Certain patients present a health care conundrum. “Super-utilizers” account for only five percent of patients, but they accrue more than 60 percent of health care costs. These patients make frequent trips to hospital emergency rooms or have repeated inpatient hospital stays, resulting in costly health care, but not necessarily good-quality care. For example, one Pennsylvania woman had more than 50 CAT scans within a short span of time at various area hospitals. Super-utilizers often have multiple chronic medical conditions and social complexities that make their care difficult...
AF4Q Alliances, are leading multiple initiatives to improve the quality of care while lowering costs in their communities. As part of this effort, some Alliances have launched programs to educate consumers about unnecessary variations in the cost and quality of care. The American Institutes for...
It's not easy getting an idea, let alone a project, off the ground. It's even harder keeping it afloat. The Aligning Forces for Quality New Mexico Alliance, and its partnership with New Mexico's state Medicaid office as well as other state leaders, provides an interesting example of how the public and private sector worked together to test an innovative payment reform model that may serve as an example to other states seeking to boost administrative efficiency.
Launching a new model of health care payment while adapting to a changing health care landscape takes time and...
The intensity of health care services received has much to do with rising health care costs. Many health conditions have many treatment options, some being more costly than others. One example is back pain. There are multiple treatment options, including surgery, physical therapy, anti-inflammatory medication, and MRI or CT scans. There is no simple rule for which is the best option in a given situation for a patient.
…the best decisions require shared decision-making.
Risks and benefits vary for each treatment option—...
High-deductible, consumer-directed health plans currently cover one out of three of all employees in the Cincinnati area. These plans, with their low premiums and minimal charges for preventive care, make staying well more cost effective than ever. On the other hand, getting sick, experiencing an injury, or having a chronic condition can result in significant out-of-pocket expenses. Employees with these plans are finding the choices they make about their health and health care can impact their monthly budget in a big way.
If you’re in the market for a new car, it’s easy to find out if, say, a Toyota costs more than a comparable Chrysler. In fact, a small amount of research can help a consumer compare prices on just about any good or service in America.
The exception: health care. If you need a hip replacement, diabetes treatment, or heart surgery, and you want to know how much you will have to pay, you’re likely out of luck. Health care costs in America are such a mystery that often even doctors and most people who work in hospitals or clinics don’t know what they’re...
For more than 20 years, the Dartmouth Atlas Project (www.dartmouthatlas.org) has focused on regional variations in the quality of health care services delivered across the United States. This research has emphasized that too often supply drives demand. Patients receive surgeries, tests, and procedures they may not need and that sometimes cause harm, which drives costs up and quality down. While the results are eye opening, few who provide and pay for health care appear to have acted on this information for younger,...
Margie Namie, RN, MPH, CPHQ, divisional vice president of quality at Mercy Health in southwest Ohio, was honored to be named one of 73 Innovation Advisors (IAs) in the first cohort of the Centers for Medicare & Medicaid Services Innovation Center (CCMI). Her participation in the program brought an added bonus: reductions in readmissions and costs.
Read the rest of this AF4Q Bright Spot here.
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