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Home / News & IndustryManaged Care Insight and Analysis
Updated: January 26, 2010
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 lump sum.

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 problems.

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 levels.

For more information on Health Affairs, visit www.healthaffairs.org.


  This article was taken from:
Pay-For-Performance Reporter

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