The Triple Aim is an approach to optimizing health system performance, proposing that health care institutions simultaneously pursue 3 dimensions of performance:
Lack of financial incentives for providers to manage the total cost of care for an episode of illness. Limited research shows cost savings for some conditions. Payment mechanism is at an early stage of development.
The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. The crawling pace of doctor-payment reform. Under the Bundled Payments for Care Improvement initiative, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care.
These models may lead to higher quality, more coordinated care at a lower cost to Medicare. The participants include organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1, providers who have partnered with those organizations.
CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.
Are bundled payments part of the key to reducing healthcare costs? Earlier this year, CMS released a proposed rule that announced its intention to create a mandatory bundled payment program for hip and knee replacements in a number of randomly selected metropolitan statistical areas MSAs around the country.
The History of Bundled Payments For a number of years, both before and after passage of the Affordable Care Act ACA inCMS has experimented with a range of alternative payment models intended to increase value by lowering the costs and increasing the quality of care.
Both demonstration projects suggested the potential for improved value through bundled payments. A report on the ACE Demonstration project indicated that most of the five participating sites believed cost savings had been achieved, largely due to successful vendor negotiations and the ability to gain-share with physicians.
While it is too soon to assess the impact of the BCPI models, early indications suggest that organizations participating in Model 2 bundles which include the anchor hospitalization, all concurrent professional services, and all other services delivered within a designated episode length of 30, 60, or 90 days are improving utilization of lower-cost home health agencies over skilled nursing facilities and are decreasing readmissions although emergency department visits without a hospitalization may have increased.
Overall, then, CMS experiments with bundled payments indicate that they may be more effective than other value-based experiments that have been tested in reducing expenditures while maintaining the quality of patient outcomes.
At the same time, there is little evidence that participating organizations have been able to achieve dramatic reductions in expenditures. Improvements in the Final Rule In the evolution of CJR from the proposed rule to the final rule, some significant changes have been made to improve the program for hospitals in the affected MSAs.
First, CMS has agreed to risk- stratify payments for hip replacement bundles depending on whether the patient has a fracture. This is important for at least two reasons.
First, patients with fractures are typically higher-cost cases: Anecdotal evidence from HFMA members whose organizations are participating in the BPCI initiative indicates that a higher-than-expected number of fracture cases can have a significant negative impact on performance against baseline.
Hip replacement surgeries in lower-volume hospitals will often involve emergency cases, such as a fracture, rather than prescheduled surgeries, so a higher payment rate for fracture cases will help lower- volume organizations that otherwise may not have the same incentives or ability to devote resources to improving bundled episodes of care.1 Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California San Francisco, San Francisco, California Since Don Berwick and colleagues introduced the Triple Aim into the health care lexicon, this concept has spread to all corners of the health care.
A much-needed and hard-hitting plan, from one of the great Democratic minds of our time, to reform America's broken health-care system. Undoubtedly, the biggest domestic policy issue in the coming years will be America's health-care system. Jun 22, · Mitch McConnell, the Senate majority leader, after a Republican meeting about the health care bill on Thursday.
Credit Credit Doug Mills/The New York Times. CASE REDUCING HEALTH CARE COSTS Polson Corporation is a large high-technology automotive and electronics products company employing 70, workers.
It has recently developed a nationwide, managed health-care network in order to reduce its skyrocketing benefits costs. FAQ #2: What is Naturopathic Medicine View the printable PDF version.
Naturopathic medicine is a distinct practice of medicine that emphasizes prevention and the self-healing process to treat each person holistically and improve outcomes while lowering health care costs. “Reducing Administrative Costs and Improving the Health Care System,” New England Journal of Medicine, , 20, 4 Casalino Lawrence P., Sean Nicholson, David N.
Gans, et al.