Medicare

Innovations

Physician-Led Clinics Offer Integrated, Coordinated Care to High-Risk Seniors Under Capitated Contracts, Leading to Strong Performance on Quality Metrics, Low Inpatient Use, and High Patient Satisfaction 11/04/14

A physician-led practice offers integrated, coordinated care under capitated contracts to high-risk, moderate- and low-income seniors enrolled in Medicare Advantage plans, leading to high levels of adherence to recommended screening services, good blood glucose control among patients with diabetes, below-average use of inpatient services, high patient satisfaction, and improvements in patient access to medications.  

Community-Based Health Coaches and Care Coordinators Reduce Readmissions Using Information Technology To Identify and Support At-Risk Medicare Patients After Discharge 03/23/14

Supported by mobile technology, trained health coaches and nurse care coordinators use home visits and telephone-based monitoring to identify and address declines in health status in recently discharged Medicare patients, leading to a significant reduction in readmissions and associated cost savings.

Hospital Gain-Sharing Program Offers Incentives to Physicians Based on Their Efficiency, Producing Significant Cost Savings Without Decline in Quality 03/17/14

A group of 12 New Jersey hospitals offered upside incentives to individual physicians based on their performance on various efficiency metrics, leading to significant cost savings without negatively affecting quality of care.

State Medicaid Program Pays Additional Capitated Fee to Integrated Primary Care and Mental Health Homes, Leading to Better Outcomes and Lower Costs 03/01/14

The Missouri Medicaid Health Home program provides capitated payments to primary care and mental health medical homes that adopt an integrated staffing model that allows patients to receive both medical and mental health care, leading to better health outcomes and lower utilization and costs.

Statewide Health Information Exchange Provides Daily Alerts About Emergency Department and Inpatient Visits, Helping Health Plans and Accountable Care Organizations Reduce Utilization and Costs 08/07/13

A statewide health information exchange provides health plans and accountable care organizations with daily alerts on patients visiting the emergency department or being admitted to an inpatient facility, allowing them to take steps to curb use of these high-cost venues and replace them with lower-cost primary care visits.

Care Coordinators Engage in Culturally Sensitive Discussions About Advance Directives With Seniors, Increasing Completion Rates and Reducing Disparities Between African Americans and Whites 07/11/13

Care coordinators in a large integrated system engage in culturally tailored discussions with low-income seniors about completing advance directives, leading to higher completion rates and a narrowing of the gap in completion rates between African Americans/black immigrants and whites.

State–Federal Program Provides Capitated Payments to Plans Serving Those Eligible for Medicare and Medicaid, Leading to Better Access to Care and Less Hospital and Nursing Home Use 03/13/13

A combined State-Federal program pays health plans a capitated fee to provide and coordinate acute, primary, long-term care as well as social services to those eligible for Medicare and Medicaid, leading to enhanced access to care, fewer inpatient admissions and nursing home placements, and high levels of beneficiary and provider satisfaction.

Health Plan's Multifaceted Strategy Involving Care Coordination, Disease Management and Physician Incentives Leads to Better Outcomes and Reduced Costs for Medicare Advantage Enrollees 03/03/13

HealthSpring's Partnership for Quality program offers bonuses to physician practices and onsite care coordination and disease management support, leading to significantly better outcomes and reduced costs for Medicare Advantage enrollees.

Increased Reimbursement and Dedicated Funds Allow Remote Primary Care Clinics to Provide Around-the-Clock Care, Leading to Fewer Medical Evacuations and Higher Quality of Care 01/07/13

Five clinics in remote parts of Alaska and Washington state receive additional reimbursement from Medicare and dedicated Federal funds that allow them to provide around-the-clock care, leading to fewer medical evacuations (and associated cost savings), better quality care, and high levels of satisfaction in the communities they serve.

Physician Practices Use Software-Facilitated System to Complete Medicare Annual Wellness Visit, Improving Preventive Care and Generating High Satisfaction 09/21/12

Primary care practices use a software-facilitated process to proactively schedule and efficiently complete required components of Medicare's Annual Wellness Visit and to identify and address care gaps, leading to improvements in the provision of preventive services and high physician and patient satisfaction.

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