Download Final report : evaluation of tools and metrics to support by Soeren Mattke, Kristin R. Van Busum, Grant Martsolf PDF

By Soeren Mattke, Kristin R. Van Busum, Grant Martsolf

The sufferer safety and cheap Care Act (ACA) areas robust emphasis on caliber of care as a way to enhance results for americans and advertise the monetary sustainability of our future health care method. incorporated within the ACA are new disclosure necessities that require health and wellbeing plans to supply a precis of advantages and assurance that appropriately describes the advantages less than the plan or assurance. those requirements  Read more...

Introduction --
Technical strategy --
Conceptual Framework --
Provider-Facing Structural features of well-being Plans --
Member-Facing Structural features of future health Plans --
Process Measures --
Outcomes Measures --
State of perform in enterprise Decisionmaking approximately future health Plans --
Conclusions --
Appendix A: Description of precis of advantages and assurance and thesaurus of phrases --
Appendix B: Description of seek ideas and instruments --
Appendix C: Descriptions of caliber dimension and Reporting corporations --
Appendix D: Descriptions of caliber size and Reporting enterprises.

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Extra info for Final report : evaluation of tools and metrics to support employer selection of health plans

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For a high-risk pregnancy, a woman can be assigned a dedicated nurse case manager throughout the pregnancy. Such programs are fairly widespread; 65 percent of the 70 plans in our sample offer a pregnancy or newborn management program. , 2006). PHRs were designed to have an individual’s medical history stored in one location and empower them to take ownership of their care. , information on allergies and family history). The availability of PHRs is less frequent than the other products and services discussed above.

However, as we noted, there are many possible payment arrangements and employers are unlikely to have a deep understanding of each payment arrangement and are therefore less likely to choose the “best” option. Furthermore, it is also important to keep in mind that the payment models are not unambiguously defined and that the same term can have different meanings in different contexts. For example, CMS has a very detailed definition and regulations for Medicare ACOs, NCQA has put forth its own accreditation standards for ACOs, and individual health plans are using their own definitions.

Under this circumstance, there is no distinction between provider and payer. ** Pay for performance elements can be used under any payment arrangement. , union plans), participants, and beneficiaries to have a general 8 It should be noted that the actual degree of risk sharing will depend on the contractual details of the payment arrangements. 16 understanding of how providers under a given health plan option are paid. However, as we noted, there are many possible payment arrangements and employers are unlikely to have a deep understanding of each payment arrangement and are therefore less likely to choose the “best” option.

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