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Author: Jacob Glazer Publisher: World Scientific Publishing Company ISBN: 9813202882 Category : Business & Economics Languages : en Pages : 208
Book Description
The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.
Author: Jacob Glazer Publisher: World Scientific Publishing Company ISBN: 9813202882 Category : Business & Economics Languages : en Pages : 208
Book Description
The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications.
Author: Jacob Glazer Publisher: World Scientific Publishing Company ISBN: 9789813202870 Category : Business & Economics Languages : en Pages : 208
Book Description
"The book pulls together a series of articles by the authors that initiated the research areas of "optimal risk adjustment" and "optimal quality reporting." The papers present the basic theoretical models and link them to empirical application. Design of health insurance premiums to achieve efficient and fair outcomes is also covered. The chapters in the book also cover the intellectual development of approaches to health insurance regulation, beginning with more abstract models to those with explicit empirical and policy applications."--Publisher's website.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309072808 Category : Medical Languages : en Pages : 360
Book Description
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Author: Publisher: ISBN: 9780309449205 Category : Medicare Languages : en Pages : 0
Book Description
"Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting For Social Risk Factors in Medicare Payment: Data is the fourth in a series of five brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report provides guidance on data sources for and strategies to collect data on indicators of social risk factors that could be accounted for Medicare quality measurement and payment programs"--Publisher's website.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309102162 Category : Medical Languages : en Pages : 273
Book Description
The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America's health care investments. This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation's health care system in both the public and private sectors.
Author: Soeren Mattke Publisher: Rand Corporation ISBN: 0833082418 Category : Medical Languages : en Pages : 106
Book Description
The Affordable Care Act places strong emphasis on quality of care as a means to improve outcomes for Americans and promote the financial sustainability of our health care system. 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 that can be used to evaluate plan options.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309477891 Category : Medical Languages : en Pages : 399
Book Description
In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 030946921X Category : Medical Languages : en Pages : 161
Book Description
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Author: U. S. Department Human Services Publisher: Createspace Independent Pub ISBN: 9781483925677 Category : Medical Languages : en Pages : 156
Book Description
This review is part of the Closing the Quality Gap: Revisiting the State of the Science series, which aims to provide critical analysis of the existing literature on quality improvement strategies for a selection of diseases and practices. The review focuses on “bundled payment,” a strategy for health care quality improvement and cost containment. This strategy has been the subject of increasing interest, with the Centers for Medicare & Medicaid Services announcing a large national bundled payment initiative in August 2011. Other reviews in the series will address a range of quality improvement topics arising from portfolios (areas of research) of the Agency for Healthcare Research and Quality (AHRQ). We define “bundled payment” as a method in which payments to health care providers are related to the predetermined expected costs of a grouping, or “bundle,” of related health care services. In contrast, fee-for-service payment typically involves payments for individual services, while capitation involves a single per capita prospective payment for all services over a fixed period of time, regardless of the number of services or episodes of care provided within that period. Within the bundled payment model, a variety of specific payment methods are possible. Bundles may be defined in different ways, covering varying periods of time and including single or multiple health care providers of different types. In addition, given the diversity and complexity of the U.S. health care delivery system, bundled payment programs may be implemented in a variety of contexts that may influence their effects on spending and quality. Bundled payment should create a financial incentive for providers to reduce the number and cost of services contained in the bundle. Providers are typically given discretion over the allocation of the services used to treat the patient's episode most effectively. This flexibility may encourage providers to use resources to coordinate care; often, these services are not reimbursed under fee-for-service payment. If the bundle includes services delivered by multiple providers in multiple settings, providers have to create a mechanism for managing the shared payment for a given treatment or condition, which could also foster coordination. Several types of undesired effects of bundled payment have also been postulated. The most significant potential undesired effects include underuse of effective services within the bundle, avoidance of high-risk patients, and an increase in the number of bundles reimbursed (increasing health spending). Providers under bundled payment may “game” the system by changing coding practices to maximize reimbursement for the bundle (“upcoding”) or by moving services in time or location to qualify for separate reimbursement (“unbundling”). This review was designed to address the uncertainties about the effects of bundled payment on spending and quality measures. It should help readers (1) understand what the evidence shows about the effects of bundled payment on health care spending and quality of care, and (2) understand key design and contextual features of bundled payment programs and their association with bundled payment effects. The review addressed three Key Questions: 1. What does the evidence show on the effects of bundled payment versus usual (predominantly fee-for-service) payment on health care spending and quality measures? 2. Does the evidence show differences in the effects of bundled payment systems by key design features? 3. Does the evidence show differences in the effects of bundled payment systems by key contextual factors?
Author: Jacob Glazer
Author: Jacob Glazer
Author: Jacob Glazer
Author: Institute of Medicine
Author: 
Author: Institute of Medicine
Author: Soeren Mattke
Author: National Academies of Sciences, Engineering, and Medicine
Author: National Academies of Sciences, Engineering, and Medicine
Author: United States. Social and Rehabilitation Service
Author: U. S. Department Human Services