Anthony Shih

Using Medicare Payment Policy To Transform The Health System: A Framework For Improving Performance

As the largest payer for health services in the United States, Medicare has the potential to use its payment policies to stimulate change in the organization of care to improve quality and mitigate cost growth. This paper proposes a framework in which Medicare would offer an array of new bundled payment options for physician group practices, hospitals, and delivery systems, with incentives to encourage greater integration in the organization of health care delivery and the provision of more coordinated care to beneficiaries. These changes could also serve as a model for other payers to improve quality and efficiency throughout the health system.

Effect of quality improvement organization activities on outpatient diabetes care in eastern New York State.

Background:Quality improvement organizations (QIOs) are contracted to improve the quality of care delivered to Medicare beneficiaries. The purpose of this study was to determine whether provider participation in New York State QIO activities resulted in significant improvements in the quality of diabetes care during the recent contract cycle with the Centers for Medicare & Medicaid Services. Research Design:A retrospective analysis between participating and nonparticipating providers on their performance in 3 quality measures (biennial ophthalmology examination, biennial lipid profile monitoring, annual hemoglobin A1c monitoring) was used. Data of New York State Medicare beneficiaries before and after QIO intervention activities were examined to determine change in performance. General linear models were created to examine the effect QIO participation had on the change in performance for each measure. Results:Providers who participated in QIO activities had significant absolute improvements in lipid monitoring compared with nonparticipating providers at high baseline performance for low (3.10%, P < 0.001), medium (2.57%, P < 0.001), and high (1.51%, P = 0.002) baseline patient volume, and medium baseline performance for low (2.38%, P < 0.001), and medium (1.85%, P < 0.001) baseline patient volume. The same trend was seen for hemoglobin A1c monitoring (4.28%, P < 0.001; 3.57%, P < 0.001; 2.15%, P < 0.001; 2.63%, P = 0.001; 1.92%, P = 0.006). For ophthalmology examination, participation resulted in significant changes at low (2.28%, P = 0.003) and medium (1.73%, P = 0.009) baseline patient volume. Conclusion:The study results suggest QIO activities can improve outpatient diabetes care; however, limitations in the study design preclude any definitive remarks.