Professional Point: Medicare win a must in health reform era

The Evolving Surgeon Shortage in the Health Reform Era

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-011-1430-0 ◽

2011 ◽

Vol 15 (7) ◽

pp. 1104-1111 ◽

Cited By ~ 16

Author(s):

George F. Sheldon

Keyword(s):

Health Reform ◽

Reform Era ◽

Surgeon Shortage

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A provider-payor approach for determining value in the health reform era: Early reports on the mQure initiative.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.255 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 255-255 ◽

Cited By ~ 1

Author(s):

Douglas D. Letson ◽

Karen K. Fields ◽

Diane K. Hammon ◽

Rachel V. Lee ◽

John W. Peabody ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Cancer Care ◽

Health Reform ◽

Clinical Performance ◽

Diagnostic Tools ◽

Measurement Tool ◽

Evidence Based ◽

Care Organization ◽

Reform Era ◽

Detailed Measurement

255 Background: Determining value requires detailed measurement of clinical services and associated costs. In the health reform era value demonstration presents a challenge for both providers and payors: providers, unable to demonstrate value, will be unable to attract payors or patients and expand market share; payors, unable to choose the right providers, will lose opportunities to lower costs and raise quality. Methods: In July 2012, the Moffitt Cancer Center (MCC) launched the mQure (MCC – Quality Understanding Research and Evidence) Initiative to (1) measure and improve clinical performance, (2) increase compliance to evidence-based/cost conscious cancer-care pathways, and (3) demonstrate value. We introduced Clinical Performance and Value (CPV) vignettes, a value measurement tool, to measure pathway adherence, determine diagnostic accuracy and appropriate use of diagnostic tools starting with breast and lung cancer. For selected performance items identified by the CPVs, we audited medical records directly. Results: Measurement revealed high value practices, for example, diagnostic accuracy, appropriate rates of biopsy and more accurate staging compared to other groups. Value determination led to one signed plus two pending payor partnerships to implement a shared savings contract, find ways to reduce utilization and explore creating payor-led networks. The focus on individual responsibility for adherence to evidence-based practices has had an unanticipated and seemingly paradoxical benefit of shifting the group to narrow practice variation thereby shifting providers to a more self-aware culture. An external benefit is that the value signal has led to discussions to form accountable care organization (ACO) networks for cancer care. Since mQure’s inception, MCC has created partnerships with 3 hospitals. Based on the breast cancer initiative alone, financial models indicate an estimated savings of up to $2 million annually that arise from higher quality, fewer unnecessary tests and improved pathway compliance. Conclusions: In just one year, the large scale mQure project has led to expanded provider partnerships, new quality-based arrangements with payors and the formation a specialty-ACO.

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Winning Policy Change to Promote Community Health Workers: Lessons From Massachusetts in The Health Reform Era

American Journal of Public Health ◽

10.2105/ajph.2011.300402 ◽

2011 ◽

Vol 101 (12) ◽

pp. 2211-2216 ◽

Cited By ~ 22

Author(s):

Terry Mason ◽

Geoffrey W. Wilkinson ◽

Angela Nannini ◽

Cindy Marti Martin ◽

Durrell J. Fox ◽

...

Keyword(s):

Community Health ◽

Community Health Workers ◽

Policy Change ◽

Health Reform ◽

Health Workers ◽

Reform Era

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Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?

American Journal of Public Health ◽

10.2105/ajph.2011.300335 ◽

2011 ◽

Vol 101 (12) ◽

pp. e1-e5 ◽

Cited By ~ 45

Author(s):

Jacqueline Martinez ◽

Marguerite Ro ◽

Normandy William Villa ◽

Wayne Powell ◽

James R. Knickman

Keyword(s):

Community Health ◽

Community Health Workers ◽

Health Reform ◽

Health Workers ◽

Reform Era ◽

Delivery Of Care

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Collaboration Across the Safety Net in the Era of Health Reform: Opportunities or Obstacles?

Medical Care Research and Review ◽

10.1177/1077558716638989 ◽

2016 ◽

Vol 74 (3) ◽

pp. 286-310 ◽

Cited By ~ 1

Author(s):

Katherine H. Mead ◽

Erin Brantley ◽

Julia Zur ◽

Debora Goetz Goldberg

Keyword(s):

Affordable Care Act ◽

Health Reform ◽

Safety Net ◽

Community Action ◽

System Transformation ◽

Reform Era ◽

Patient Protection ◽

Common Goals ◽

Safety Net Providers ◽

Insurance Exchanges

While implementation of the Patient Protection and Affordable Care Act brings significant opportunities for safety net providers (SNP), local systems vary in how well they adapt to the rapidly evolving environment. Collaboration may enhance SNP capacity to leverage opportunities in the health reform era. Our study examines key opportunities and challenges SNPs face under health reform and how providers use collaboration as a strategy to adapt to the new environment. A qualitative study of 78 executives at safety net organizations identified six priorities that pose both opportunities and challenges for SNP, and around which collaboration is used as a strategy to achieve common goals: Medicaid expansion, outreach and enrollment, capacity and access, health system transformation, health insurance exchanges, and reductions in government funding. Three types of collaborations emerged: policy and advocacy, community action, and practice-based. Types of collaborations and stakeholders involved appeared to vary by priority.

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