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6 Finance
Pages 67-76

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From page 67...
... The following definition of finance that supports quality improvement -- whose origins trace to the Quality Chasm report -- was accepted by participants in this session and served as the framework for the discussions that followed: Payment incentives should be aligned with quality improvement. Fair payment should be provided for good clinical management of patients, so that providers neither gain nor lose financially for taking care of the sickest patients and most complex cases.
From page 68...
... The example, in a study using Medicare data, even participants also underscored that any changes after controlling for confounding variables, a to the finance system should be budget 400 percent variation was found nationwide, by neutral -- meaning that the issue is not the hospital service area, in the likelihood that a absence of sufficient resources. To the person with heart failure would be admitted to contrary, many participants noted that, if the hospital (Fisher et al., 2000)
From page 69...
... They also statement during the commitment portion of the identified the following impediments to summit: "I was struck by Don Berwick's redesigning existing payment models to remarks yesterday, that Appleton Wisconsin's reimburse only effective care: has the lowest decile per beneficiary costs for Medicare and that the major health plan serving · The CPT® (current procedure terminology) that area had the highest HEDIS® scores in the code encounter model rewards clinicians on country in 2002 [American Hospital Publishing, the basis of volume (AMA, 2004)
From page 70...
... basis for what is known to be effective processes of care; an example is a compound Kim Horn, president and chief executive officer metric encompassing the core aspects of of Priority Health and a team member of the diabetes care -- HbA1c monitoring, blood Grand Rapids Medical Education and Research pressure monitoring, biennial lipid testing, and Center community, provided an example of a annual eye and foot screening. Such an pay-for-performance initiative during the approach, currently under way at finance session.
From page 71...
... depression working group proposed a The group adopted the philosophy of "no wrong "transformational aim" of redesigning the door," which means that those who suffer from finance system to pay for equitable, effective, depression should have high-quality access, Box 6-2. Depression Working Group's Pay-for-Performance Strategies · Reimbursing new modalities for delivering care, such as telephone- and web-based clinical systems · Covering depression screening for all members upon enrollment, as well as periodic follow-up · Assigning one agent who is responsible for intervening if care is not coordinated effectively across multiple providers · Integrating employee assistance programs with mental health benefit administration · Incorporating depression screening, longitudinal monitoring, and treatment into the management of chronic conditions 71
From page 72...
... For generate a resource pool from savings that example noncoverage of high-dose would accrue over time, which would be chemotherapy plus autologous bone marrow reinvested in diabetes care -- used, for example, transplants for breast cancer today is to build on information and communications appropriately based on the evidence, as five technology infrastructure. The heart failure and major randomized clinical trials have pain control working groups also supported documented no improvement in survival rates as channeling savings from pay-for-performance compared with the less-costly standard-dose initiatives back to improvements in information chemotherapy regimen (Mello and Brennan, and communications technology to ensure that 2001)
From page 73...
... Provide Payment for Proven Quality Support Services Francois de Brantes, program leader for Health Services such as care coordination and patient Care Initiatives at General Electric -- a national self-management support enhance the delivery champion participant at the summit -- offered of quality care but are often not covered benefits the following perspective with regard to outside of integrated delivery systems. purchasers' roles in benefit design: Additionally, those services when performed by hospital nurses are embedded in housekeeping We ought to as purchasers, both large costs.
From page 74...
... In addition to assessing medication use, adherence, side effects, interactions, and achievement of therapeutic goals, pharmacists check blood pressure, perform foot exams, and help patients set goals during these visits. Additionally, as an incentive to patients to participate, copayments were waived for disease-related medications and all diabetic supplies, including syringes, and test strips were provided free of charge as long as participants remained compliant with the contract they agreed to at the start of the program.
From page 75...
... In: Wennberg Coordinating Government Roles in Improving JE, Cooper MM, eds. The Dartmouth Atlas of Health Care Quality.
From page 76...
... :1102­1108. over high-dose chemotherapy with autologous Wennberg JE, Fisher ES, Stukel TA, Skinner JS, bone marrow transplant for breast cancer.


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