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RAND Corporation Provides Objective Research Services and Public Policy Analysis. Performance-Based Bundled Payments-Oct2009. October 2009 | Back to Table of Contents Performance-Based Bundled Payments Benefits and burdens of this pay-for-performance strategy. By David J. Satin, M.D., and Justin Miles Abstract Performance-based bundled payments have emerged as the most recent iteration of pay for performance. In his September 9 address to a joint session of Congress, President Barack Obama specifically called for greater financial accountability, quality, and efficiency within the American health care system. Obama’s is only one of many voices touting the potential benefits of P4P in medicine, which has emerged in recent years as an attempt to encourage high- quality care through reimbursement. The Concept The initial goal of P4P programs was to promote quality by aligning physician compensation with evidence-based care.

An important distinction between P4P and performance-based bundled payments is that performance-based bundles replace, rather than augment, traditional fee-for-service payments. Conclusion. Getting A Grasp On Global Payments: Prix Fixe Vs. ‘I’ll Have The Lobster’ As the Patrick administration pushes Massachusetts forward toward the cost-cutting phase of health reform, one of its guiding concepts is to shift the state from “fee for service” to “global payments.” That is, instead of being paid for each bit of care they give, health care providers will be put on an overarching “global” budget for each patient. But how do we know that global payments work? And do they really save money? WBUR’s Martha Bebinger asks those important questions today in her report here, and takes a look at the early experience of some local global-payment hotspots: Commonwealth Care Alliance, Harvard Vanguard and Blue Cross Blue Shield.

Already, she reports: There’s a lot going on behind the scenes. Yet another early adopter of global payments, Lowell General Physicians Hospital Organization, is featured in a piece by Pippin Ross in the latest issue of the magazine CommonWealth, here. Children's Hospital Boston Joins the Alternative Quality Contract -- BOSTON, Jan. 24, 2012. Hospital and physicians agree to rate freeze for 2012 BOSTON, Jan. 24, 2012 /PRNewswire-USNewswire/ -- Blue Cross Blue Shield of Massachusetts (BCBSMA), Children's Hospital Boston, Children's Physicians' Organization and the Pediatric Physician Organization at Children's (PPOC) today announced an agreement to a new contract that marks the first pediatric-only hospital to sign the Alternative Quality Contract (AQC).

The contract includes a 0% rate increase for 2012 and modest increases below general inflation through the remainder of the three-year contract. Introduced in 2009, the AQC is a modified global payment model designed to slow the growth in health care spending and improve patient care by helping physicians and hospitals redesign their care to emphasize quality and value over volume. "The agreement with BCBSMA is aligned with our ongoing efforts to both improve quality and reduce costs," said Sandra Fenwick, President and COO, Children's Hospital Boston.

Merrill Matthews and Mark Litow: Why Medicare Patients See the Doctor Too Much. Medical Industry Leadership Institute Seminar - Michael Chernew, PhD, Harvard Medical School - Event Detail - Carlson School of Management. Five Payment Models: The Pros, the Cons. Back to Table of Contents | February 2011 Five Payment Models: The Pros, the Cons, the Potential By Janet Silversmith on behalf of the MMA Work Group to Advance Health Care Reform ■ Among the leading strategies to reform health care is the development and implementation of new payment models. The goal is to change the way physicians, hospitals, and other care providers are paid in order to emphasize higher quality at lower costs—in other words, to improve value. In an effort to build on its health care reform activities that began in 2005, the Minnesota Medical Association convened a work group in 2010 to develop recommendations on how payment reform can best be advanced. . ■ Payment ModelsThe five payment models that the MMA work group reviewed are fee for service, pay for coordination, pay for performance, episode or bundled payment, and comprehensive care or total cost of care payment.

Several different perspectives can be used to evaluate payment models. References1. Massachusetts On Track To 'Crack The Code' For Health Care Cost Control. By Gov. Deval Patrick This month, we celebrate the sixth anniversary of Massachusetts' health care reform. Our reforms are an expression of values, a codifying of our belief that health is a public good and that everyone deserves access to affordable, high-quality care. Mass. Gov. Patrick Like President Barack Obama's Affordable Care Act, we took a hybrid approach, relying mainly on private insurance provided through the workplace, and added varying degrees of public subsidy depending on a person's ability to afford private insurance. It's working. In addition, more than 90 percent of our residents have a primary care physician, and four out of five respondents to a recent survey have seen their primary care doctor in the last year.

We're healthier, too. All this while adding about 1 percent to state spending on health care. Those are the numbers, but policy matters most where it touches people. Our next challenge is slowing the growth in health care premiums. Bundled payment. History[edit] Bundled payments began as early as 1984 when The Texas Heart Institute under the direction of Denton Cooley began to charge flat fees for both hospital and physician services for cardiovascular surgeries.[5][12] Authors from the Institute claimed that its approach "maintain[ed] a high quality of care" while lowering costs (e.g., in 1985 the flat fee for coronary artery bypass surgery at the Institute was $13,800 versus the average Medicare payment of $24,588).[12] In 1991, a "Medicare Participating Heart Bypass Center Demonstration" began in four hospitals across the United States; three other hospitals were added to the project in 1993, and the project concluded in 1996.[1][14] In the demonstration, Medicare paid global inpatient hospital and physician rates for hospitalizations for coronary artery bypass surgery; the rates included any related readmissions.[1] Among the published evaluations of the project were the following: Advantages[edit] Considerations[edit]

Shared Savings Program | Centers for Medicare & Medicaid Services. Massachusetts Looks at ‘Global Payments’ to Lower Health Cost. Employer-Sponsored Health Insurance | Yale Journal of Medicine & Law: An Undergraduate Publication. Employer-sponsored insurance is a cornerstone of the U.S. healthcare system, in some ways as vital as the drugs, devices, and medical services that the insurance covers. Employer-sponsored insurance has been de­scribed as the equivalent of “private social security” and remains the most prominent form of health insurance in the United States, at 62.9% of the under-65 population, according the Kaiser Family Foundation. Employer-sponsored health insurance coverage for all workers (click to enlarge) America’s heavy reliance on em­ployer-sponsored insurance is, by many accounts, an accident of histo­ry that evolved in an unplanned way and, as some see it, without the ben­efit of intelligent design.

It now faces challenges that are unparalleled in its roughly 70-year history – including ap­parently unsustainable cost increases – and the system’s ability to cope with these challenges over the long term is far from certain. Coverage by Blue Cross Blue Shield (click to enlarge) EBRI: Part-Time Status Shuts More Out of Coverage. In this April 10, 2012, file photo, people wait in a line at a job fair in Gresham, Ore. The state releases its latest jobless figures, Tuesday, April 17, 2012. (AP Photo/Rick Bowmer, file) Fewer workers say they have access to employer-sponsored health coverage.

Paul Fronstin, a researcher at the Employee Benefit Research Institute (EBRI), Washington, writes about that shift in an analysis of trends in employment-based health benefits over the period from 1997 to 2010. Fronstin, drawing on government survey data, notes that the percentage of nonelderly U.S. adults with employment-based coverage, either as the employees or dependents, fell to 58.7% in 2010, 62.4%. The percentage of workers with coverage their own employers fell to 51.5% in 2010, from 54.2% in 2007. One reason for the drop is that the percentage of employers offering employees health plans fell to 67.5% in 2010, from 70.1% in 2010.

The ineligibility rate fell to 14.7% in 2010, from 17.2% in 1997. Paul Starr's Home Page. Chapter 4 - Employer-Sponsored Health Coverage - Covering Health Issues, 6th Ed. (2011 Update) Content Last Updated: 11/8/2012 3:11:30 PM Graphics Last Updated: 4/10/2012 4:52:15 PM Note: Terms in green will show glossary definitions when clicked. Originally written by Paul Fronstin, Ph.D., Employee Benefit Research Institute, and updated by Paul Fronstin of EBRI and Bill Erwin of the Alliance for Health Reform. Updated on November 6, 2012 by Marilyn Werber Serafini of the Alliance for Health Reform. Over 170 million individuals were covered by employment-based health benefits in 2011.1 The percentage of individuals with such coverage was 55.1 percent in 2011, down from 55.3 percent in 2010, 56.1 percent in 2009, and 65.1 percent in 2000.2 Due to the ACA, about 3 million to 5 million fewer people will obtain employer-sponsored coverage each year from 2019 through 2022 than would have been the case under prior law.3 Sixty-one percent of firms offered health benefits to their workers in 2012 – similar to the 60 percent that offered them the year before.

Research Papers / Publications - Health Care Management Department. Dept. of Public Policy: The Moral-Hazard Myth. Tooth decay begins, typically, when debris becomes trapped between the teeth and along the ridges and in the grooves of the molars. The food rots. It becomes colonized with bacteria. The bacteria feeds off sugars in the mouth and forms an acid that begins to eat away at the enamel of the teeth. Slowly, the bacteria works its way through to the dentin, the inner structure, and from there the cavity begins to blossom three-dimensionally, spreading inward and sideways. When the decay reaches the pulp tissue, the blood vessels, and the nerves that serve the tooth, the pain starts—an insistent throbbing.

The tooth turns brown. Several years ago, two Harvard researchers, Susan Starr Sered and Rushika Fernandopulle, set out to interview people without health-care coverage for a book they were writing, “Uninsured in America.” People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Case Examples and Resolution Agreements. Medicare. This booklet provides basic information about what Medicare is, who is covered and some of the options you have for choosing Medicare coverage. For the latest information about Medicare, visit the website or call the toll-free number listed below. Website: Toll-free number: ( ) TTY number: Medicare is our country’s health insurance program for people age 65 or older. Medicare is financed by a portion of the payroll taxes paid by workers and their employers.

The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. Medicare has four parts Hospital insurance (Part A) helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care and hospice care. Medical insurance (Part B) helps pay for doctors’ services and many other medical services and supplies that are not covered by hospital insurance. Medicare Advantage (Part C) plans are available in many areas. A word about Medicaid A U.S. citizen; or. Medicare: FAQs. HTML Version. M E D I C A R ED É J À V U ? W E B E X C L U S I V E 15 December 2004 Medicare Advantage: Déjà Vu All Over Again? Experiences with Medicare+Choice suggest major challenges that will affect both beneficiaries and the Medicare program. By Brian Biles, Geraldine Dallek, and Lauren Hersch Nicholas ABSTRACT:The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 expands the role of private health plans in Medicare through prescription drug plans and a revised Medicare+Choice (M+C), renamed Medicare Advantage, program.

This paper discusses the factors responsible for the failure of M+C to develop as intended in 1997 and analyzes the challenges for MMA implementation in light of these factors. In November 2003 congress adopted the most far-reaching changes in the Medicare program since its enactment in 1965. The MMA legislation envisions that beginning in January 2006, all beneficiaries must enroll in a private plan to receive drug benefits.

Provider instability. The Legislative Process Illustrated. Introduction to Health Policy : Lecture Materials. Essentials of Health Policy and Law, Second Edition. Introduction to Public Policy. The Powers of Congress. Introduction The United States is a government of enumerated powers. Congress, and the other two branches of the federal government, can only exercise those powers given in the Constitution. The powers of Congress are enumerated in several places in the Constitution. The most important listing of congressional powers appears in Article I, Section 8 (see left) which identifies in seventeen paragraphs many important powers of Congress. In this section, we consider how several of the enumerated powers of Congress under the original Constitution have been interpreted.

No enumerated power has justified more exercises of congressional power than the Article I, Section 8 power to "regulate commerce among the several states. " The next series of cases illustrate two divergent approaches to analyzing whether an activity is reachable under the commerce power. Two girls working in Loudon Hosiery Mills (Tennessee) in 1910. N.L.R. U. President Lyndon Johnson signing the 1964 Civil Rights Act Ollie In U. Discourse and Public Policy. Key Concepts Problem solving process Governmental framework Plural politics This course is informed by the idea of public policy making as a democratic process of solving problems. This reading views that process from the perspective of communication and offers two illustrative cases.

Other ways to view public policy making are found in sources listed at the end of this reading. Public policy exists to solve problems affecting people in society (1). Case 1 On October 24, 2007 Pennsylvania announced a new standard of food safety aimed to prevent “mislabeling” of food products, especially “misleading” labels. Politics influenced the decision. The agency’s decision was immediately controversial in Pennsylvania and elsewhere. In mid-November, Pennsylvania’s governor postponed the ban, then cancelled it.

This snapshot captures the basics. What This Case Shows Common features of policy making are illustrated here. Solutions are selective. Case 2 Case 2 deals with a state's budgeting process. POLSC431: Public Policy Process. The study of public policy is intended to offer every citizen an understanding of the various and vast roles played by the different branches of the U.S. federal government as well as by state, county, and local governments in various areas of contemporary American life. It is also a field that focuses on the priorities of American society as portrayed in the public policy choices that elected representatives make on the part of citizens and the size of different interest groups that advocate on behalf of particular policy goals.

This course looks at the process of making public policy from beginning to end and in a wide array of particular policy areas that are of importance to contemporary American society. Moreover, because the process of public policymaking is best explored by examining particular instances of public debate over a wide array of specific policy areas, this course will adopt a case study approach to explore particular topics. Course Designer: Levi Fox. Patient Safety Advocates for Health Care Issues: Empowered Patient Coalition. Urban Studies and Planning | 11.002J Fundamentals of Public Policy, Fall 2004 | Lecture Notes.

An Introduction to the Policy Process: Theories, Concepts, and Models of ... - Thomas A. Birkland. PPA 503 – The Public Policy-Making Process.