By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    improving patient experience
    6 Ways to Improve Patient Satisfaction Within Hospitals
    December 1, 2021
    degree for healthcare job
    What Are The Health Benefits Of Having A Degree?
    March 9, 2022
    custom software development is changing healthcare
    Digital Customer Journey Mapping and its Importance for Healthcare
    July 21, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    Can Thinking Younger Make You Live Longer?
    April 20, 2011
    Image
    Obesity’s Outlook Unchanged
    June 13, 2011
    When It’s An Emergency Elderly Not Treated As Well in Hospitals
    July 16, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies
eHealthHealth ReformHospital AdministrationMobile HealthPolicy & LawPublic HealthTechnology

Implementing Innovative Value-Based Purchasing and Readmission Reduction Strategies

Principle Healthcare
Last updated: October 7, 2012 8:30 am
Principle Healthcare
Share
1 Min Read
SHARE

No longer is the clock ticking; rather the alarm has sounded and value-based purchasing has commenced.  As this aptly titled article, “Medicare Rolls Out Carrots and Sticks for Hospital Quality”, the author points out that the Centers for Medicare & Medicaid Services (CMS) is now withholding 1 percent of its regular hospital payments and putting that money into a fund to reward hospitals that score well on No longer is the clock ticking; rather the alarm has sounded and value-based purchasing has commenced.  As this aptly titled article, “Medicare Rolls Out Carrots and Sticks for Hospital Quality”, the author points out that the Centers for Medicare & Medicaid Services (CMS) is now withholding 1 percent of its regular hospital payments and putting that money into a fund to reward hospitals that score well on 20 different quality measures.  Breaking that number down further reveals that seventy percent of a hospital’s score will be based on 12 measures that show how frequently hospitals performed recommended protocols, while the remaining 30 percent of a hospital’s value-based purchasing payment will be based on how it scored on patient surveys taken after they were discharged.

And as if this isn’t enough to contend with, CMS has also enacted the Readmissions Reduction Program, aimed at curtailing the number of patients that are sent back to the hospital.  With one in five Medicare patients typically being readmitted within one month, bringing this number down will help hospitals and healthcare systems avoid the 1% penalty looming in their future.  Some view the penalties as counterproductive since a patient’s behavior beyond the four walls of the hospital is simply beyond their control. And while medication adherence, diet, insurance and mental health status help drive many of these readmissions, CMS believes that hospital can significantly improve transitions and coordination of care.

In the face of two landmark program launches, what will your hospital’s valued-based purchasing and reductions readmission approach be?  According to Evolent Health, a joint venture between the University of Pittsburgh Medical Center system’s Insurance Division and the Advisory Board Company, a variety of paths can be taken based on a provider’s appetite for risk.  Ranging from individual programmatic efforts, to patient centered medical homes or accountable care organizations, providers must first review complex case management, condition management, and pharmacy utilization management to determine the right mix.

Specifically, Evolent Health believes that the following five key ingredients must exist in order to succeed at value-based purchasing:

More Read

Worried About Teen Births? Read Our Paper
Handling Death – Use of the GRIEV_ING Mnemonic
A Short Guide To Medical Waste Management For Every Facility
8 Mistakes to Avoid when Securing Cloud Services
Telehealth and the Manhunt for the Boston Marathon Bombers
  • Creating a Coherent View –organizations must integrate multiple sources of information, provide real-time alerts for ED admissions, and be able to transmit care manager notes to the appropriate providers
  • Prioritizing High-Risk Patients – entities must be able toassess patients over a discrete period of time by collecting data and processing it through a rules engine to create predictive models for readmission risks and risk scores
  • Providing the Right Intervention by Building a Targeted and Tiered Intervention Portfolio  – organizations must stratify patients into buckets and create menus of interventions and care management operations to address particular patients
  • Engaging at the Appropriate Intensity Level – depending on intensity, patients must be engaged in the appropriate format and/or forum

Given the current trend in healthcare spend, one would be hard pressed to argue the need for population health management, care coordination and home monitoring technology and processes.  And while large and medium size urban healthcare institutions have the ability to address these mandates head on, the question becomes – how will smaller entities in less well developed communities fare?  A first step in the innovation for value-based purchasing, according to Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare, is to develop internal processes and a registry for purposes of gaining a better understanding of your patient populations and identifying gaps in care.

 

TAGGED:value-based purchasing
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025
Learn how to Renew your Medical Card in West Virginia
Learn how to Renew your Medical Card in West Virginia
Health
May 15, 2025
Dr. Klaus Rentrop Shares Acute Myocardial Infarction heart treatment
Dr. Klaus Rentrop Shares Acute Myocardial Infarction
Cardiology
May 13, 2025

You Might also Like

Post SCOTUS Arguments, Waiting Game Begins

March 29, 2012

Bracing for More Medicare Cuts

October 20, 2011
Image
BusinessHospital Administration

Medical Director: Characteristics of Success

April 14, 2013

Online Bill Pay Starts to Accelerate in Healthcare

March 22, 2015
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?