advantage plans. Mod Healthc 2016; 46:11. [PMID: 30399265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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129
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Paterick ZR, Ngo E, Patel N, Chandrasekaran K, Tajik J, Paterick TE. Malpractice Considerations: New Concerns on the Horizon. J Med Pract Manage 2016; 32:177-181. [PMID: 29944813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Physicians practicing medicine in today's ever-shifting and advancing medical world are at risk for malpractice liability. The introduction of a vast array of telecommunication media into the physician world is creating a growing area of malpractice risk for physicians. This article explores the new malpractice considerations facing physicians in our constantly evolving digital world. Although they are novel and just on the horizon, these risks are real, and it is prudent for every practicing physician to consider them carefully.
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130
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131
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Twiddy D. Beating the Prior Authorization Blues. Fam Pract Manag 2016; 23:15-19. [PMID: 27626115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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132
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Hollenbeck BK, Bierlein MJ, Kaufman SR, Herrel L, Skolarus TA, Miller DC, Shahinian VB. Implications of evolving delivery system reforms for prostate cancer care. Am J Manag Care 2016; 22:569-575. [PMID: 27662220 PMCID: PMC5117461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Prostate cancer treatment is a significant source of morbidity and healthcare spending. Evolving clinical data have supported expanding surveillance as a means to "right-size" treatment. Integrated delivery systems afford the possibility of hastening this objective. STUDY DESIGN Retrospective cohort study of Medicare beneficiaries. METHODS We used a 20% sample of national Medicare claims to assess the impact of healthcare integration on rates of treatment and potential overtreatment in men newly diagnosed with prostate cancer between 2007 and 2011. Rates were measured according to the extent of integration within a market (ie, none, low, intermediate, and high). Generalized estimating equations were used to assess the relationship between integration and utilization, adjusting for confounders. RESULTS Rates of treatment declined across all markets (P <.01 for overall time trend), but the rate of decline was similar for the 4 market types (P = .27). In the most integrated markets, the rate decreased by 28.8%, or from 55.5 per 10,000 population in 2007 to 39.5 per 10,000 in 2011. After adjusting for confounders, men residing in the most integrated markets were 2.1% less likely to be treated with curative intent compared with those living in areas without integrated delivery systems (P = .04). However, rates of potential overtreatment were similar across all markets regardless of the level of integration (P = .21). CONCLUSIONS Healthcare integration was associated with small declines in prostate cancer treatment in newly diagnosed men, but not with potential overtreatment. Integrated care alone may be insufficient to curtail potential overtreatment of prostate cancer.
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Affiliation(s)
- Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan, 2800 Plymouth Rd, NCRC Bldg 16, Ann Arbor, MI 48109-2800. E-mail:
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133
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Abstract
Quality health care relies upon communication in a patient's preferred language. Language access in health care occurs when individuals are: (1) Welcomed by providers regardless of language ability; and (2) Offered quality language services as part of their care. Federal law generally requires access to health care and quality language services for deaf and Limited English Proficient (LEP) patients in health care settings, but these patients still find it hard to access health care and quality language services.Meanwhile, several states are implementing Medicaid Accountable Care Organization (ACO) initiatives to reduce health care costs and improve health care quality. Alternative payment methods used in these initiatives can give Accountable Care Organizations more flexibility to design linguistically accessible care, but they can also put ACOs at increased financial risk for the cost of care. If these new payment methods do not account for differences in patient language needs, ACO initiatives could have the unintended consequence of rewarding ACOs who do not reach out to deaf and LEP communities or offer quality language services.We reviewed public documents related to Medicaid ACO initiatives in six states. Some of these documents address language access. More could be done, however, to pay for language access efforts. This article describes Medicaid ACO initiatives and explores how different payment tools could be leveraged to reward ACOs for increased access to care and quality language services. We find that a combination of payment tools might be helpful to encourage both access and quality.
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Affiliation(s)
- Rachel Gershon
- Rachel Gershon, J.D., M.P.H., is a health policy attorney and associate at the University of Massachusetts Medical School's Center for Health Law and Economics. Lisa Morris, M.S.T.D., is the Director of Cross Cultural Initiatives at the University of Massachusetts Medical School's MassAHEC Network. Warren Ferguson, M.D., is the Vice Chair and Professor at the University of Massachusetts Medical School's Department of Family Medicine & Community Health
| | - Lisa Morris
- Rachel Gershon, J.D., M.P.H., is a health policy attorney and associate at the University of Massachusetts Medical School's Center for Health Law and Economics. Lisa Morris, M.S.T.D., is the Director of Cross Cultural Initiatives at the University of Massachusetts Medical School's MassAHEC Network. Warren Ferguson, M.D., is the Vice Chair and Professor at the University of Massachusetts Medical School's Department of Family Medicine & Community Health
| | - Warren Ferguson
- Rachel Gershon, J.D., M.P.H., is a health policy attorney and associate at the University of Massachusetts Medical School's Center for Health Law and Economics. Lisa Morris, M.S.T.D., is the Director of Cross Cultural Initiatives at the University of Massachusetts Medical School's MassAHEC Network. Warren Ferguson, M.D., is the Vice Chair and Professor at the University of Massachusetts Medical School's Department of Family Medicine & Community Health
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135
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Abstract
IMPORTANCE The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care. OBJECTIVES To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act. EVIDENCE Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016. FINDINGS The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law's reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain. CONCLUSIONS AND RELEVANCE Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation's most complex challenges.
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136
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Neumann ME. ESCOs feeling some positive vibes over patient care. Nephrol News Issues 2016; 30:8. [PMID: 30513161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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137
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Stefanacci RG, Ohioma D. Why Different Health Systems Treat The Same Kind of Patient Differently. Manag Care 2016; 25:33. [PMID: 28121584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
ACOs may be the answer to striking the right balance between utilization and clinical outcomes, but separate Part D coverage throws a wrench into the works.
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138
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Affiliation(s)
- Robert Kocher
- From Venrock, Palo Alto (R.K.), the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (R.K.), and Stanford University School of Medicine (R.K.) and Stanford Graduate School of Business (A.C.), Stanford - all in California; and the John F. Kennedy School of Government, Harvard University, Cambridge, MA (A.C.)
| | - Anuraag Chigurupati
- From Venrock, Palo Alto (R.K.), the Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles (R.K.), and Stanford University School of Medicine (R.K.) and Stanford Graduate School of Business (A.C.), Stanford - all in California; and the John F. Kennedy School of Government, Harvard University, Cambridge, MA (A.C.)
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139
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Van Alstin CM. How docs get into the tech game: From health information exchanges to e-prescribing to evidence-based medicine, sometimes a clinical perspective is just what the doctor ordered. Health Manag Technol 2016; 37:6-9. [PMID: 29474046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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140
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Abstract
IMPORTANCE Patients treated outside of their Medicare Shared Savings Program (MSSP) accountable care organization (ACO) likely benefit less from the ACO's integration of care. Consequently, the MSSP's open-network design may preclude ACOs from improving value in care. OBJECTIVES Quantify out-of-ACO care in a single urban ACO and examine associations between patient-level predictors and out-of-ACO expenditures. RESEARCH DESIGN Secondary data analysis using Centers for Medicare and Medicaid ACO Program Claim and Claim Line Feed dataset (dates of service January 1, 2013-December 31, 2013). Two-part modeling was used to examine associations between patient-level predictors and likelihood and level of out-of-ACO expenditures. SUBJECTS Patients were included if they were prospectively assigned to the MSSP in 2013. Patients were excluded if they declined to share data with the ACO, were not retrospectively confirmed to be in the ACO, or had missing data on covariates. Analytic sample included 11,922 patients. MEASURES Total out-of-ACO expenditures and out-of-ACO expenditures by place of service. RESULTS Of total expenditures, 32.9% were paid to out-of-ACO providers, and 89.8% of beneficiaries had out-of-ACO expenditures. The presence of almost all medical comorbidities increased out-of-ACO expenditures ($800-$3000 per comorbidity) across the study population. Racial/ethnic minority groups spent between $1076 and $1422 less outside of the ACO than white patients, which was driven by less out-of-ACO outpatient office expenditures ($417-$517 less for each racial/ethnic minority group). CONCLUSIONS Out-of-ACO expenditures represented a significant portion of expenditures for the study population. Medically complex patients spent more outside of the ACO and represent an important population to study further.
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Affiliation(s)
- Maria A. Han
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
- Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, CA
| | - Robin Clarke
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
- UCLA Faculty Practice Group, Los Angeles, CA
| | - Susan L. Ettner
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
- Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA
| | - William Neil Steers
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
- Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, CA
| | - Mei Leng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA
- Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, CA
- Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA
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Muhlestein D, Tu T, de Lisle K, Merrill T. Hospital participation in ACOs associated with other value-based program improvement. Am J Manag Care 2016; 22:e241-e248. [PMID: 27442307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES This paper analyzes whether hospital participation in an accountable care organization (ACO) impacts a hospital's quality improvement and cost reduction outcomes in other value-based purchasing (VBP) programs, including the Hospital Value-Based Purchasing Program (HVBP), the Hospital Readmissions Reduction Program (HRRP), and the Hospital-Acquired Conditions (HAC) Reduction Program. STUDY DESIGN Using VBP performance data and Leavitt Partners' ACO data, 2 analyses were performed: 1) a descriptive comparison of VBP performance of hospital ACOs compared with non-ACO hospitals, and 2) a longitudinal analysis of hospitals that became part of an ACO during the second year of performance data. METHODS In the descriptive analysis, we compared VBP scores for hospital ACOs with non-ACO hospitals. To estimate the effect that becoming an ACO had on a hospital, we evaluated the performance of hospitals that became part of an ACO to all hospitals that never became part of an ACO. RESULTS For fiscal year 2016, hospital ACOs performed better than non-ACO hospitals for the HRRP, but not on the HVBP and the HAC Reduction Programs. Longitudinal analysis, however, reveals that results are varied, with evidence that hospitals joining ACOs did increasingly better than their peers for the HRRP, but had inconsistent results year-over-year with the HVBP. CONCLUSIONS Despite similar goals, hospital participation in an ACO is not correlated with improved performance in all Medicare VBP programs. Organizations pursuing accountable care and also attempting to maximize Medicare VBP program performance must recognize the differences in program objectives and create strategies unique to each.
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Affiliation(s)
- David Muhlestein
- Leavitt Partners, 299 South Main St, Ste 2300, Salt Lake City, UT 84112. E-mail:
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142
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Giannulli T. Independent doctors find success with physician-led ACOs. Med Econ 2016; 93:54. [PMID: 27526417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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143
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Thompson F, Bennett D. Transforming care delivery in a value-based environment. Physician-led ACO leverages population health to improve quality and reduce costs. Health Manag Technol 2016; 37:18-19. [PMID: 27443076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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144
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Bloomfield C. Don't Get Shortchanged: A Guide To ACO Prep. Provider 2016; 42:45-46. [PMID: 27301083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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145
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Chiffelle RL. PHOs: An ideal vehicle to create ACOs. MGMA Connex 2016; 16:39-41. [PMID: 27386692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Lypson ML, Woolliscroft JO, Roll LC, Spahlinger DA. AM Last Page. Health Professions Education Must Change: What Educators Need to Know about the Changing Clinical Context. Acad Med 2016; 91:602. [PMID: 26535865 DOI: 10.1097/acm.0000000000000984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Monica L Lypson
- formerly assistant dean for graduate medical education and currently associate chief of staff/education, Ann Arbor VA Healthcare System, and professor of internal medicine and learning health sciences senior associate dean for clinical affairs, executive director, UM Medical group, professor of internal medicine, University of Michigan Medical School
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147
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Liggin R. Four steps to a winning accountable care strategy. Health Manag Technol 2016; 37:28. [PMID: 27215113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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148
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King J, Patel V, Jamoom E, DesRoches C. The role of health IT and delivery system reform in facilitating advanced care delivery. Am J Manag Care 2016; 22:258-265. [PMID: 27143291 PMCID: PMC4878450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To examine whether physicians using health information technology and participating in new models of payment and delivery were more likely to perform care processes associated with improved care delivery. STUDY DESIGN Nationally representative, cross-sectional data on US office-based physicians from the 2012 National Ambulatory Medical Care Survey Physician Workflow Survey. METHODS Multivariate regression analysis of whether physicians routinely performed 14 specific care processes in 4 categories: population management, quality measurement, patient communication, and care coordination. Key independent measures were electronic health record (EHR) use and accountable care organization (ACO) or patient-centered medical home (PCMH) participation. RESULTS A majority of physicians reported routinely conduct at least 1 care process related to care coordination (89%), patient communication (69%), and population management (67%); less than half reported performing at least 1 quality measurement process routinely (44%). EHR use and ACO or PCMH participation were independently associated with a higher likelihood of performing care processes. Physicians who were using EHRs in combination with participation in ACO or PCMH initiatives had the highest likelihood of routinely performing the care processes: physicians who used an EHR and participated in ACO or PCMH initiatives were between 6 and 22 percentage points more likely to routinely perform the care processes than physicians with EHRs alone. CONCLUSIONS In 2012, physicians using EHRs and participating in ACO or PCMH initiatives were more likely than other physicians to be routinely engaging in care processes expected to improve healthcare outcomes. Yet, many US physicians were not performing these processes routinely. This analysis highlights several specific areas where more work is necessary to facilitate wider adoption of these activities.
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Affiliation(s)
| | - Vaishaili Patel
- Office of the National Coordinator for Health Information Technology, 330 C St, SW, Rm 7025A, Washington, DC 20201. E-mail:
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149
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Teitelbaum H, Goozner M. 'If you are disruptive, somebody's ox is being gored'. Mod Healthc 2016; 46:48-49. [PMID: 27079040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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150
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Chien AT, Schiavoni KH, Sprecher E, Landon BE, McNeil BJ, Chernew ME, Schuster MA. How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract. Acad Pediatr 2016; 16:200-7. [PMID: 26523636 DOI: 10.1016/j.acap.2015.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/15/2015] [Accepted: 10/24/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE From 2009 to 2010, 12 accountable care organizations (ACOs) entered into the alternative quality contract (AQC), BlueCross BlueShield of Massachusetts's global payment arrangement. The AQC included 6 outpatient pediatric quality measures among 64 total measures tied to pay-for-performance bonuses and incorporated pediatric populations in their global budgets. We characterized the pediatric infrastructure of these adult-oriented ACOs and obtained leaders' perspectives on their ACOs' response to pediatric incentives. METHODS We used Massachusetts Health Quality Partners and American Hospital Association Survey data to characterize ACOs' pediatric infrastructure as extremely limited, basic, and substantial on the basis of the extent of pediatric primary care, outpatient specialist, and inpatient services. After ACOs had 16 to 43 months of experience with the AQC, we interviewed 22 leaders to gain insight into how organizations made changes to improve pediatric care quality, tried to reduce pediatric spending, and addressed care for children with special health care needs. RESULTS ACOs' pediatric infrastructure ranged from extremely limited (eg, no general pediatricians in their primary care workforce) to substantial (eg, 42% of workforce was general pediatricians). Most leaders reported intensifying their pediatric quality improvement efforts and witnessing changes in quality metrics; most also investigated pediatric spending patterns but struggled to change patients' utilization patterns. All reported that the AQC did little to incentivize care for children with special health care needs and that future incentive programs should include this population. CONCLUSIONS Although ACOs involved in the AQC were adult-oriented, most augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Katherine H Schiavoni
- Harvard Medical School, Boston, Mass; Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, Mass
| | - Eli Sprecher
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Bruce E Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Mass; Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Barbara J McNeil
- Department of Health Care Policy, Harvard Medical School, Boston, Mass; Department of Radiology, Brigham and Women's Hospital, Boston, Mass
| | - Michael E Chernew
- Department of Health Care Policy, Harvard Medical School, Boston, Mass
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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