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Health Care Payment Approaches

Journal Article

Challenges in Assessing the Process-Outcome Link in Practice

Expanded use of clinical process-of-care measures to assess the quality of health care in the context of public reporting and pay-for-performance applications led to a desire to demonstrate its value in terms of improved patient outcomes.

Jan 19, 2015
Report

Predictive Model Could Apply to Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services uses a resource-based relative value (RBRV) scale to calculate payments for physicians. The values of the scale were validated with predictive modeling, and the result may be helpful in two key applications: flagging codes as potentially misvalued and determining why a code is valued differently than predicted.

Jan 16, 2015
Research Brief

RAND Modeling Offers Support for Transparent and Consistent CMS Physician Fee Schedules

The current process used by the Centers for Medicare & Medicaid Services for valuing physician work is based on physician survey responses. RAND researchers examined the feasibility of developing a model based instead on external data sources.

Jan 16, 2015
News Release

New Approach to Quality-Based Incentives Avoids Undesired Effects on Health Care Providers Who Care for Disadvantaged ...

Changing health care pay-for-performance programs to account for differences among providers in their patient characteristics can make the incentive schemes more equitable and avoid a redistribution of resources away from providers who care for socioeconomically disadvantaged patients.

Jan 14, 2015
Journal Article

New Approach to Quality-Based Incentives Avoids Undesired Effects on Health Care Providers Who Care for Disadvantaged Patients

Changing health care pay-for-performance programs to account for differences among providers in their patient characteristics can make the incentive schemes more equitable and avoid a redistribution of resources away from providers who care for socioeconomically disadvantaged patients.

Jan 9, 2015
Journal Article

Consumers Who Buy Subsidized Health Plans May Face Higher Costs in Competitive Markets

For people who buy subsidized coverage through marketplaces created under the ACA, those who live in areas with more plan offerings may have to pay a higher premium to receive the same deductible when compared to consumers in regions with fewer options.

Jan 9, 2015
Commentary

The Great Patient Experience Survey Myth

Patient experience with care is an essential element in any assessment of health care quality. Surveys give patients a voice and provide fair and relevant indicators that complement other metrics of health care quality to inform patients' choices and providers' decisions about how to improve care.

Dec 10, 2014
Report

Quantitative Evaluation of the Impact of the Healthy Communities Initiative in Cincinnati

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.

Oct 10, 2014
Commentary

The Winding Path to Effective Bundled Payment

It's not unusual for a demonstration to fall short of its original objectives. Learning from such cases is part of the innovation process. This is especially worthwhile for bundled payment, which has many potential benefits for patients, providers, and payers.

Aug 29, 2014
News Release

Effort to Adopt Bundled Payments Across California Falls Short of Goals

A pilot program intended to implement and test a cost-saving strategy for orthopedic procedures at hospitals in California failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden and concerns about financial risk.

Aug 4, 2014
Journal Article

Bundled Payments Fall Short in California

Despite widespread interest in bundled payments as a strategy to control health care costs, implementation efforts continue to disappoint. A pilot program in California failed to meet its goals, succumbing to recruitment challenges, regulatory uncertainty, administrative burden, and concerns about financial risk.

Aug 4, 2014
Report

Final Report: Evaluation of Tools and Metrics to Support Employer Selection of Health Plans

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.

Apr 3, 2014
News Release

Promise of Value-Based Purchasing in Health Care Remains to Be Demonstrated

After a decade of experimentation with reforms that give health providers financial incentives to improve performance, relatively little is known about how to best execute such strategies or judge their success.

Mar 4, 2014
Report

Measuring Success in Health Care Value-Based Purchasing Programs: Summary and Recommendations

Reviews what has been learned over the past decade about performance-based payment strategies in health care and offers recommendations for the design, implementation, and monitoring and evaluation of value-based purchasing programs.

Mar 4, 2014
Report

Promise of Value-Based Purchasing in Health Care Remains to Be Demonstrated

After a decade of experimentation with reforms that give health providers financial incentives to improve performance, relatively little is known about how to best execute such strategies or judge their success.

Mar 4, 2014
Journal Article

Beyond Black and White: Race/Ethnicity and Health Status Among Older Adults

This study examined physical and mental health, health symptoms, sensory and functional limitations, risk factors, and multimorbidity among older Medicare managed care members to assess disparities associated with race/ethnicity.

Mar 1, 2014
Journal Article

Effects of Medicare Payment Reform: Evidence from the Home Health Interim and Prospective Payment Systems

Medicare continues to implement payment reforms that shift reimbursement from fee-for-service toward episode-based payment, affecting average and marginal payment.

Jan 21, 2014
News Release

Factors Linked to Creation of Accountable Care Organizations Identified

Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations, medical practice structures intended to improve medical care and cut costs.

Oct 7, 2013
Journal Article

Factors Linked to Creation of Accountable Care Organizations Identified

Regions of the United States where doctors and hospitals are consolidated into large networks are more likely to have accountable care organizations, medical practice structures intended to improve medical care and cut costs.

Oct 1, 2013
Journal Article

Review of Experiences in Three Countries Informs England's Patient Choice Scheme

The experiences of Finland, Norway, and Sweden in offering patient choice schemes highlight England's need to carefully monitor the impact of enhanced choice in primary care to ensure that related policies truly enhance access to and improve the quality of care, and not inadvertently benefit those who are more able to exercise choice.

Sep 1, 2013

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