Value Based Purchasing and Medicare

Don Berwick I think is doing an excellent job. Here is a good summary of his latest initiative to improve quality for Medicare recipients:

http://www.healthleadersmedia.com/page-1/QUA-265552/Berwick-Announces-CMS-Final-ValueBased-Purchasing-Rules

Update on Quality

Quality is the holy grail of health care. Until it can be well defined and measured, controlling the cost of care will continue to be a challenge. Hospitals are critical in the effort but they are just part of the equation according to an interview w/Kenneth Kizer founder of the National Quality Forum:

The way to manage this increased intensity on quality, Kizer says, requires providers to adopt "a team activity."

• Does the health provider have teams in place to support the patient at home so he doesn't end up back in the hospital?
• Is anyone calling the patient to see if they took their medications? And ask if they are okay?
• Is anyone asking how the patients are doing on their diets?

Read the whole interview here:
http://www.healthleadersmedia.com/content/QUA-265810/NQF-Founder-Quality-Measure-Science-Still-Immature.html

DOL Report on Covered Benefits Not Helpful

One of the ways HHS is going to develop an essential benefits package is to look what is covered now. Its sole of info on this is a DOL survey released 4/15/11. But the report has major limitations according to this article:

http://www.healthleadersmedia.com/page-3/HEP-265768/DOL-Report-Flunks-a-Major-Test

More HIs Operating Clinics to Save Money

http://www.kaiserhealthnews.org/Stories/2011/May/04/Insurers-Turn-To-Clinics-For-Cost-Control.aspx

Forget ACOs says Milliman

Instead an integrated delivery system should partner w/ a health plan to best manage care under the MA program.

http://www.healthleadersmedia.com/content/HEP-265567/Health-Plan-Provider-Partnerships-May-Trump-ACOs.html

Update on Essential Benefits Definition

The HHS Secretary has the final word on what benefits will be deemed essential w/ the help of the IOM. Special interest groups are of course saying their services (chiro, dental, substance abuse, etc.) are. A fine line has to be tread here because if the coverage becomes too expensive individual will forgo the coverage and risk the minimal penalty. More details:

http://finance.fortune.cnn.com/2011/05/04/how-rich-health-care-mandates-could-bust-the-budget/

Medicare to Look at Hospital Patient Satisfaction Scores

Another provision of the ACA to be rolled out:

http://www.kaiserhealthnews.org/Stories/2011/April/28/medicare-hospital-patient-satisfaction.aspx?utm_source=khn&utm_medium=internal&utm_campaign=viewed