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Objective. To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs. Data Sources. Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016. Study Design. The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed. Data Collection/Extraction Methods. Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization. Principal Findings. Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability. Conclusion. Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness. Key Words. Population health management, program evaluation, attrition, intention-to-treat, cost savings, U.S. federal health care reform is centered on providing high-quality, affordable health care while reducing spending (Key features of the Affordable Care Act, 2014). Developing innovative ways to address the [...]

Objective. To assess whether provider organizations exhibit distinct profiles of low-value service provision. Data Sources. 2007-2011 Medicare fee-for-service claims and enrollment data. Study Design. Use of 31 services that provide minimal clinical benefit was measured for 4,039,733 beneficiaries served by 3,137 provider organizations. Variation across organizations, persistence within organizations over time, and correlations in use of different types of low-value services within organizations were estimated via multilevel modeling, with adjustment for beneficiary sociodemographic and clinical characteristics. Principal Findings. Organizations provided 45.6 low-value services per 100 beneficiaries on average, with considerable variation across organizations (90th/ 10th percentile ratio, 1.78; 95 percent CI, 1.72-1.84), including substantial between-organization variation within hospital referral regions (90th/10th percentile ratio, 1.66; 95 percent CI, 1.60-1.71). Low-value service use within organizations was highly correlated over time (r, 0.98; 95 percent CI, 0.97-0.99) and positively correlated between 13 of 15 pairs of service categories (average r, 0.26; 95 percent CI, 0.24-0.28), with the greatest correlation between low-value imaging and low-value cardiovascular testing and procedures (r, 0.54). Conclusions. Use of low-value services in provider organizations exhibited substantial variation, high persistence, and modest consistency across service types. These findings are consistent with organizations shaping the practice patterns of affiliated physicians. Key Words. Low value, efficiency, quality measurement, Medicare, At the leading edge of payment reform are new payment models that rely on financial incentives at the level of provider organizations to improve health care value. For example, both [...]

About one-third of hospitals and health systems responding to a recent industry survey said they participate in voluntary value-based payment models that offer bonus payments to organizations that meet cost [...]

APMs are a critical element of the Affordable Care Act (ACA), often not recognized as the lynchpin for the law's ability to achieve its primary objective: to reduce the cost [...]

Although many hospitals and health systems view outpatient physical therapy as ancillary and not worthy of a substantial allocation of resources, making it a priority makes good business sense considering [...]

On Taesday, June 20, the Centers for Medicare & Medicaid Services (CMS) released a Proposed Rule (1) to continue the rollout of the Quality Payment Program (QPP), an initiative to [...]

As we enter 2017, the market environment for healthcare organizations, including both providers and managed care payers, continues to evolve rapidly across regional, state, and federal levels. (a) Since the [...]

Providers want to maintain state-level liability wins, and McConnell seems sympathetic. 'Now I say to our members of the state Legislature, we're not trying to rewrite state tort laws here, [...]

Byline: Maria Castellucci Stakeholders from across the industry have been working together over the last 10 months on a national strategy to improve quality of care over the next decade. [...]

The U.S. Department of Health and Human Services (HHS) anticipates that, by 2018, half of all traditional or fee-for-service Medicare payments will be tied to new, value-based payment models. The [...]

A new report suggested Medicare could save $1.57 for every $1 spent delivering free meals to frail seniors after a hospitalization; the study comes as lawmakers look to restrain costs [...]

Byline: Harris Meyer With just a few weeks to go before its June 6 launch, lawmakers, providers, and advocates are wary about the Veterans Affairs Department's ability to roll out [...]

The consolidation of hospitals and physician practices is a natural result of the renewed focus on the quality of care under the Patient Protection and Affordable Care Act (ACA) (PL. [...]

Physicians participating in many existing alternative payment models (APMs)--including most Medicare accountable care organizations (ACOs)--will not qualify to receive future Medicare pay increases under a proposed rule issued by the [...]

To ensure compliance, hospitals must develop chargemaster structures that reflect industry standards and establish defensible pricing strategies. Although the goal of the Centers for Medicare & Medicaid Services (CMS) Jan. [...]

Modern Healthcare asked healthcare trade groups which requirements they'd like to see killed when the Trump team starts culling federal regulations. Here's a sampling of what they said: American Hospital [...]

Byline: Steven Ross Johnson With less than four months before a new administration moves into the Oval Office, experts and stakeholders are taking stock of President Barack Obama's landmark healthcare [...]

The healthcare industry in our country is poised to reach greater heights, both in growth in volumes and in the quality of care. Nurses play a vital and major role [...]

In a system long driven by volume, the ACA introduced value-based payment programs that seek instead to reward providers based on the quality of the care they deliver. In other [...]