Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients

Williams, Devin V.; Liu, Tiffany C.; Zywiel, Michael G.; Hoff, Miranda K.; Ward, Lorrayne; Bozic, Kevin J.; Koenig, Karl

doi:10.1016/j.hjdsi.2018.10.001

Cited by 8 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Where: Outcomes include measures stratifi ed in Tiers 1, 2, and 3. Costs may consider costs over the complete pathway; t = time Financial outcome Direct cost savings ( Ackerman et al, 2019 ;Bernstein et al, 2019;Boltz et al, 2019 ;Bolz & Iorio, 2016 ;Chatfi eld et al, 2019 ;Dundon et al, 2016 ;Ebinger et al, 2018 ;Featherall et al, 2019;Glotzbach et al, 2018 ;Goretti et al, 2020 ;Gray et al, 2019 ;Iorio et al, 2016 ;Lee et al, 2016 ;Pelt et al, 2016 ) Indirect cost savings ( DiGioia & Greenhouse, 2012 ;Weiss et al, 2019 ) Reduced variance in cost ( Ackerman et al, 2019 ) Sustainable ( Goretti et al, 2020 ) Clinical outcome improvement Reduced complications ( Danilyants et al, 2019 ;Goretti et al, 2020 ;Rosner et al, 2018 ) Reduced mortality ( Colegate-Stone et al, 2016 ;DiGioia & Greenhouse, 2012 ;Iorio et al, 2016 ) Improved laboratories and recovered from comorbidities ( Abdulla et al, 2012 ;Goretti et al, 2020 ;Iorio et al, 2016 ;D. V. Williams et al, 2019 ) Perioperative outcomes ( J.…”

Section: Value Effect Reported By Studiesmentioning

confidence: 99%

“…B. Reduced pharmacological treatment time ( Hernandez et al, 2019 ;Kirkpatrick et al, 2015 ;Lee et al, 2016 ) Volume 66, Number ( Hernandez et al, 2019 ;Ahn et al, 2019 ;Goretti et al, 2020 ;Parker et al, 2017 ;Weiss et al, 2019 ) Improved/favorable quality of life scores ( Ahn et al, 2019 ;Iorio et al, 2016 ;Parker et al, 2017 ; Improved well-being ( Hernandez et al, 2019 ;Bateni et al, 2019 ;Goretti et al, 2020 ) Provider education and value culture Support for innovative implementations ( Boltz et al, 2019 ) Value consciousness and engagement ( Ackerman et al, 2019 ;Chatfi eld et al, 2019 ;Gustafsson et al, 2016 ;Navarro et al, 2018;Noria et al, 2015 ;Ravikumar et al, 2010 ) Replicable ( Goretti et al, 2020 ) Hospital management Increased hospital capacity ( Abdulla et al, 2012 ;Ackerman et al, 2019 ;Bolz & Iorio, 2016 ;Chatfi eld et al, 2019 ;Dundon et al, 2016 ;Featherall et al, 2019;Gabriel et al, 2019 ;Gray et al, 2019 ;Johnson et al, 2019 ;Kirkpatrick et al, 2015 ;Kulkarni et al, 2011 ;Noria et al, 2015 ;Pelt et al, 2016 ;Weiss et al, 2019 ;D. V. Williams et al, 2019 ) Improved discharge effi ciency…”

Section: Value Effect Reported By Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Value-Based Healthcare Initiatives in Practice: A Systematic Review

Zanotto¹,

Etges²,

Marcolino³

et al. 2021

Journal of Healthcare Management

View full text Add to dashboard Cite

EXECUTIVE SUMMARY Value-based initiatives are growing in importance as strategic models of healthcare management, prompting the need for an in-depth exploration of their outcome measures. This systematic review aimed to identify measures that are being used in the application of the value agenda. Multiple electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Central Register of Controlled Trials) were searched. Eligible studies reported various implementations of value-based healthcare initiatives. A qualitative approach was used to analyze their outcome measurements. Outcomes were classified according to a tier-level hierarchy. In a radar chart, we compared literature to cases from Harvard Business Publishing. The value agenda effect reported was described in terms of its impact on each domain of the value equation. A total of 7,195 records were retrieved; 47 studies were included. Forty studies used electronic health record systems for data origin. Only 16 used patient-reported outcome surveys to cover outcome tiers that are important to patients, and 3 reported outcomes to all 6 levels of our outcome measures hierarchy. A considerable proportion of the studies (36%) reported results that contributed to value-based financial outcomes focused on cost savings. However, a gap remains in measuring outcomes that matter to patients. A more complete application of the value agenda by health organizations requires advances in technology and culture change management.

show abstract

Section: Value Effect Reported By Studiesmentioning

confidence: 99%

Section: Value Effect Reported By Studiesmentioning

confidence: 99%

Value-Based Healthcare Initiatives in Practice: A Systematic Review

Zanotto¹,

Etges²,

Marcolino³

et al. 2021

Journal of Healthcare Management

View full text Add to dashboard Cite

show abstract

“…By measuring PROMs and providing patient-centered value-based care throughout patient participation in an IPU, unnecessary follow-up appointments are minimized while efficiency of care is increased. Providing quality care in as few appointments as possible is particularly important for subsets of orthopaedic patients who have difficulties obtaining access to care, such as the uninsured, the underinsured, and the older population 49,50 .…”

Section: Integrated Practice Unitsmentioning

confidence: 99%

AOA Critical Issues: Patient-Reported Outcome Measures

Makhni

Hennekes

Baumhauer

et al. 2023

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

:Patient-centered care is essential to providing high-quality value-based care. Patient-reported outcome measures (PROMs) are arguably the best tools available to orthopaedic providers for providing patient-centered care. Many clinical opportunities exist for the implementation of PROMs into routine practice, such as shared decision-making, mental health screening, and prediction of postoperative disposition. Routine use of PROMs is also an adjunct to the streamlining of documentation, patient intake, and telemedicine visits, and hospitals can aggregate PROMs for the purpose of risk stratification. Physicians can harness the power of PROMs for quality improvement initiatives and improvement of the patient experience. Despite these numerous applications, PROMs are frequently underutilized tools. Understanding the many benefits of PROMs may allow orthopaedic practices to justify investing in these valuable tools.

show abstract

“…An example of high-value care that increased access to care for vulnerable populations is a musculoskeletal integrated practice unit (IPU), which established a safety-net clinic that replaced an existing orthopaedic clinic that had used a fee-for-service model 12 . A retrospective cohort analysis showed that the IPU increased access and improved short-term surgical outcomes while reducing costs in a population of uninsured and underinsured patients who were seeking musculoskeletal care.…”

Section: Value-based Health Care In Orthopaedic Surgery: Rationale An...mentioning

confidence: 99%

Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

Lin

Bozic

Ibrahim

et al. 2022

Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

:Health-care expenses have been projected to increase from 17.7% of the U.S. gross domestic product (GDP) in 2014 to 19.6% in 2024. The unsustainable increase in health-care costs has contributed toward support for value-based health care (VBHC) reform. Contemporary VBHC reform programs relevant to orthopaedic surgery include the voluntary Bundled Payments for Care Improvement initiatives (BPCI and BPCI-Advanced) and the Comprehensive Care for Joint Replacement (CJR) program, a mandatory bundled payment program.The purported benefits of transitioning from volume-based reimbursement to value-based reimbursement include moving from a fragmented provider-centered care model to a patient-centered model, with greater care coordination and alignment among providers focused on improving value. VBHC models allow innovative strategies to proactively invest resources to promote value (e.g., the use of nurse navigators) while eliminating unnecessary resources that do not promote value. However, major concerns regarding VBHC include the absence of medical and socioeconomic risk stratification as well as decreased access for higher-risk patients.This article identifies the benefits and potential unintended consequences of VBHC reform, with a focus on joint arthroplasty. We also discuss some potential strategies to promote innovation and improve value without compromising access for vulnerable patients.

show abstract

Impact of an integrated practice unit on the value of musculoskeletal care for uninsured and underinsured patients

Cited by 8 publications

References 26 publications

Value-Based Healthcare Initiatives in Practice: A Systematic Review

Value-Based Healthcare Initiatives in Practice: A Systematic Review

AOA Critical Issues: Patient-Reported Outcome Measures

Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

Contact Info

Product

Resources

About