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The ability to assess the value of various health-care activities, processes, and outcomes is critical for decision making and essential to maintain the fidelity of value-based payment mechanisms. However, value is subjective and differs by perspective, context, and situation. Furthermore, the complex nature of health-care delivery and payment complicates efforts to determine the value of individual components or interventions. While a variety of methods exist to quantify and compare value, none have been able to fully capture value for all stakeholders. As an alternative, a general framework that guides how one should define, measure, and interpret value would provide some needed consistency for those looking to assess value while allowing for enough flexibility to address different perspectives, situations, and evaluation goals. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the need for reforms to address the major economic losses linked to the insufficient control of high blood pressure or hypertension in the U.S. Also cited are the data from the National Health and Nutrition Examination Survey (NHANES) on the number of American adults with hypertension, and the various forms of productivity loss like short-term absences from work, impairments to activities of daily living, and premature mortality.

Objectives: To describe the essential components of an Agile Implementation (AI) process, which rapidly and effectively implements evidence‐based healthcare solutions, and present a case study demonstrating its utility. Design: Case demonstration study. Setting: Integrated, safety net healthcare delivery system in Indianapolis. Participants: Interdisciplinary team of clinicians and administrators. Measurements: Reduction in dementia symptoms and caregiver burden; inpatient and outpatient care expenditures. Results: Implementation scientists were able to implement a collaborative care model for dementia care and sustain it for more than 9 years. The model was implemented and sustained by using the elements of the AI process: proactive surveillance and confirmation of clinical opportunities, selection of the right evidence‐based healthcare solution, localization (i.e., tailoring to the local environment) of the selected solution, development of an evaluation plan and performance feedback loop, development of a minimally standardized operation manual, and updating such manual annually. Conclusion: The AI process provides an effective model to implement and sustain evidence‐based healthcare solutions. [ABSTRACT FROM AUTHOR]

The Fistula First Breakthrough Initiative (FFBI) has improved the awareness of the value of fistula creation in patients with end-stage renal disease (ESRD). The FFBI Health Policy Workgroup has been charged with reviewing the relationship of policy and economic issues to this project. This article reviews the efforts and successes of renal community clinical activities and reemphasizes the economic impact of fistula creation and catheter reduction on the health care system. Major obstacles are discussed, and existing tools and efforts designed to address them are outlined. The FFBI Health Policy Workgroup then identifies less frequently recognized barriers to the achievement of the FFBI goals and suggests solutions to them. It concludes that nephrologists need to assume the leadership role and drive fistula creation and central venous catheter reduction to achieve programmatic success. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the total cost to Medicare associated with the presence of anemia in congestive heart failure (CHF) patients. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify anemia, CHF, and comorbid conditions in 2002, and total Medicare costs were calculated for 2003. The mean patient age was 77.8 years. Anemia, present in 32% of CHF patients, was associated with older age, female sex, nonwhite race, and increasing burden of comorbidity. The total per-member-per-month cast in 2003 was $1781.01 among CHF patients with anemia in the preceding year compared with $1142.38 for CHF patients without anemia, a ratio of 1.56 (95% confidence interval, 1.5589-1.5592). When adjustment was made for baseline demographic factors and comorbid conditions, the corresponding ratio was 1.25 (95% confidence interval, 1.2546-1.2548). Anemia, a common association of CHF in elderly patients, is an antecedent association of increased societal medical expenditure. [ABSTRACT FROM AUTHOR]