Evolving Toward Value

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Features

Partnering Around Value-Based Payment
Five case studies illustrate how payers, hospitals, and physicians are successfully partnering to gain experience with alternative payment structures, including capitation, shared savings, bundled payment, and reference pricing.

Communitywide Approaches to Aging
Enterprising healthcare and community leaders are testing new ways to ensure that seniors get all the services they need—including health care, support care, and transportation—in a coordinated manner so they can remain in their communities as long as possible. But major challenges remain before these pockets of excellence become the status quo for all elders.

     Sidebar: Funding New Innovations for Aging at Home

     Audio: A Cincinnati Partnership to Reduce Readmissions

     Web Extra: Creating Care Plans for Patients with Complex

     Tool: Sample Ambulatory Care Plan for Frail, Older

When to Outsource Versus Insource
The rapid consolidation within the healthcare industry means that many organizations are getting so large and multifaceted that they may need to reconsider their outsourcing versus insourcing strategy. Here are stories from five healthcare organizations.


Q&A

ICD-10: The Pros and Cons for Value
The increased specificity and thoroughness of ICD-10 coding will deepen the understanding of diseases and help to identify the most effective approaches to treatment and disease management. But this transition is a costly one—both in terms of dollars and staff time.


Breakthrough Map

8 Stages to Service Line Growth

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This infographic from HFMA’s Leadership publication illustrates eight common stages that hospitals and health systems often progress through when pursuing service line growth.


Profiles

The Outpatient Migration: Nursing’s Role

An interview with Linda Burnes Bolton

“The footprint of the healthcare delivery system is widening, and nurses need to expand their reach to the places where people live, work, play, and go to school,” says Linda Burnes Bolton, DrPH, RN, FAAN, vice president, nursing and CNO, Cedars-Sinai Medical Center, Los Angeles.

     Audio: A Cedars-Sinai Population Management Tactic

Fixing Disjointed Incentives

An interview with Atul Gawande, MD

“Without a system, things fall through the cracks,” says Atul Gawande, MD, MPH, surgeon, Brigham and Women’s Hospital. “And you can provide tremendous leverage and benefit by organizing people with relatively simple systems like a checklist.

Employers in the Driver’s Seat

An interview with David Lansky

When asked about reference pricing, the Pacific Business Group on Health’s David Lansky says: “I hope that this approach will not be an enduring solution, but that it will be a signal to the market that everybody needs to perform at this level—and continuously improve from this level—going forward.”

     Audio: Providers Contracting with Employers


Case Study

GlobalHealth HMO Uncovers Hidden Opportunities to Prevent Unnecessary Admissions

By Karen Wagner

The Oklahoma health plan has used predictive modeling to identify a hidden group of members with a high risk for an acute event. By making sure that these members get needed care, the HMO has already reduced ED encounters by 20 percent.


Columns

Acquisitions and Affiliations: Why Transparency Matters

By Joseph J. Fifer, president & CEO, HFMA

“Each organization is in the best position to make the case that an acquisition or affiliation has not led to higher prices in a particular market area. No research study can address community-specific issues and concerns as well as the organizations that serve that community,” writes Fifer.

Hard Versus Soft Savings from IT Investments

By Russell Branzell, president and CEO, CHIME

“The experience of Baylor Scott & White Health shows that soft savings contribute to long-term value," writes Branzell.


Last Word

Developing Leadership Skills
Four healthcare leaders share what skills they struggled with when they first became managers—and how they gained expertise in those areas.

Publication Date: Wednesday, August 20, 2014