Value Driven Healthcare and Geriatric Medicine: Implications for Today's Changing Health System (Paperback, 2018)

1. Introduction - The Legacy of the Affordable Care Act · US healthcare spending, categories, regional variability, comparison to other countries · Growth of healthcare spending 1960-2010 and history of policy efforts to contain spending growth · Aims of the Affordable Care Act: Improve access, Improved quality, Slow the rate of healthcare cost increase · Outcomes of the Affordable Care Act: 20 million more individuals insured, enhanced uniform healthcare coverage requirements, improvement of the Medicare Health Insurance Trust Fund reserves, Healthcare inflation flat 2010-2015 · Definition of value-based healthcare purchasing 2. Quality Indicators, Outcomes, and Performance Pay · History of policy efforts to enhance healthcare quality · Nursing homes and long-term care, STAR ratings, Nursing Home Compare · Hospitals, DRG's, Inpatient Quality Reporting Program, Hospital Compare, Medicare Annual Payment Updates · Home and community-based services, Home Health Compare · Physician PQRS and MACRA 3. Are the Drivers of Healthcare Change Changing Healthcare Outcomes? · Standardization and reporting versus quality improvement · Measures of success: Better health care (IOM 6 domains), Access (preventive care, population health), Slow the rate of healthcare inflation · High value care · Quality reporting requirements · Transfer of healthcare costs and risk to insurance, corporations, individuals 4. Value-Based Healthcare Purchasing · Transparency and accountability in healthcare · Variability in cost and utilization · High value care recommendations 5. New Models of Healthcare Delivery · Trajectory of healthcare models, cost, risk, population impact · Bundled payments models · Single and to detailed risk for healthcare organizations · Capitated models · Disease state innovations · Transitions of care programs (hospital initiated post discharge interventions, joint accountability for hospitals home health agencies long-term care facilities) · Hospital at home · Telehealth and coordinated transitions of care 6. Educating New Healthcare Providers for the 21st Century · Collaborative practice models · Inter-professional teamwork · Education regarding new healthcare models 7. The Primary Care dilemma · Incentives for primary care · The composition of primary care workforce · New models of primary care delivery 8. Transitions of Care · Value-based purchasing in the continuum of care · Cost avoidance as a new cost center · Systematic assessment in targeting of modifiable risk factors 9. Through the Looking Glass - Visions of the Future of Healthcare · Global healthcare system budgeting · Value-based purchasing and stimulation of new healthcare models · Oversight of healthcare training · Risk sharing and the scope of personal responsibility for healthcare