Explore the latest in health care reform, including innovations in health care delivery and payment models, the politics of reform, and more.
This Viewpoint reviews the features of managed care organizations (MCOs) and managed competition, which seek to incentivize high-quality care and control spending through care coordination and shared financial risk and savings, and argues that the 2 are imperfect approaches to health care and payment reform but the most promising options for controlling costs short of price controls.
This randomized clinical trial assesses the effects of dementia care provision via telephone and internet on key outcomes for persons with dementia and their caregivers in rural and urban regions of 3 states compared with usual care.
This cohort study of 131 779 patients with head and neck cancer examines the association of the Patient Protection and Affordable Care Act with insurance status across socioeconomic and demographic subpopulations.
In this Viewpoint, Ehab Hanna, MD, president of the American Head and Neck Society, gives the 2019 annual meeting address.
This Viewpoint discusses details of the Radiation Oncology Model, a 90-day episode-based alternative payment model proposed by the Centers for Medicare & Medicaid Services (CMS) intended to reduce inappropriate overuse of proton beam therapy, intensity-modulated radiation therapy (IMRT), and other expensive radiation oncology services.
This Viewpoint discusses the importance of expanding accountability in quality-based payment reform from clinicians alone to include health systems and patients to align financial incentives for improving health outcomes among all the elements that contribute to the cost and enjoy the benefits of achieving them.
This Viewpoint discusses the importance of structuring value-based purchasing models around principles of physician professionalism to ensure that measures that lead to more payment are clinically meaningful, do not increase administrative burden, do not displace clinicians’ intrinsic motivation to help patients with financial motivations, and do not incentivize physicians to avoid sicker, more complicated patients.
In the context of limited evidence to date that national health care quality improvement (QI) initiatives are effective, this Viewpoint proposes shifting the focus of QI efforts to high-need, high-cost individuals, such as frail older patients and those at the end of life, because they are especially vulnerable to adverse consequences of low-value, high-cost care.
This Viewpoint argues that changing the Oncology Care Model to hold clinicians accountable for inappropriate drug utilization, not drug costs, could improve the model while preventing unintended disincentives to clinicians for using effective treatments.
In the context of “attribution gaps” that leave payers uncertain which physicians are to be credited with patient care quality and outcome measures in accountable care organization (ACO) payment models, this Viewpoint discusses the importance of patient selection of primary care providers to patient-centered value-based care, and changes CMS will need to implement to integrate the measure.
This Viewpoint characterizes the costs of medical supply acquisition and waste as an underrecognized contributor to health care expenditures and proposes policy and practice reforms, such as standardizing reuse of some supplies and extending expiration dates on others that could optimize supply availability and generate savings without adverse effects on patients.
This survey study analyzes NHIS data from nearly 18 000 patients with a cancer diagnosis before and after implementation of the Affordable Care Act (ACA) to evaluate patterns and patient-reported reasons for not having health insurance before and after the ACA.
This cross-sectional study estimates the difference in Medicaid enrollment associated with Indiana’s expansion of Medicaid using a Section 1115 waiver.
This Viewpoint uses recent US state legislation mandating investments in primary care to discuss the lack of evidence supporting assumptions that primary care spending will save downstream health care costs, the reasons why that might be, and implications for policy, payment, and practice reforms.
This Viewpoint reviews evidence for associations between Medicaid expansion under the Affordable Care Act and self-reported health outcomes, condition-specific outcome measures from administrative data, and state and national health indicators for low-income populations.
This study uses National Ambulatory Medical Care Survey data to assess the percentage of psychiatrists who have accepted Medicaid-insured patients before and after Medicaid expansion.
This analysis quantifies the contribution of regression to the mean to declining readmission rates at hospitals initially penalized under the Medicare Hospital Readmissions Reduction Program.
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