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HCI3 Library

A New Payment Model for Quality: Why Care Now?

Since the publication of Crossing the Quality Chasm, the quest for significantly improved health care quality for all Americans has been joined by a wide variety of stakeholders. Beginning with the Institute of Medicine, virtually all recent commentators on quality acknowledge that for real change to occur, we need a different payment model.

A Vision to Transform U.S. Health Care
The programs to make it a reality.

HCI3 - Improving Health Care Quality and Value with evidence-based incentive programs and a fair and powerful model for payment reform.

Accountable "Care Organization" or “Accountable Care” Organization

The Patient Protection and Affordable Care Act (ACA) includes a number of delivery system and payment reform initiatives that hold much promise for bending the cost curve.

The legislation provides for mandatory programs like value based purchasing, pilot and demonstration programs like bundled payments, and voluntary opportunities like Accountable Care Organizations (ACOs). But, the ACA also provides for a close to unlimited potential for the Center for Medicare and Medicaid Innovation (CMI) to affect both payment and delivery system reform.

Acute Myocardial Infarction (AMI) ECR Playbook
ECR Definition Summary

AMI Playbook/ECR Definition Summary 

Additional Facility Costs due to PACs: Example Calculation

The Additional facility costs due to PACs calculation is used to separate the cost associated with the typical hospital stay and cost associated with the PAC.

Analyzing Sources of Variation within Episode Costs:

The objective of this report is to summarize the results of a comprehensive data analysis and identify opportunities for improvement both in terms of 1) lowering costs and 2) improving quality of care using the unique features of the Prometheus Payment model’s Evidence-informed Case Rates (ECRs). After summarizing an overall view of the results of the data analysis, this report will identify areas of opportunity in your data and extract information that will make your data actionable.

Asthma Care Recognition Program Clinician Guide

The Asthma Care Recognition Program is a Bridges to Excellence Clinician Recognition Program intended to identify clinicians who deliver high-value asthma care to adult patients. The program is designed with an understanding that adult patients may seek the care of various types of practitioners— primary care (PCPs), pulmonologists, allergy and immunologists, and others —for treatment and management of their asthma. Accordingly, the measures reflect that clinicians should do the following.

Asthma ECR Playbook
ECR Definition Summary

Asthma Playbook/ECR Definition Summary

Bariatric Surgery (BARI) ECR Playbook
ECR Definition Summary

Bariatric Playbook/ECR Definition Summary

Bending the Curve Through Health Reform Implementation
QUALITY. INDEPENDENCE. IMPACT.

Reducing health care spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans. Some of our reform recommendations were addressed completely or partially in ACA, and others were not. While more should be done legislatively, the current reform legislation includes important opportunities that will require decisive steps in regulation and execution to fulfill their potential for curbing spending growth.