A Global Equity Model (GEM) for the Advancement of Community Health and Health Equity

Patient Preferences for Postmastectomy Breast Reconstruction

“…The Institute of Medicine Committee on Quality of Health Care in America Crossing the Quality Chasm: A New Health System for the 21st Century report emphasized that patients should have enough information to choose among treatment options, and the US Preventive Services Task Force has repeatedly encouraged SDM about health care services, leading to growing interest in the development and implementation of patient decision aids to facilitate SDM . As the Center for Medicare & Medicaid Services continues to accelerate toward alternative payment models, high-cost and high-volume procedures, such as breast reconstruction, may begin to be considered for bundled reimbursement, with the expectation that clinicians meet quality performance targets, such as evidence that patient preferences are incorporated into the treatment decision . Thus, it is critical that health care professionals continually investigate methods that reliably elicit patient treatment preferences, thereby enhancing SDM and improving value-based care.…”

“…46 As the Center for Medicare & Medicaid Services continues to accelerate toward alternative payment models, high-cost and highvolume procedures, such as breast reconstruction, may begin to be considered for bundled reimbursement, with the expectation that clinicians meet quality performance targets, such as evidence that patient preferences are incorporated into the treatment decision. [47][48][49][50] Thus, it is critical that health care professionals continually investigate methods that reliably elicit patient treatment preferences, thereby enhancing SDM and improving value-based care.…”

The Next Generation of Payment Reforms for Population Health – An Actionable Agenda for 2035 Informed by Past Gains and Ongoing Lessons

“…Total cost of care models, characterized by a per‐capita cap on total expenditures for Medicare beneficiaries per model year, build upon hospital global budgets and provide a vehicle for improving resource allocation at the community level to support progress for health equity. Pennsylvania's rural health model can be conceptualized as a test case for the implementation of global budgets within specific subpopulations (patients seeking care at participating rural hospitals) while Maryland's global budget revenue model has generated compelling evidence for the use of global budgets across the entire population of a state 59–61 …”

“…Pennsylvania's rural health model can be conceptualized as a test case for the implementation of global budgets within specific subpopulations (patients seeking care at participating rural hospitals) while Maryland's global budget revenue model has generated compelling evidence for the use of global budgets across the entire population of a state. [59][60][61] Third, CMS has reinforced that supporting care innovations is a key function of payment reform. To date, most demonstration models have largely been contractual innovations in health care financing as opposed to clinical or care delivery innovation.…”

Transforming Specialty Care Delivery and Payment Under Global Budgets—Insights from the Provision of Surgical Services in Maryland

“…At the systems level, separating reimbursement from volume can provide systems serving vulnerable populations—such as rural hospitals and safety-net hospitals—with predictable and sustainable financing. To embed equity into future models, policy makers can consider frameworks such as the Global Equity Model, which assesses the success of payment reforms via improvements in health rather than financial changes alone . For example, the TCOC model embeds disparities indices into its quality measures and sets population health goals for key conditions including diabetes and childhood asthma.…”