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Contributor: Congress Must Act to Stop America’s Amputation EpidemicThe Amputation Reduction and Compassion Act (H.R. 2631) would ensure that Medicare and Medicaid both cover peripheral artery disease screening for at-risk beneficiaries without the cost-sharing requirements that could make some patients balk at seeking care.
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Maximizing Your Potential for Reimbursement Under the Quality Payment ProgramIt’s midway through the year and practices most likely have selected their quality measures and are collecting data to meet the reporting requirements under CMS’ Quality Payment Program under the 2018 Final Rule. But how do you know your practice is working to maximize your performance? It is all about communication and planning.
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Improving Patient Outcomes Through DataFor caregivers to use data properly, they must understand that much of the actionable data lives outside the healthcare system.
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Number of Manufacturers and Generic Drug Pricing From 2005 to 2017Regardless of the number of manufacturers, generic drug prices presented double-digit average increases from 2012 to 2015.
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How Patients Distinguish Between Clinical and Administrative Predictive Models in Health CarePatients are less comfortable with predictive models used for health care administration compared with those used in clinical practice, signaling misalignment between patient comfort, policy, and practice.
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Cross-Sector Data in ActionA look at the experiences of 2 leaders in cross-sector collaboration show how cross-sector data can guide the development of innovative initiatives to improve people’s lives.
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CMS Announces Transformative Updates to the MA VBID ModelUpdates to CMS' Medicare Advantage (MA) Value-Based Insurance Design (VBID) model broaden the scope of the existing model by testing a wide range of MA service delivery and/or payment approaches.
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Too Much, Too Fast: Providers Need More Time to Operationalize Medicare's New Radiation Oncology ModelCMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.
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Measuring Value for Low-Acuity Care Across SettingsTo analyze value of low-acuity care, an existing model is adapted to highlight factors impacting how stakeholders assess emergency department care compared with alternatives.
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The Essential Facts of Life Are the Foundation of HealthOn a humanitarian mission to Puerto Rico, Adam Sharp, MD, learned that to improve health, the essentials of food, housing, and water must be available and should be prioritized over medications, surgeries, and therapies.
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Contributor: Institutional Engagement With Physicians Is Key to Managing Cost and QualityAlthough physicians’ clinical decisions serve as the biggest drivers behind the cost of care, hospitals have long been reluctant to take financial accountability. If such accountability is to be transformed from a diffuse fear to a manageable managerial task, institutional engagement with physicians will be a critical next step.
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Contributor: Solving the US Physician Diversity ProblemThe representation of Black physicians is alarmingly low, but the opportunities for change are possible and urgent. Health care leaders and human resource departments need to address these disparities, and increasing diversity among their workforce is an excellent place to begin.
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Telepsychiatry Trends to Expect in 2019As healthcare closes the book on 2018, here are trends and changes the industry can expect to see on the telepsychiatry front in 2019.
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CAQH CORE Certification Impact: Simplifying PayerThe Council for Affordable Quality Health Committee on Operating Rules for Information Exchange is making great strides in certifying health plans for implementing electronic information exchange between payers and providers. The good news for providers is that very little is required of them to reap the benefits of these certification efforts.
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Impossible Math: Financing a Freestanding Birth Center and Supporting Health EquityBirths in freestanding birth centers are increasing, and the number of birth centers is increasing, as well, but capacity is not keeping up with demand. Freestanding birth centers provide many of the same services that are provided for low-risk pregnancies in hospitals, and there is evidence of equivalent or better outcomes of care both here in the United States and in abroad. Yet, freestanding birth centers are paid less than hospitals for doing the same work.
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MACRA Continues to Catalyze Movement Towards ValueGiven that 2018 marks the last year of the transition-year policies, implementation challenges identified during the first 2 years of Medicare Access and CHIP Reauthorization Act (MACRA) preparation and execution must be addressed to ensure effective delivery of high-value care as intended.
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Lessons From a 25-Year Study of Type 1 DiabetesFrom funding innovative research to advocating for government action to providing a support structure for our community, no other organization does more to fight type 1 diabetes (T1D) than JDRF.
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Grassroots Public Health Management in Managed CareCommunity coalitions are a backbone of public health, and offer a unique perspective towards implementation of managed care disease management/case management programs.
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Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of HealthAlthough it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations.
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Increasing the Longevity of Accountability, Designing Cooperative Models, and Transferring Risk Across a Lifetime of Accountable CareTo achieve longer accountable relationships, a bridge from one insurer to another could be built through continuity of accountability amid insurance transitions, improved risk prediction, and cooperation in the design of accountable care models.
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New MIPS Improvement Activity Supports Remote Patient MonitoringDespite growth in the market, CMS has been slow to recognize the value that telehealth can bring to clinical encounters by encouraging utilization of telehealth technology through reimbursement models. However, now CMS has taken steps to encourage practices to leverage telehealth and remote monitoring activities through changes to the Quality Payment Program.
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Contributor: How Payers Can Be Effective in New Value-Based Models for CKDThe author discusses how value-based payment models in chronic kidney disease can improve total cost and quality of care for patienst with chronic kidney disease (CKD).
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Modernizing the Stark Law Will Improve Care for Medicare Patients and Lower CostsCurbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.
