Anthem Quality

Millions of people in the United States live with serious illnesses such as cancer, heart disease, chronic obstructive pulmonary disorder (COPD), amyotrophic lateral sclerosis, Parkinson's disease, and dementiaâ€"often for many years. Those facing serious illness have a range of interconnected medical and non-medical needs, and the way their care is financed has a large impact on the care they receive. Medicare is the predominant payer, but both Medicaid and private payers also play significant roles in financing care for serious illness. In an effort to address the complex needs of people with serious illness, public and private health care payers are testing innovative financing strategies and alternative payment models. These innovative approaches signal a gradual transition from the traditional-fee-for-service system that pays providers based on the quantity of services to a system based on the value of care provided and a heightened focus on improved quality of care at lower cost. To explore this evolving financing and payment landscape for serious illness care within public- and private-sector programs, the Roundtable on Quality Care for People with Serious Illness developed a workshop, Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness. The workshop convened clinicians, researchers, policy analysts, and patient advocates, as well as representatives from academia, government and private health care plans, and insurers to discuss challenges and opportunities in financing high-quality care for people with serious illness. This publication summarizes the presentations and discussions from the workshop.

Millions of Americans of all ages face the challenge of living with serious illnesses such as advanced cancer, heart, or lung disease. Many people with serious illness are increasingly cared for in community settings. While the number of community-based programs to provide care for those with serious illness has grown significantly, the quality of care provided is not consistent across geographic locations or care settings. Care for the serious illness population often features gaps in coordination across sites of care and poor patient and family perceptions as to the quality of care provided. In an effort to better understand and facilitate discussions about the challenges and opportunities related to identifying and implementing quality measures for accountability purposes in community-based serious illness care, the National Academies of Sciences, Engineering, and Medicine held a public workshop on April 17, 2018, in Washington, DC. Workshop participants explored the current state of quality measurement for people with serious illness, their families, and caregivers, with the aim of identifying next steps toward effectively implementing measures to drive improvement in the quality of community-based care for those facing serious illness. This publication summarizes the presentations and discussions from the workshop.

The American health care industry has undergone such dizzying transformations since the 1960s that many patients have lost confidence in a system they find too impersonal and ineffectual. Is their distrust justified and can confidence be restored? David Dranove, a leading health care economist, tackles these and other key questions in the first major economic and historical investigation of the field. Focusing on the doctor-patient relationship, he begins with the era of the independently practicing physician--epitomized by Marcus Welby, the beloved father figure/doctor in the 1960s television show of the same name--who disappeared with the growth of managed care. Dranove guides consumers in understanding the rapid developments of the health care industry and offers timely policy recommendations for reforming managed care as well as advice for patients making health care decisions. The book covers everything from start-up troubles with the first managed care organizations to attempts at government regulation to the mergers and quality control issues facing MCOs today. It also reflects on how difficult it is for patients to shop for medical care. Up until the 1970s, patients looked to autonomous physicians for recommendations on procedures and hospitals--a process that relied more on the patient's trust of the physician than on facts, and resulted in skyrocketing medical costs. Newly emerging MCOs have tried to solve the shopping problem by tracking the performance of care providers while obtaining discounts for their clients. Many observers accuse MCOs of caring more about cost than quality, and argue for government regulation. Dranove, however, believes that market forces can eventually achieve quality care and cost control. But first, MCOs must improve their ways of measuring provider performance, medical records must be made more complete and accessible (a task that need not compromise patient confidentiality), and patients must be willing to seek and act on information about the best care available. Dranove argues that patients can regain confidence in the medical system, and even come to trust MCOs, but they will need to rely on both their individual doctors and their own consumer awareness.

This book discusses how effective navigation requires a team approach to oncology care and should never be considered an “add-on” resource or service. The Academy of Oncology Nurse & Patient Navigators (AONN) is the only national professional organization for navigation professionals, and has more than 6,000 members, 90% of which are oncology nurse navigators. They are the experts on creating team-based programs, which remove the risk of others trying to reinvent the wheel by designing a navigation program from scratch. They also understand the role of effective navigation across the entire continuum of care, and understand and are able to apply other key aspects of navigation, including clinical trial screenings and tumor board coordination and monitoring, as well as measurement using evidence-based navigation metrics, to name but a few.It is the only book designed to educate and support anyone developing a new navigation program, or wanting to improve one they have created.As such it offers a guide for cancer centers needing to develop and implement an oncology navigation program; understand and successfully meet and exceed the Commission on Cancer accreditation standards linked to navigation; expand or improve their current navigation program as well as demonstrate its value using reliable measurable results, including patient satisfaction and improved- quality clinical outcomes. This comprehensive book also provides insights into applying the information presented to the real world of oncology care.

The ? eld of critical care medicine is in the midst of a dramatic change. Technological and s- enti? c advances during the last decade have resulted in a fundamental change in the way we view disease processes, such as sepsis, shock, acute lung injury, and traumatic brain injury. Pediatric intensivists have been both witness to and active participants in bringing about these changes. As the understanding of the pathogenesis of these diseases reaches the cellular and molecular levels, the gap between critical care medicine and molecular biology will disappear. It is imperative that all physicians caring for critically ill children in this new era have a th- ough understanding of the applicability of molecular biology to the care of these patients at the bedside in order to keep up with the rapidly evolving ? eld of critical care medicine. To the same extent, the practice of critical care medicine is in the midst of fundamental change. In keeping with the Institute of Medicine’s report “Crossing the Quality Chasm,” the care of critically ill and injured children needs to be safe, evidence-based, equitable, ef? cient, timely, and fami- centered [1,2]. In the following pages, these changes in our specialty are discussed in greater scope and detail, offering the reader fresh insight into not only where we came from, but also where we are going as a specialty.

This is the second book in the series of books that we edit on the Management of Medical Technology (MMT) published by Kluwer Academic Publishers. The fIrst book Managing Technology in Health Care offered a broad-brushed view of the topics involved in the new and exciting area of MMT that we have launched. A group of distinguished scholars contributed to the fIrst book. While working on the first book in the series, and on a variety of articles in MMT, we began to realize that there is an urgent need for a comprehensive and highly focused book which will introduce and define the area of MMT. In addition, we had just completed the two studies of MMT in American hospitals, and had a magnificent database fully analyzed. With three months left in the first author's sabbatical, and thanks to the encouragement from our editor at Kluwer, Gary Folven, we took to the task of writing this book. The merging in this book of the description of a new intellectual space, and the write-up of the results from our MMT studies have created a unique blend of very attractive reading material. The reader will find this book to be a fascinating adventure into a newly-created area of intellectual endeavor, coupled with fIndings about how the health care delivery system manages teclUlology. Regardless of the reader's background, this book will certainly be of interest, as it links the medical and business frameworks.

This book looks at how numbers and statistics have been used to underpin quality in news reporting. In doing so, the aim is to challenge some common assumptions about how journalists engage and use statistics in their quest for quality news. It seeks to improve our understanding about the usage of data and statistics as a primary means for the construction of social reality. This is a task, in our view, that is urgent in times of ‘post-truth’ politics and the rise of ‘fake news’. In this sense, the quest to produce ‘quality’ news, which seems to require incorporating statistics and engaging with data, as laudable and straightforward as it sounds, is instead far more problematic and complex than what is often accounted for.