Value-based Healthcare: Part 1—Designing and Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Keswani, Aakash; Koenig, Karl; Bozic, Kevin J.

doi:10.1007/s11999-016-4999-5

Cited by 42 publications

(23 citation statements)

References 3 publications

(3 reference statements)

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“…Consistent with the principle of ''downstreaming'' care [7], all patients seen in the IPU will initially be evaluated by a specialty-trained orthopaedic nurse practitioner or physician assistant (termed an ''associate provider''). The associate provider will review information collected prior to the visit with the patient and help the patient understand which treatment options may be appropriate based on her preclinic PROs, level of patient activation, and chronic comorbidities.…”

Section: Ipu In Practicementioning

confidence: 99%

“…Last month [7], we highlighted the importance of measuring performance in order to optimize value. These data will also be critical for orthopaedic providers and payors to develop population-level, risk-sharing contracts.…”

Section: Payment and Contracting Approachesmentioning

confidence: 99%

“…L ast month, we introduced the integrated practice unit (IPU)-a patient-centered, value-based, multidisciplinary care model-designed to treat conditions over the full care cycle [7]. This month, we focus on: (1) One institution's plan for implementing IPUs, (2) potential obstacles to adopting this approach, and (3) approaches for addressing those obstacles.…”

mentioning

confidence: 99%

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Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Keswani

Koenig

Ward

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Section: Ipu In Practicementioning

confidence: 99%

Section: Payment and Contracting Approachesmentioning

confidence: 99%

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Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Keswani

Koenig

Ward

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

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“…Health systems have responded to these challenges with clinical and financial innovations. Clinical innovations include new models of care coordination, joint clinical guidelines for MCC patients and alternative delivery models which include bundling of services 10–14. Financial innovations include value-based payments and bundled payment schemes.…”

Section: Introductionmentioning

confidence: 99%

Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

et al. 2019

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ObjectiveTo (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs.DesignRetrospective cross-sectional study.SettingMount Sinai Health System, set in all five boroughs of New York City, USA.Participants192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014.MethodsWe classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected.Results61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%.ConclusionsIn this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.

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“…A recent development in healthcare is the transformation from volume-based to value-based care. 10 In terms of value (ie, patient health benefits per healthcare dollar spent), 11 most current models lack (1) an ability to measure outcomes that matter to patients, (2) transparency around measured clinical and financial outcomes, and (3) care coordination across all providers in the care pathway. According to Porter and Teisberg, 10 transformation to value-based healthcare requires a shift from silos organized by specialty to care organized around a patient's medical condition, including the whole pathway.…”

mentioning

confidence: 99%

Benchmarking Cancer Centers: From Care Pathways to Integrated Practice Units

Wind

Gonçalves

Marosi

et al. 2018

J Natl Compr Canc Netw

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Structuring cancer care into pathways can reduce variability in clinical practice and improve patient outcomes. International benchmarking can help centers with regard to development, implementation, and evaluation. A further step in the development of multidisciplinary care is to organize care in integrated practice units (IPUs), encompassing the whole pathway and relevant organizational aspects. However, research on this topic is limited. This article describes the development and results of a benchmark tool for cancer care pathways and explores IPU development in cancer centers. The benchmark tool was developed according to a 13-step benchmarking method and piloted in 7 European cancer centers. Centers provided data and site visits were performed to understand the context in which the cancer center operates and to clarify additional questions. Benchmark data were structured into pathway development and evaluation and assessed against key IPU features. Benchmark results showed that most centers have formalized multidisciplinary pathways and that care teams differed in composition, and found almost 2-fold differences in mammography use efficiency. Suggestions for improvement included positioning pathways formally and structurally evaluating outcomes at a sufficiently high frequency. Based on the benchmark, 3 centers indicating that they had a breast cancer IPU were scored differently on implementation. Overall, we found that centers in Europe are in various stages of development of pathways and IPUs, ranging from an informal pathway structure to a full IPU-type of organization. A benchmark tool for care pathways was successfully developed and tested, and is available in an open format. Our tool allows for the assessment of pathway organization and can be used to assess the status of IPU development. Opportunities for improvement were identified regarding the organization of care pathways and the development toward IPUs. Three centers are in varying degrees of implementation and can be characterized as breast cancer IPUs. Organizing cancer care in an IPU could yield multiple performance improvements.

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Value-based Healthcare: Part 1—Designing and Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Cited by 42 publications

References 3 publications

Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns

Benchmarking Cancer Centers: From Care Pathways to Integrated Practice Units

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