Category: CMS

Case managers and advanced practice nurses in Aetna’s Transitional Care pilot have also successfully partnered to reduce readmissions. Dr. Randall Krakauer, national medical director, Medicare at Aetna, describes the key focus and the complementary roles that reduced 90-day readmissions by 25 percent. Dr. Krakauer also weighs in on the pros and cons of bundled payments,…

Healthcare reform partially fueled Baptist Health System’s desire to participate in the CMS Acute Care Episode (ACE) pilot that is testing bundled or episodic payments for selected orthopedic and cardiac procedures, explains Michael Zucker, Baptist’s chief development officer. He describes some early returns from the experience, highlights the provider’s role in Baptist’s multi-pronged awareness campaign…

Geisinger Health Plan’s successful Transitions of Care program is the health plan’s response to rising rehospitalization rates among Medicare patients, a major concern of both CMS and private payors. Geisinger Health Plan’s Doreen Salek defines the transition teams’ key area of focus when providing a “clean and clear handoff” of a patient from one care…

Redesigning a practice into one that is more efficient and patient-centered begins with a readiness assessment tool and goal-setting with key organization members, says Dr. John Michos, medical director of the Virginia Health Quality Center. The size of the practice can affect the approach to transformation. Smaller practices may find it easier to implement change,…

Diane Flanders, director of coordinated care systems for MassHealth, provided an overview of the unique partnership that is designed to keep its seniors as well as possible, and in their homes and communities for as long as possible. Sarah Keenan, clinical liaison with Medica and Flanders described how to create a coordinated care management approach…

Miscommunication during the care transition puts elderly patients at risk for reduced quality of care, poorer outcomes and unnecessary procedures, according to Gregg Lehman, president and CEO of Inspiris. He defines the key players on the care transition team, suggests strategies for improving communications during this crucial phase and describes his organization’s approach to dual…

David Hunsaker, president of public programs, APS Healthcare, describes how to maintain contact with the Medicaid population, dispels some of the myths about the Medicaid population and discusses ways to reduce non-urgent emergency room usage among Medicaid recipients. Source: Maintaining Contact and Care with the Medicaid Population

Hear from Julie Baker, director, healthcare advisory practice, PricewaterhouseCoopers, on what is driving the move toward pay-for-performance programs, history on some of the programs in place now and what this means for physician practices evaluating the new voluntary physician quality reporting program launched by the Centers for Medicare and Medicaid Services. Baker’s remarks are excerpted…

Objectives and methods: The re-negotiation of the 10-year 2004 First Ministers’ Accord provides an opportunity to review medicare’s fundamentals. We used the published results from 13 Commonwealth Fund international health surveys to assess Canadians’ views of health system performance and compared these to the views of respondents from Australia, the United Kingdom and the United…