Value Driven Healthcare and Geriatric Medicine (eBook)

James S. Powers, MDVA Tennessee Valley Healthcare SystemVanderbilt University School of MedicineGeriatric Research Education and Clinical CenterNashville, TN Dr. Powers is Professor of Medicine at Vanderbilt University School of Medicine and Associate Clinical Director at the Tennessee Valley Healthcare System, Geriatrics Research Education and Clinical Center (TVHS GRECC), Nashville TN.  He is Geriatrics Fellowship Program Director.  The views expressed are his own and based on his experience of over three decades developing evaluating, and sustaining geriatric healthcare models and educational programs throughout the Mid-South.  The main premise of this book is that value-based purchasing for healthcare is likely to remain a constant for the foreseeable future despite any changes in the financing of healthcare.  The second is that value-based purchasing drives quality metrics which are important levers for changes in healthcare delivery.  Dr. Powers focuses on quality improvement and evaluating educational and clinical outcomes, maintains a large practice and teaches geriatrics to healthcare professionals of all disciplines.

1.   Introduction – The Legacy of the Affordable Care Act ·         US healthcare spending, categories, regional variability, comparison to other countries ·         Growth of healthcare spending 1960-2010 and history of policy efforts to contain spending growth ·         Aims of the Affordable Care Act: Improve access, Improved quality, Slow the rate of healthcare cost increase ·         Outcomes of the Affordable Care Act: 20 million more individuals insured, enhanced uniform healthcare coverage requirements, improvement of the Medicare Health Insurance Trust Fund reserves, Healthcare inflation flat 2010-2015 ·         Definition of value-based healthcare purchasing   2.  Quality Indicators, Outcomes, and Performance Pay ·         History of policy efforts to enhance healthcare quality ·         Nursing homes and long-term care, STAR ratings, Nursing Home Compare ·         Hospitals, DRG’s,  Inpatient Quality  Reporting Program, Hospital Compare, Medicare Annual Payment Updates ·         Home and community-based services, Home Health  Compare ·         Physician PQRS and MACRA   3.  Are the Drivers of Healthcare Change Changing Healthcare Outcomes? ·         Standardization and reporting versus quality improvement ·         Measures of success: Better health care (IOM 6 domains), Access (preventive care, population health), Slow the rate of healthcare inflation ·         High value care ·         Quality reporting requirements ·         Transfer of healthcare costs and risk to insurance, corporations, individuals   4.  Value-Based Healthcare Purchasing ·         Transparency and accountability in healthcare ·         Variability in cost and utilization ·         High value care recommendations   5.  New Models of Healthcare Delivery ·         Trajectory of healthcare models, cost, risk, population impact ·         Bundled payments models ·         Single and to detailed risk for healthcare organizations ·         Capitated models ·         Disease state innovations ·         Transitions of care programs (hospital initiated post discharge interventions, joint accountability for hospitals home health agencies long-term care facilities) ·         Hospital at home ·         Telehealth and coordinated transitions of care   6.  Educating New Healthcare Providers for the 21st Century ·         Collaborative practice models ·         Inter-professional teamwork ·         Education regarding new healthcare models   7.  The Primary Care dilemma ·         Incentives for primary care ·         The composition of primary care workforce ·         New models of primary care delivery   8.  Transitions of Care ·         Value-based purchasing in the continuum of care ·         Cost avoidance as a new cost center ·         Systematic assessment in targeting of modifiable risk factors     9.  Through the Looking Glass - Visions of the Future of Healthcare ·         Global healthcare system budgeting ·         Value-based purchasing and stimulation of new healthcare models ·         Oversight of healthcare training ·         Risk sharing and the scope of personal responsibility for healthcare