|New Strategy Shows Promise Of Improved Quality At Less Cost
Episodes of care is emerging as the latest strategy that could both curb medical spending and improve the quality of care.
The approach, so far, is largely conceptual with little
real-world experience that might help guide the design or adoption of
the strategy, according to the study published in the journal Health Affairs.
The current payment system encourages overuse of
services because physicians and others are paid separately for each
procedure or test performed, critics said.
Researchers from RAND Health analyzed claims information
from a large group of Medicare beneficiaries and identified key issues
that should be considered to help determine how to define episodes of
care and identify which provider is accountable for an episode.
Despite finding too many unanswered questions slowing
implementation of the strategy, "We’ve identified steps that
should be taken to help move from concept to implementation," said
Peter Hussey, the study’s lead author and a policy researcher at
RAND, a nonprofit research organization.
Under an episode of care approach, some or all of the
services related to the management of a patient’s chronic or
acute medical condition would be grouped together and paid for in a
Supporters of the strategy say it would shift the
financial incentives in a way that would encourage providers to
eliminate unnecessary procedures and tests, as well as promoting the
best quality care to help patients stay healthy or recover quickly.
One daunting challenge is defining what provider is
responsible for managing treatment for different conditions, a
complicated task because patients frequently are treated by a wide
variety of providers and in numerous settings for many different
For example, RAND researchers found that in more than
half of the hip fractures they examined among Medicare beneficiaries,
patients were treated in four or more different settings. For some
conditions, including diabetes and low-back pain, most patients were
treated in just one setting.
In addition, many of the patients studied had multiple
chronic conditions such as high blood pressure and elevated cholesterol
For more information on Health Affairs, visit www.healthaffairs.org.