Costs and productivity in patient-centered medical homes

Costs and productivity in patient-centered medical homes

Author: Jerry Cromwell

Publisher: RTI Press

Published: 2016-07-28

Total Pages: 26

ISBN-13:

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To address the fragmentation and discontinuities in health care, patient-centered medical homes (PCMHs) provide additional care coordination services for an extra management fee with the goal of saving private and public insurers money while improving the quality of care. Because empirical evidence showing PCMH financial success is unavailable, we use claims data from 312 PCMHs and a matched set of comparison practices to simulate the required reductions in hospital admissions, readmissions, and other services necessary to achieve statistically detectable savings thresholds. We also determine staff coordination time and productivity levels necessary to result in detectable savings. Our results indicate that PCMHs will have to generate annual savings between 3 percent and 30 percent depending upon the underlying cost variation per beneficiary, number of demonstration practices, and the extent of beneficiary clustering within practices. Eliminating all readmissions or most non-hospital services alone will not achieve required savings, even in larger initiatives. In order to be cost-effective, additional physician and nurse time coordinating care will have to be quite productive in reducing costly health services. If so, this likely will result in substantial profits for highly productive PCMHs.


The Healthcare Imperative

The Healthcare Imperative

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2011-01-17

Total Pages: 852

ISBN-13: 0309144337

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The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.


Hidden Costs, Value Lost

Hidden Costs, Value Lost

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2003-06-19

Total Pages: 212

ISBN-13: 0309133203

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Hidden Cost, Value Lost, the fifth of a series of six books on the consequences of uninsurance in the United States, illustrates some of the economic and social losses to the country of maintaining so many people without health insurance. The book explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare. Hidden Costs, Value Lost concludes that the estimated benefits across society in health years of life gained by providing the uninsured with the kind and amount of health services that the insured use, are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year.


Rewarding Provider Performance

Rewarding Provider Performance

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2007-02-17

Total Pages: 273

ISBN-13: 0309102162

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The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America's health care investments. This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation's health care system in both the public and private sectors.


Interprofessional Education in Patient-Centered Medical Homes

Interprofessional Education in Patient-Centered Medical Homes

Author: C. Scott Smith

Publisher: Springer

Published: 2015-08-24

Total Pages: 124

ISBN-13: 3319201581

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This book discusses the application of complex adaptive systems theory to the design and evaluation of patient-centered medical homes (PCMHs). The three defining goals of PCMHs are to spread patient-care roles among healthcare team members, focus on disease prevention and include the patient in the healthcare team. It explains why some PCMH pilots are highly successful while others do not show much benefit, covers specific sub-theories that allow for bracketing of different aspects of the clinic system and highlights strategies by which institutions can engage in this process. Inter professional Education in Patient-Centered Medical Homes is a valuable resource for faculty and managers of health professions teaching clinics, deans of medical and health professional schools and medical administrators.


Essentials of Health Policy and Law

Essentials of Health Policy and Law

Author: Sara E. Wilensky

Publisher: Jones & Bartlett Learning

Published: 2022-03-25

Total Pages: 412

ISBN-13: 1284273210

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Essentials of Health Policy and Law, Fifth Edition provides students of public health, medicine, nursing, public policy, and health administration with an introduction to a broad range of seminal issues in U.S. health policy and law, analytic frameworks for studying these complex issues, and an understanding of the ways in which health policies and laws are formulated, implemented, and applied. Thoroughly revised, the Fifth Edition explores the key health policy and legal changes brought about by the Biden Administration and the presently Democrat-controlled Congress. It also addresses the Covid-19 pandemic, and its many devastating and intertwined health, economic, and social consequences.


Algorithms and Architectures for Parallel Processing

Algorithms and Architectures for Parallel Processing

Author: Yang Xiang

Publisher: Springer

Published: 2012-09-04

Total Pages: 351

ISBN-13: 3642330657

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The two volume set LNCS 7439 and 7440 comprises the proceedings of the 12th International Conference on Algorithms and Architectures for Parallel Processing, ICA3PP 2012, as well as some workshop papers of the CDCN 2012 workshop which was held in conjunction with this conference. The 40 regular paper and 26 short papers included in these proceedings were carefully reviewed and selected from 156 submissions. The CDCN workshop attracted a total of 19 original submissions, 8 of which are included in part II of these proceedings. The papers cover many dimensions of parallel algorithms and architectures, encompassing fundamental theoretical approaches, practical experimental results, and commercial components and systems.


Physician Leader

Physician Leader

Author: Hanah Polotsky

Publisher: CRC Press

Published: 2024-02-20

Total Pages: 229

ISBN-13: 1003846122

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Physicians are often asked to lead healthcare teams, departments, divisions, practices, and hospitals. Though many of them are experts in their fields, they are rarely prepared or educated in business management and leadership. Based on the authors’ interviews with many physician and non-physician executives and leaders, medical training contributes little to leadership skills. Many physicians leave medical training with a command-and-control leadership style that later has to be unlearned to succeed in a team-based healthcare environment. This book will help physician leaders to shed derailers and authoritarian leadership tendencies picked up in years of medical training. It is intended for (1) physicians who are transitioning to healthcare leadership roles, (2) senior-level physician and non-physician leaders as a coaching model to develop their physician leader direct reports, and (3) administrative leaders who are partnering with physician leaders. Both authors progressed from mid-level leadership roles to the C-suite, one as a physician leader and one as an administrative leader. As such, they have leveraged their operational excellence expertise to design the Iterative Leadership Model that includes the leader’s mindset, Leadership Strategies, and a coaching framework: GUIDES (Gather, Understand, Identify, Design, Execute, and Self-Reflect) that is based on the scientific method, PDSA (Plan, Do, Study, Act), A3 thinking, and the SOAP (Subjective, Objective, Assessment, and Plan) note format. The authors masterfully integrate personal reflections, coaching examples, illustrative fictional vignettes, and GUIDES exercises to support leaders in the self-development and self-improvement of seven critical Leadership Attributes: strategic thinking, effective communication, coaching, team-building, change management, continuous learning, and problem-solving.