March 2016

Coronary artery bypass grafting and cardiac valve surgery have dramatically different risk-adjusted outcomes over the 90 days following discharge, and demonstrate the opportunity for care improvement.

Analysis of 77,462 family practice providers showed large regional differences in types of procedures performed, and significant differences in submitted charges and payments, across regions.

Findings from a systematic review show that employer-led efforts to date have produced few promising strategies for improving the value of health spending.

Anthony D. Slonim, MD, DrPH, president and chief executive officer for Renown Health and chair of The American Journal of Managed Care (AJMC)’s ACO and Emerging Healthcare Delivery Coalition, spoke to AJMC about what it means to be a physician leader, the industry’s move to population health, the ACO Coalition, and more.

PQRS and GPRO encompass patient experience, chronic condition management, and population health arenas so that physician reimbursement can be tied to performance. The authors describe how to accurately improve your quality metrics.

Although health plan accountable care models have evolved provider readiness, data, analytics, and the use of performance measurement are important components of plan-provider partnerships.

The author discusses the new paradigm for case management services, including inpatient and outpatient responsibilities, in order to succeed in the era of the Affordable Care Act.

Proactive identification of cognitive impairment and compensatory destigmatized patient/familial psychoeducation regarding “forgetfulness” in hospitalized patients with congestive heart failure may reduce readmission rates substantially.