5. Payment Incentives

This page contains additional references for Chapter 5 of Responding to Healthcare Reform: A Strategy Guide for Heatlhcare Leaders.  The most current additions are at the top of the page.  It also includes the annotated references from the book and their associated hyperlinks.

Current References

Center for Medicare and Medicaid Innovation
The Innovation Center’s mission is to help transform the Medicare, Medicaid and CHIP programs to deliver better healthcare, better health and reduced costs through improvement for CMS beneficiaries and in so doing, help to transform the healthcare system for all Americans.

Center for Healthcare Quality and Reform.  This Center is addressing  a number of major issues in the implementation of the ACA with a speical emphasis on ACOs:

 - Identifying and encouraging action on major opportunities for improving quality and decreasing costs (i.e., increasing value) in the health care system.

-  Identifying and encouraging changes in healthcare payment systems to reward, rather than penalize, efforts to improve value in healthcare delivery.

-  Identifying and encouraging changes in organizational structures and relationships among healthcare providers needed to improve value in healthcare delivery. 

 The Integrated Healthcare Association is a statewide multi-stakeholder leadership group that promotes quality improvement, accountability and affordability of health care in California. IHA is a nonprofit association working to actively convene all healthcare parties for cross sector collaboration on health care topics. IHA administers regional and statewide programs and serves as an incubator for pilot programs and projects.

The Integrated Healthcare Association
is a statewide multi-stakeholder leadership group that promotes quality improvement, accountability and affordability of health care in California. IHA is a nonprofit association working to actively convene all healthcare parties for cross sector collaboration on health care topics. IHA administers regional and statewide programs and serves as an incubator for pilot programs and projects.  IHA had been particularly helpful in the development of the Accountable Care Organization concept.

  

Dentzer, Susan. Geisinger Chief Glenn Steele: “Seizing Health Reform’s Potential To Build A Superior System.” Health Affairs, June 2010; 29(6): 1200-1207.

Extract: We’ve had a sustainable bending of the curve, if you will, in our Medicare Advantage plan, and now also in Medicare fee-for-service chronic disease management, from what was projected. You and I know that nationally, we’re hoping to bend the curve by 1.5 percentage points over ten years. We’ve achieved 7–8 percent. Our costs are still going up, but they’re 7–8 percent lower than what they would have been because of our fundamental reengineering of our community practice–based care.

Morris, Lewis. “Combating Fraud In Health Care: An Essential Component Of Any Cost Containment Strategy.” Health Affairs, September/October 2009; 28(5): 1351-1356.

ABSTRACT: Federal health care programs, including Medicare and Medicaid, are under attack by dishonest people who lie to the government and exploit its programs to steal taxpayers’ money. The full extent of health care fraud cannot be measured precisely. However, the Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public and private health care programs are 3–10 percent of total health spending, or $75–$250 billion in fiscal year 2009. Successful efforts to stop such abuses, without unduly burdening legitimate providers, require aggressive, innovative, and sustained attention to protect taxpayers and beneficiaries.

Annotated References from Responding to Reform

Allen, G. 2007. “Medicare Fraud Acute in South Florida.” National Public Radio report. [Online broadcast; originally broadcast 10/11/07.] www.npr.org/templates/story/story.php?storyId=15178883.

Blendon, R. J., M. Brodie, J. M. Benson, D. E. Altman, L. Levitt, T. Hoff, and L. Hugick. 1998. “Understanding the Managed Care Backlash.” Health Affairs 17 (4): 80.

Abstract: This paper examines the depth and breadth of the public backlash against managed care and the reasons for it. We conclude that the backlash is real and influenced by at least two principal factors: (1) A significant proportion of Americans report problems with managed care plans; and (2) the public perceives threatening and dramatic events in managed care that have been experienced by just a few. In addition, public concern is driven by fear that regardless of how well their plans perform today, care might not be available or paid for when they are very sick.

Bodenheimer, T. and H. H. Pham. 2010. “Primary Care: Current Problems and Proposed Solutions.” Health Affairs 29 (5): 799.
First 100 Words: The membership of health maintenance organizations (HMOs) now exceeds 50 million people and may grow by an additional 50 million by the year 2000. But all is not well in HMO-land. An angry and determined backlash is spreading across the nation. In 1996 alone, 1000 pieces of legislation attempting to regulate or weaken HMOs were introduced in state legislatures, and 56 laws were passed in 35 states. The backlash movement brings together patients who complain of services denied and physicians who are suffering the loss of autonomy and income. There are several manifestations of the backlash.

CMS. 2011. “Details for Medicare Acute Care Episode Demonstration.” [Online information; retrieved 1/10/11.] www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=3&sortOrder=descending&itemID=CMS1204388&intNumPerPage=10

The Acute Care Episode (ACE) Demonstration provides global payments for acute care episodes within Medicare fee-for-service (FFS). The focus is on select orthopedic and cardiovascular inpatient procedures. ACE Demonstration goals are to: improve quality for FFS Medicare beneficiaries; produce savings for providers, beneficiaries, and Medicare using market-based mechanisms; improve price and quality transparency for improved decision making; and increase collaboration among providers.

——. 2008. “The Medicare Recovery Audit Contractor (RAC) Program: An Evaluation of the 3-Year Demonstration.” [Online report; published June 2008.] https://www.cms.gov/RAC/Downloads/RACEvaluationReport.pdf

Fisher, E. S., M. B. McClellan, J. Bertko, S. M. Lieberman, J. J. Lee, J. L. Lewis, and J. S. Skinner. 2009. “Fostering Accountable Health Care: Moving Forward in Medicare. Health Affairs 28 (2): w219.

 Laxminarayan, R. 2010. “Avoiding the Unnecessary Costs of Hospital-Acquired Infections.” [Online article; published 3/19/11.] www.rff.org/Publications/WPC/Pages/Avoiding-the-Unnecessary-Costs-of-Hospital-Acquired-Infections.aspx.

 Lohr, S. 2008. “Health Care that Puts a Computer on the Team.” New York Times. [Online article; published 12/26/08.]: www.nytimes.com/2008/12/27/business/27record.html?pagewanted=1&_r=2&sq=Marshfield clinic&st=cse&scp=1.

Mass.gov. 2011. “Healthcare Cost and Quality Council.” [Online source; retrieved 1/10/11.]www.mass.gov/?pageID=hqcchomepage&L=1&L0=Home&sid=Ihqcc.
A state-based organization that publicly report healthcare quality.  

Medicare Payment Advisory Commission (MedPAC). 2009. Report to Congress, Chapter 2, p. 49, June.  ———. 2007. Report to Congress, Chapter 5, June.

MN Community Measurement. 2011. Website. [Online source; retrieved 1/10/11.]  www.mncm.org/site.
A state-based organization that publicly report healthcare quality.

 My San Antonio. 2009. “Providers Nationwide Watch Medicare Experiment Here.” [Online article; published 10/12/09.]  www.mysanantonio.com/default/article/Providers-nationwide-watch-Medicare-experiment-844486.php#page-1

 Praxel, T. A. 2009. “Quality Improvement in the Marshfield Clinic.” Presentation at the Institute for Clinical Systems Improvement Annual Meeting, Oct. 26.

 Thorpe, K. E., and L. L. Ogden. 2010. “Analysis & Commentary: The Foundation that Health Reform Lays for Improved Payment, Care Coordination, and Prevention.” Health Affairs 29 (6): 1183.

 Wisconsin Collaborative for Healthcare Quality. 2011. Website. [Online source; retrieved 1/10/11.] www.wchq.org.
 A state-based organization that publicly report healthcare quality.

 

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