Managing specialty care in an era of heightened accountability: Emphasizing quality and accelerating savings

American Journal of Managed Care

Volumn 21, Issue 4, 2015, Pages 284-292

  Peabody, John W ^a,b   Huang, Xiaoyan ^c   Shimkhada, Riti ^a   Rosenthal, Meredith ^d  

^a QURE Healthcare   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

^c Providence Heart Institute   (United States)

^d HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCOUNTABLE CARE ORGANIZATION; ARTICLE; ATRIAL FIBRILLATION; BUDGET; CARDIOLOGY; CARDIOVASCULAR DISEASE; CLINICAL PRACTICE; COST CONTROL; EVIDENCE BASED PRACTICE; HEALTH CARE COST; HEALTH CARE QUALITY; HEART FAILURE; HUMAN; ISCHEMIC HEART DISEASE; MANAGED CARE; PRACTICE GUIDELINE; PREVALENCE; PRIORITY JOURNAL; REIMBURSEMENT; VIGNETTE; COST BENEFIT ANALYSIS; ECONOMICS; HEART DISEASES; INSURANCE; ORGANIZATION AND MANAGEMENT; PROCEDURES; UNNECESSARY PROCEDURE;

ACCOUNTABLE CARE ORGANIZATIONS; ATRIAL FIBRILLATION; CARDIOLOGY; COST SAVINGS; COST-BENEFIT ANALYSIS; HEALTH CARE COSTS; HEART DISEASES; HEART FAILURE; HUMANS; INSURANCE CLAIM REVIEW; PRACTICE GUIDELINES AS TOPIC; UNNECESSARY PROCEDURES;

EID: 84928378887     PISSN: 10880224     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (34)

1. Heidenreich PA, Trogdon JG, Khavjou OA, et al. American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation. 2011;123(8):933-944.
2. Cacoub PP, Zeymer U, Limbourg T, et al REACH Registry Investigators. Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the Reduction of Atherothrombosis for Continued Health (REACH) Registry Europe. Heart. 2011;97(8):660-667.
3. Weingarten SR, Stone E, Green A, et al. A study of patient satisfaction and adherence to preventive care practice guidelines. Am J Med. 1995;99(6):590-596.
4. Fox KA, Steg PG, Eagle KA, et al GRACE Investigators. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA. 2007;297(17):1892-1900.
5. Peterson ED, Roe MT, Mulgund J, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006;295(16):1912-1920.
6. Bates DW, Kuperman GJ, Wang S, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10(6):523-530.
7. Kahn R, Robertson RM, Smith R, Eddy D. The impact of prevention on reducing the burden of cardiovascular disease. Circulation. 2008;118(5):576-585.
8. Weissman JS, Bailit M, D'Andrea G, Rosenthal MB. The design and application of shared savings programs: lessons from early adopters. Health Aff (Millwood). 2012;31(9):1959-1968.
9. Delbanco SF, Martin Anderson K, Eikel Major C, Kiser MB, Wammack Toner B; Catalyst for Payment Reform; Booz Allen Hamilton. Promising payment reform: risk-sharing with accountable care organizations. The Commonwealth Fund website. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2011/jul/1530delbancopromisingpaymentreformrisksharing-2.pdf. Published July, 2011. Accessed March 17, 2015.
10. Newman D; Congressional Research Service. Accountable care organizations and the Medicare Shared Savings Program. CRS Report for Congress. http://www.hklaw.com/files/Uploads/Documents/HealthcareReformCenter/ACOandMSSMemorandumApr252011.pdf. Published April 25, 2011. Accessed March 17, 2015.
11. Bailit M, Hughes C; Bailit Health Purchasing. Key design elements of shared-savings payment arrangements [issue brief]. New York, NY: The Commonwealth Fund; August 2011.
12. Cote B. Implementation of pathways: payers to share savings with compliant groups. OBR [Oncology Business Review] On-conomy website. http://obroncology.com/documents/OBR-sept-Pathways.pdf. Published September 2010. Accessed March 17, 2015.
13. US Senate Finance Committee. Empiric Data Lacking to Support Claims of Savings With Group Purchasing Organizations, September 2010. http://www.grassley.senate.gov/sites/default/files/about/upload/2010-09-24-GPO-Report.pdf. Accessed March 17, 2015.
14. Tu K, Cauch-Dudek K, Chen Z. Comparison of primary care physician payment models in the management of hypertension. Can Fam Physician. 2009;55(7):719-727.
15. Kaiser C. Survey: are the days of independent cardiologists numbered? Cardiovascular Business website. http://www.cardiovascularbusiness.com/topics/practice-management/survey-are-days-independent-cardiologists-numbered. Published May 28, 2010. Accessed March 17, 2015.
16. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283(13):1715-1722.
17. Peabody JW, Luck J, Glassman P, et al. Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med. 2004;141(10):771-780.
18. Peabody J, Shimkhada R, Quimbo S, et al. Financial incentives and measurement improved physicians' quality of care in the Philippines. Health Aff (Millwood). 2011;30(4):773-781.
19. Peabody JW, Florentino J, Shimkhada R, Solon O, Quimbo S. Quality variation and its impact on costs and satisfaction: evidence from the QIDS study. Med Care. 2010;48(1):25-30.
20. Frei CR, Bell AM, Traugott KA, et al. A clinical pathway for community-acquired pneumonia: an observational cohort study. BMC Infect Dis. 2011;11:188.
21. Huang Z, Lu X, Duan H. On mining clinical pathway patterns from medical behaviors. Artif Intell Med. 2012;56(1):35-50.
22. Aoki T, Nakajima T, Saito Y, et al. Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection. World J Gastroenterol. 2012;18(28):3721-3726.
23. Hauck LD, Adler LM, Mulla ZD. Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia. Ann Epidemiol. 2004;14(9):669-675.
24. Walker J, McKethan A. Achieving accountable care - "it's not about the bike." N Engl J Med. 2012;366(2):e4.
25. Fisher ES, Shortell SM, Kreindler SA, Van Citters AD, Larson BK. A framework for evaluating the formation, implementation, and performance of accountable care organizations. Health Aff (Millwood). 2012;31(11):2368-2378.
26. Hussey, PS, Wertheimer S, Mehrotra A. The association between health care quality and cost: a systematic review. Ann Intern Med. 2013;158(1):27-34.
27. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press; 2012.
28. Rotter T, Kinsman L, James E, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010;3:CD006632.
29. Schippits MG, Schippits KM. Clinical pathways leading healthcare reform: transformational strategies for oncology and beyond. J Med Pers. 2013;11(2): doi:10.1007/s12682-013-0151-4.
30. Neubauer MA, Hoverman JR, Kolodziej M, et al. Cost effectiveness of evidence-based treatment guidelines for the treatment of non-small-cell lung cancer in the community setting. J Oncol Practice. 2010;6(1):12-18.
31. Loeb M, Carusone SC, Goeree R, et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. JAMA. 2006;295(21):2503-2510.
32. Gesme DH, Wiseman M. Strategic use of clinical pathways. J Oncol Pract. 2011;7(1):54-56.
33. Carlson B. Controlling the cost of care through clinical pathways. Biotechnol Healthc. 2009;6(1):23-26.
34. Winn W, Wong J, Cooper T, Olsen RS, Trehan JA, Feinberg BA. Potential cost savings of a continuous quality improvement program as part of an oncology medical home. J Clin Oncol 31, 2013 (suppl; abstr e17579).