Anthem’s program provides doctors with additional payments if they lower the cost of patients’ care. By Christine Kern, contributing writer
Wake Forest School of Medicine is comprised of a Level 1 trauma center which receives more than 100,000 emergency visits a year and an academic program with 40 residents and 25 faculty members. Wake Forest was using antiquated processes to make medical protocols and administrative information available to physicians which resulted in the loss of critical information. Additionally, these systems were not integrated with the physician’s mobile devices, resulting in vital exam time being lost as doctors were forced to leave the exam room to find a room with computer access to search for relevant information. Resident physician Illtifat Husain, who had used Box cloud-based storage as a medical student, suggested the cloud-based storage provider to James O’Neill, M.D., assistant professor, Wake Forest Baptist department of emergency medicine, as a possible solution. After testing by a select group of residents and faculty, Wake Forest chose Box for all its cloud-based storage needs. This Q&A with O’Neill and Box health advisor Missy Krasner looks into the reasons why Box was selected and the results Wake Forest experienced. Compiled by John Oncea, editor, Health IT Outcomes
Health data breaches have become epidemic - experts offered up their advice on how to best avoid them By Katie Wike, contributing writer
Survey shows healthcare claims executives may be underestimating ICD-10, Affordable Care Act By Katie Wike, contributing writer
As new value-based payment models emerge in the healthcare industry, hospitals that demonstrate high-quality, efficient patient care will have a distinct advantage over those organizations that remain mired in unwarranted variation in care processes, unnecessary and duplicative tests, and an inability to coordinate care.
How to Create, Implement, and Operate a Successful Program.
Many industry leaders championed a free market approach to healthcare during the 12th Annual World Health Care Congress last week. Here are a few key reasons why I don’t think this model is “the fix” our industry so desperately needs.
An Accountable Care Organization (ACO) utilizes a payment and care delivery system that bases payments to providers on quality metrics and seeks to reduce the total cost of care for a certain population of patients. ACOs use a range of payment models and consist of groups of coordinated healthcare providers that provide care to groups of patients. ACOs are accountable to a third-party payer and the group of patients for the appropriateness, quality, and efficiency of the health services they provide.
In 2011, the Department of Health and Human Services (DHHS) set forth initial guidelines for ACOs to be created under the Medicare Shared Savings Program. These guidelines contained all necessary steps required for a physician, health care provider, or hospital to voluntarily participate in ACOs.
The quality measures used to evaluate an ACO's performance as defined by the Center for Medicare and Medicaid Services (CMS) fall into five domains. These domains are patient/caregiver experience, care coordination, patient safety, preventative health, and at-risk population/frail elderly health.
The three stakeholders in an ACO are the providers, payers, and patients. Providers are a network of hospitals, physicians, and other healthcare professionals. The primary payer is the federal government, Medicare, but also includes other payers such as private insurances or employee-purchased insurance. The patient population of an ACO will primarily consist of Medicare beneficiaries, but in larger ACOs can also include those who are homeless and uninsured.
According to a new report, a lack of out-of-network interoperability is the biggest obstacle facing ACOs today. By Katie Wike, contributing writer