The role of health care providers is undergoing a tectonic shift. Systems of formal accountability have emerged to replace self-regulation and trust in the medical profession and its institutions.
Through gain-sharing arrangements, providers must assume an insurance function and the responsibility to manage populations, rather than individual patients. Team-based care and complex support technology are supplanting the traditional patient-physician dyad. Rapid consolidation changes the face of medical practice.
These changes present an unprecedented opportunity for providers to overcome the limitations of the traditional, encounter-based system of care delivery. Payment arrangements that reward value—rather than volume—allow for innovative approaches to managing patients and populations. Meanwhile, technology will translate evidence into effective, efficient, and patient-centric care.
An episode-based framework of health care quality measurement could provide a more complete picture of care than current methods. Existing quality measures could be used, but new ones would need to be developed to fill gaps in the framework.
For some clinical decisions, there may be a 'sweet-spot' in which the benefits of intuitive versus reflective clinical decisonmaking are in balance.
Patients whose doctors provide advice on quitting smoking are more likely to be satisfied with the care they receive.
This study aims to assess the quality of health care performance measurement.
Developing an episode-based framework of health care quality measurement would allow for more comprehensive assessments of care quality than currently available methods.
This study assesses the effects of behavioral interventions and rates of inappropriate (not guideline-concordant) antibiotic prescribing during ambulatory visits for acute respiratory tract infections.
Clinical home visit programs for Medicare beneficiaries are a promising approach to supporting aging in place and avoiding high-cost institutional care.
Documents the current range of health plans' chronic care management services, identifies best practices and industry trends, and examines factors in the plans' operating environment that limit their ability to optimize chronic care programs.
Published evaluations of medical home interventions have found limited effects on quality and utilization of care.
This second of three reports follows the progress of a three-year project intended to support the transformation of federally qualified health centers into advanced primary care practices in support of Medicare beneficiaries.
Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided.
This study aims to evaluate effects of a multi-payer pilot promoting patient-centered medical home implementation in 15 small and medium-sized primary care groups in Colorado.
To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio.
ProPublica's Surgeon Scorecard displays "Adjusted Complication Rates" for named surgeons for eight surgical procedures performed in hospitals. This perspective critiques the methods of the Scorecard and identifies opportunities for improvement.
This is a commentary on a recent CAHPS survey titled, "Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?"
This study conducted a survey of 766 adult primary care providers and staff in 34 California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change.
This report leverages existing data on wellness programs to explore patterns of wellness program availability, employers' use of incentives, and program participation and utilization among employees.
Presents information on the landscape of wellness programs, use of incentives, and their effect on participation, drawn from the first study on this topic to be based on national survey data.
Healthcare purchasers have created financial incentives for primary care practices to achieve medical home recognition.
This report describes the effects that alternative health care payment models have on physicians and their practices in the United States. It should help guide efforts to improve alternative payment programs and help practices succeed in them.
Compares the effectiveness and costs of telephone-only approach to in-person plus telephone for delivering an evidence-based, coordinated care management program for dementia.
In 2009, a Cincinnati group launched the Healthy Communities Initiative with the goals of improving health care and population health while reducing health care costs. In 2012, RAND Health Advisory Services assessed the Initiative's progress.
The authors assess the differential clinical and economic value of fidaxomicin compared with metronidazole and vancomycin in the treatment of Clostridium difficile infection (CDI).
RAND researchers used 2011 medical data to examine the impact of implementing a resource-based relative value scale to pay for physician services under the California workers' compensation system. This report details their findings.
RAND researchers created a five-step toolkit for the planning, implementation, and evaluation of a successful workplace wellness program, based on lessons learned and best practices from multiple projects and extensive research.
RAND researchers recommend that China should create an innovative health care delivery model based on population health management principles and sophisticated health information technology, rather than copy existing Western models.
Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered.
We examined where accountable care organizations (ACOs) have formed and what regional factors are predictive of ACO formation.
This fact sheet describes the results of research into the factors influencing physician professional satisfaction and their implications for health care.
This report presents the results of a series of surveys and semistructured interviews intended to identify and characterize determinants of physician professional satisfaction.
Due to volatility in healthcare costs, shared savings contracts can create systematic financial losses for payers, especially when contracting with smaller providers.
Testimony presented before the House Energy and Commerce Committee, Subcommittee on Health on June 5, 2013.
The report investigates the characteristics of workplace wellness programs, their prevalence, their impact on employee health and medical cost, facilitators of their success, and the role of incentives in such programs.
A team from RAND and the University HealthSystem Consortium (UHC) developed a toolkit to help hospitals enhance their quality improvement efforts using quality indicators from the Agency for Healthcare Research and Quality.
The Affordable Care Act (ACA) established nationwide eligibility for young adults 19 to 25 years of age to retain coverage under their parents' private health plans. We conducted a study to determine how the implementation of this provision changed rates of insurance coverage for young adults seeking medical care for major emergencies.
RAND Health research supports four strategies to restrain health care spending growth and maintain quality: foster efficient and accountable providers, engage and empower consumers, promote population health, and facilitate high-value innovation.
Health information technology has not achieved its full potential, but its benefits should grow over time. Because health care is largely regulated at the state level, the states can play a valuable role as laboratories for innovative policies.
The pharmaceutical industry can and should reconfigure its considerable resources to develop innovative and meaningful business models that are based on services that improve access and adherence to prescription drugs for common chronic conditions.
The use of dedicated anesthesia providers for routine gastroenterology (GI) procedures is seen as medically justifiable only for high-risk patients. Eliminating these services for low-risk patients could save Medicare $1.1 billion per year.
Underuse of controller therapy among Medicaid-enrolled children is common and leads to more emergency department (ED) visits and hospitalizations.
This project evaluated PROMETHEUS, a pilot project for a bundled payment alternative to fee for service. The pilot faced implementation challenges. Three years into the project, none of the pilot sites had executed contracts or made any bundled payments.
This white paper prepared for the Agency on Healthcare Research and Quality examines methodological issues raised by the generation of public-reporting of scores for measuring health care provider performance.
We simulated performance-based payments to Massachusetts practices serving higher and lower shares of patients from these vulnerable communities in Massachusetts.
Cross-sectional analysis used to measure associations between structural capabilities of primary care practices and performance on commonly used quality measures.
Examines the return on investment (ROI) that companies realize from workplace wellness programs, focusing on the ROI provided by disease management programs versus lifestyle management programs.
To broadly examine the potential health and financial benefits of HIT, this paper compares health care with the use of IT in other industries.
The energy boom of the last decade has led to rapidly increasing wealth in the Middle East, particularly in the oil and gas-rich Gulf Cooperation Council (GCC) countries.
This report attempts to help employers understand the structural differences between health plans and the performance dimensions along which plans can differ, as well as to educate employers about available tools to evaluate plan options.
We undertook a study to evaluate the effects of medical home transformation on job satisfaction in the primary care setting.
Interventions to transform primary care practices into medical homes are increasingly common, but their effectiveness in improving quality and containing costs is unclear.
If the prevalence of two innovative care delivery models — the patient-centered medical home and the nurse-managed health center — increases, projected U.S. physician shortages can be cut in half by 2025 without training a single additional physician.
