Search

Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare’s approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

This article discusses the importance of embedded researchers in healthcare systems and their collaboration with practitioners and operational leaders to improve quality and affordability. The healthcare industry is still developing its methods for data exploration, as it faces challenges such as varying data sources, unstructured data, uncertain measurement precision, data quality uncertainties, and strict regulations and policies on data access. The AcademyHealth Learning Health System (LHS) Interest Group released a call for papers to address challenges related to the use of real-world data in embedded research. The article highlights three themes that emerged from the papers submitted, including the application and integration of novel data sources, team dynamics and relationship to data and/or embedded research, and the dynamism of healthcare delivery and its impact on data and/or research. The article emphasizes the need for the right data at the right time to produce evidence for policy, practice, and research, and the development of processes, standards, and methods to use evidence from embedded health services research for transformative improvements in healthcare and health. [Extracted from the article]

The article discusses the benefits of bundled payments and best models of health care reform to provide more flexibility and freedom as well as the onus of responsibility on physicians. The need is to adopt a health care reform system that will deliver the information needed by clinicians and allow physicians the freedom to provide high-quality care at sustainable costs.

A hybrid approach combining universal risk pools, mandated coverage with income-based subsidies, and a restructured payment mechanism is found to have a great potential for improving both the equity and efficiency of health care coverage in the U.S. A collective risk pool will reallocate funds, market-disciplined carriers will facilitate payment and appropriate incentives will help in ensuring that health care expenditures are driven by informed patient and clinician decisions about the care required to achieve high-quality outcomes.

Objectives. We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity. Methods. We analyzed state cancer registry data linked to socioeconomic characteristics of patients' areas of residence for 1990-1998 time trends in the likelihood of early stage diagnosis. We appended each cancer registry record with matching subgroup estimates of self-reported mammography screening. Results. Trends in screening and stage at diagnosis were consistent within groups, but African American women had a significantly lower proportion of early stage cancers despite an advantage in screening. Population screening rates were significantly associated with early diagnosis, with a weaker association in African American women than White women (odds ratio [OR] = 1.70; P Conclusions. Improvements in screening rates during the 1990s across racial/ ethnic groups appear to have contributed significantly to earlier diagnosis within each group, but a smaller effect in African American women should raise concerns. A key health policy challenge is to ensure that screening effectively translates into earlier diagnosis.