One star can add up to millions of dollars in bonuses. Not only that, but high-achieving plans can enroll beneficiaries all year round. It all comes down to quality, and medical directors who specialize in quality assurance will especially be in the hot seat.
The pioneering advocate of the Transitional Care Model for older adults and their caregivers says that her approach is getting more attention in the health reform era. Accountable care organizations are among the interested groups. Why? It’s all about the evidence, she insists.
Their effect on health plans is unclear, as stakeholders explore options and alternative models for sharing vital diagnosis and treatment information. There are also significant concerns about the uncertainty of national standards of interoperability. Public exchanges, especially, are struggling.
Many experts say “no.” Alzheimer’s disease and other dementias pose an enormous economic threat but, for now, the U.S. Preventive Services Task Force says that routine screening is unwarranted. The question behind the question: Should physicians diagnose only conditions for which they have a cure?
The issue is clinical utility. Many tests do not have enough evidence to demonstrate exactly how they will improve outcomes. While sequencing moves toward the magic $1,000 per patient mark, some critics argue that the increasing number of variants is leading to $1 million interpretations.
More governments around the world are not buying this argument. Critics abound stateside, as well. The American Society of Clinical Oncology says that financial pressures and instability are a “major threat to practice” and that the quality of care throughout the United States is inconsistent.
Is it a simple matter of pay for volume vs. pay for value, or is the situation far more complicated?
Medication is aimed at leptin deficiency, but clinical trials may be hard for managed care plans to evaluate properly