Kooperativer Bibliotheksverbund

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Umfang: 1 online resource (xii, 412 pages) : , digital, PDF file(s).

ISBN: 1-009-01911-2 , 1-009-01917-1 , 1-009-00453-0

Inhalt: Consumers, public officials, and even managers of health care and insurance are unhappy about care quality, access, and costs. This book shows that is because efforts to do something about these problems often rely on hope or conjecture, not rigorous evidence of effectiveness. In this book, experts in the field separate the speculative from the proven with regard to how care is rendered, how patients can be in control, how providers should be paid, and how disparities can be reduced - and they also identify the issues for which evidence is currently missing. It provides an antidote to frustration and a clear-eyed guide for forward progress, helping health care and insurance innovators make better decisions on deciding whether to go ahead now based on current evidence, to seek and wait for additional evidence, or to move on to different ideas. It will be useful to practitioners in hospital systems, medical groups, and insurance organizations and can also be used in executive and MBA teaching.

Anmerkung: Title from publisher's bibliographic system (viewed on 18 Jul 2022). , Cover -- Half-title -- Title page -- Copyright information -- Contents -- List of Figures -- List of Contributors -- Preface -- 1 Baseline Observations -- Introduction -- The Problem -- This Book -- Running Down the Competition -- An Example of Challenges in Determining the Best Use of Information: Medicare's Hospital Readmission Reduction Program -- Coronavirus 2020 -- Outline of the Book -- 2 Evidence and Growth in Aggregate Spending and Changes in Health Outcomes: Where Has the Battleship Been Going, and How Can We Turn It? -- Introduction -- Innovations and Their Effects -- Would Better Evidence Affect Spending Growth? -- Components of Spending Growth -- Trends in Spending and Health Outcomes -- Drivers of Cross-National Spending Differences -- Looking at the Data -- Ups and Downs in Health Outcome Trends -- Conclusion -- 3 The Benchmark Decision Model, the Value of Evidence, and Alternative Decision Processes -- Introduction -- Where We Are Now -- What Kind of Evidence and What Good Would It Do? -- What Is Evidence, and What Is Rigorous Evidence? -- Why Evidence Is Not Sought or Used -- Thinking about the Value of Evidence: The Core Bayesian Model and Alternatives -- Warning: The following discussion is somewhat technical and theoretical. But try to get the gist of it -- you will benefit. -- Deviating from Bayesian Benchmark ''Ideal'' Behavior -- Who Cares? -- The Value of Evidence: From Theory to Practice -- Other Considerations about Risks -- A Continuum with Tradeoffs -- Safety and Effectiveness of Drugs versus Devices: What Kinds of Evidence Are Enough? -- Pragmatic Clinical Trials -- Off-Label Use of Drugs -- Tradeoffs -- Summary and a Way Forward -- Real-World Evidence -- Alternatives to RCTs -- Authoritative Evidence on Methods -- Radical Uncertainty Faced Head-On: A New View -- How to Deal with Radical Uncertainty. , Other Attempts to Better Use Evidence -- Compilations of Evidence -- Evidence on Evidence -- Evidence on Evidence of Evidence -- Is There Good News? -- Conclusion -- 4 Care Coordination -- The Problem -- Roots of the Fragmentation Problem -- Historical Sources of Fragmentation -- Historical Calls to Combat Fragmentation -- Diverse Perspectives on the Problem of Fragmentation -- Multiple Foci and Levels of Analysis -- Multiple Provider Settings and Professional Groups -- Multiple Interpretations of the Fragmentation Problem -- The Proposed Solution: Care Coordination -- Coordination in Organization Research -- Coordination in Health Care -- Solution to Specific Problems -- Solution to Broader Problems -- Primary Care and Coordination -- Theory of Action -- Elements of Primary Care -- Issues with Primary Care -- The Elements of Primary Care and Coordination: How Shaky a Foundation -- Patient Care Teams -- The Physician View of Teams -- The Nursing View of Teams -- Earlier Literature on Teams -- More Recent Literature on Teams -- Research Evidence on Teams -- Some Research Conclusions about Teams -- Care Management Practices -- Care Continuity -- Disease Management -- Patient-Centered Medical Homes -- Chronic Care Management -- Care Coordination Programs -- Research Evidence on Care Coordination -- Care Coordination Networks Involving Multiple Organizations -- Community Care Networks -- Post-Acute Care Networks -- Other Mechanisms to Promote Coordination -- The EMR System as the Solution -- Promise of the EMR -- Inherent Limits to this Promise -- Empirical Research on EMR Impact on Care Coordination -- Alternative Payment Models As the Stimulus to Coordination -- Conclusion: Challenges Facing Care Coordination -- Efforts to Reduce Costs -- Efforts to Improve Quality -- Beware of Best Practices? -- Challenges Posed by Contextual Factors. , Light at the End of the Tunnel? -- Summation and Final Thoughts -- 5 Evidence-Based Programs to Improve Transitional Care of Older Adults -- Importance of Transitional Care -- A Review of Transitional Care Evidence -- The Early Years -- Current Status -- Common Characteristics of Effective Solutions -- Common Characteristics of Ineffective Solutions -- Health Systems' Use of Proven Solutions -- Decision-Making Regarding Implementation of Proven Solutions -- The Uptake Problem -- The Replicability and Spread Problem -- Conclusion -- 6 Vertical Integration of Physicians and Hospitals: Three Decades of Futile Building upon a Shaky Foundation -- Executive Summary and Overview -- Organization of Chapter -- What Is Integration? -- Integrating Financing and Delivery -- Moving the Goalposts on Integration -- Lack of a Firm Evidence Base to Support These Initiatives -- Summary -- Integrating Physicians and Hospitals (and Maybe Health Plans, Too) -- The Historical Path to PHI: 1960-2000 -- The Rise of Hospital Systems in the 1960s and 1970s -- The Initial Push for Integration in the 1980s: Cost Containment Pressures -- Acceleration of Integration Efforts in the 1990s -- Performance Challenges Facing PHIs in the 1990s -- Summary of Twentieth Century Efforts -- The New Historical Path to PHI: 2000-2020 -- Reinvigoration of Integration in the New Millennium -- Public Sector Involvement and Reinforcement of PHI -- Payment Differentials -- Bundled Payment -- Gainsharing -- Accountable Care Organizations (ACOs) -- Summary: Integration and PHI in the New Millennium as Challenged Ideas -- Shaky Theoretical Foundation and Applicability of Industry Vertical Integration -- Typologies of Integration -- Regulators' Interest in Integration Models -- Researcher Typologies of Vertical Integration -- Health Systems Integration Study (HSIS). , Center for Organized Delivery Systems (CODS) -- University of Minnesota Studies of Hospital-Medical Group Integration -- National Study of Physician Organizations (NSPO) -- National Survey of Healthcare Organizations and Systems (NSHOS) -- Comparative Health System Performance (CHSP) Initiative -- Revisiting the Causal Model Linking Financial and Clinical Integration -- Summary Assessment of PHI Typologies and Supporting Evidence -- We Got Trouble, Right Here in River City -- Disparate Cultures, Orientations, and Goals -- Logistical Issues in PHI -- Dredging Up Past (Failed) Solutions -- Low Level and Wrong Locus of Risk-Bearing -- Focus on the Wrong Targets -- The Wrong Target: The Unrealistic Aim to ''Be Like Kaiser'' -- Physicians Themselves Aren't Aligned (and Neither Are the Parts of the Hospitals) -- A New Perspective on Integration -- Don't Expect the Chief Financial Officer to Do the Chief Operating Officer's Job -- Don't Expect the Chief Operating Officer (or Chief Medical Officer) to Do the Clinician's Job -- Some Final Comments -- Appendix: Goals of Physicians and Hospitals in PHI -- Hospital Goals -- Physicians' Goals -- 7 Evidence on Provider Payment and Medical Care Management -- Introduction -- Evidence on the Effect of Payment Models on Quantity and Total Spending -- Pay for Value, Not for Volume -- It Is a Mess in Theory, But How Might It Work in Practice? -- Medicare Capitation Efforts in Population-Based Care -- Back to the Drawing Board: What Goes on with Provider Payment Incentives in Theory, and When Might That Matter for Improvement? -- Value-Based Payment in Theory and Practice -- A Case Study of High-Level Payment Reform - The Massachusetts Alternative Quality Contract: What Does (or Did) Evidence Have to Do with It? -- What You Are Paid May Matter More Than How You Are Paid. , Behavior and Evidence about the Effects of Behavior in an Imperfect World -- Management and Provider Behavior Change -- Conclusion -- 8 Evidence on Ways to Bring about Effective Consumer and Patient Engagement -- Introduction -- Reasons for Adherence and Nonadherence -- Nudging and Libertarian Paternalism -- Encouraging Healthy Behaviors through Precommitment Strategies -- Taxes, Subsidies, and Other Strategies to Influence Health Behavior -- Use of Wellness Programs and Persistence of Behavioral Change Interventions -- Patient-Centered Care -- Conclusion -- 9 The Unmet and Evolving Need for Evidence-Based Telehealth -- Overview -- Case Example: Remote Care Monitoring with Wearable Devices -- A Primer on Telehealth Designs and Contexts -- Synchronous vs. Asynchronous -- From Home vs. Health Care Setting -- Patient-to-Provider vs. Provider-to-Provider -- Care along a Continuum and Utilization -- Telehealth's Evidence -- Timeliness and Access -- Efficiency and Costs -- Safety -- Effectiveness -- Patient-Centeredness -- Equity -- The COVID-19 ''Experiment'' and Telehealth's Future -- Summary -- 10 Evidence and the Management of Health Care for Disadvantaged Populations -- Introduction -- What General Decision Rule for Health Care Leaders? -- Vague Goals and Little Evidence -- There Are Racial and Social Disparities -- Some Conclusive Evidence, in Pictures -- Evidence on Reducing Disparities: General Observations -- Value is Subjective - and a Moving Target -- Programs Big and Small -- Specific Clinical Programs to Reduce Disparities -- Targeted Modest Programs to Reduce Disparities -- Can Health Care Systems and Insurers Gain from Using Effective Programs to Reduce Disparities? -- Insurance Coverage Expansion and Delivery Systems -- Changing the Culture of health - Who Can Do It? -- Can Payment Be Enhanced?. , Strategic Choice beyond Programs: Concrete Choices and Their Limits.

Weitere Ausg.: ISBN 1-316-51903-1

Sprache: Englisch

URL: lizenzpflichtig

URL: https://doi.org/10.1017/9781009004534