Performance-Based Medicine: Creating the High Performance Network to Optimize Managed Care Relationships (Hardcover)

Introduction

Integration and HMOs: How Did We Get This So Wrong?
Reimbursement
Coordination
Performance

Performance Measurement: A Science with No Followers
Furthering Measurement and Informed Purchasing

Reimbursement: From Fee for Service to Risk Adjusters
More Than a Trend
The Current Status of P4P

Early Pay for Performance
Decile Thresholds
More Than a Trend
The Current Status of P4P

Performance Language and Practice
Where Health Care Delivery and Information Technology Intersect
The Solution Is within Our Four Walls
Can We Get Our Terminology Correct First?
Short Term vs. Long Term
Efficiency
Effectiveness
Grades and Effectiveness
Risk Adjusters and Comparative Effectiveness
Organizational Issues of Planning and Control
Quality Data
Outcomes Data
Evidence?Based Outcomes Data
Lean Engineering
Six Sigma
Learning Organizations

Reengineering
Early Guidelines
Savings Estimates
Summary of Selected Savings Options
Guidelines and Episodes of Care
Grouping Bundles of Services
Value?Based Purchasing and Performance?Based Contracting
Setting Benchmarks and Attainment Thresholds
Small Numbers on Individual Performance Measures
What the Regulations Are Saying about Pay-for-Performance

Challenges
The Pay?for?Performance Rumors and Issues
What Types of Performance Targets?
Cost Effectiveness
Commitment
The Vision
Just Another Program
Lean Engineering
International Classification of Diseases
Web?Based Processing
Comparative Effectiveness and Ethical Limitations
Lung Volume Reduction Surgery as a QALY Example

International Reform
Competition through Improved Performance
Results

Getting Started
Introduction to Planning
Environmental Scan
Managed Care’s Involvement
Feasibility and First Steps
What Are We Trying to Prove?
Legal Issues That Might Affect What You Are Trying to Do
Tasks to Move toward an Integrated Care System
Feasibility Study for Nonaligned Hospitals and Physicians
Financial Steps
Planning Steps
General Issues to Avoid
Issues to Decide upon Early On
No Guarantee That Any of These Steps Will Produce a Result

The Future of Performance?Based Medicine
Once We Have Baseline
Operating Your Performance?Based Strategy
Episode Treatment Group
Sharing Benchmarks and Eliminating Unhealthy Conflict
Normal vs. Abnormal Conflict
Constructive Conflict
Gap Analysis as an Ongoing Operational Management Goal
Disease Grouping Connected to Delivery Systems
Patient Health Status Improvement
Building the "Front End" and the "Back End" of the Patient?Coordinated System
Patient Health Records
Gain Sharing and Risk Management
Community?Based Analysis versus National Standards
Payment as a Meaningful Driver of Permanent Behavioral Change for Physician and Patient
Managed Care Opportunity to Share or Suppress Data
Decision Tools and Artificial Intelligence
Building a Collaborative Model
Deinstitutionalize the Institutional Services
Moving Toward Life Sciences Approach to Managing Care

Appendices