Assignments Week 4
- Mini-Presentation: Bundled Payments vs. Capitation
- This week's modules explore some large-scale strategies for reducing healthcare waste. In previous weeks, we touched on the concept of "alternative payment models"; this week, we are going to look into them further, starting with the overview from the modules and concluding with an exploration of what's happening locally at UNC. In between, we ask that you become more familiar with these two larger models -- capitation and bundled payments. Provided are two HBR articles, one on capitation and one on bundled payments. Alternatively, you can swap out the bundled payments article and watch the interview with Porter and Kaplan, which is very good and gives a great breakdown of both models.
- All students: Please be prepared to discuss which you think is more feasible AND which model you'd prefer to work under. Soon we will all be applying to residency -- how much does your future institution's financial structure matter to you? Will it influence the programs to which you apply?
- Mini-Presenters: Provide an overview of the payment model to which you've been assigned. How does it work? What are challenges to implementation? Where has it been successfully implemented? What makes the model ideal (or not?) Do you believe it's feasible to see healthcare systems adopt this model? What are some considerations for health system leaders?
The Case for Capitation.pdf
How to Pay for Health Care.pdf
- Opt: Back to Narrative Medicine and the Power of the Story
- A few weeks ago, you had to the option to dive deep into the principles behind the emerging discipline, narrative medicine. Much of what narrative medicine focuses on -- listening to our patients, retelling their stories in compassionate ways, creating treatment plans that consider what's important to them -- parallels with the goals of high value care. In her article, writer Ella Saltmarshe revisits the idea of the story; how sharing narratives and experiences shows itself to be a powerful mechanism for bringing change at the macro level. She describes how stories as "light...glue...[and] as web" can be used to change systems.
- How does this idea resonate with you? (As we know, 3rd year clinical rotations requires applying our foundational knowledge with real clinical medicine; and we realize how much we start understanding medicine when we have our stories of patient care to fall back on).
- How can we take our patient stories and effect change on a larger scale? (Some ideas for group activities include "Story Slams"; see Dr. Wardrop's 2020 lecture, Week 3).
- Another point Saltmarshe brings up: we must highlight the work of mavericks, pioneers, etc. See Session 8, "Lead From Where You Stand." This is why it's important to identify and appropriately recognize HVC champions!
- Stories can help us heal wounded communities; understand others and ameliorate the inequities that plague us. How can we understand our experiences with patients, their narratives, and build a new more equitable healthcare future?
- Opt: Reality: How We are ID'ing Quality Measures in Practice
- Knowing that shifting to a value-based system creates much administrative burden on physicians, these researchers set out to look at the quality measures collected and maintained by the CMS and how much the agencies have invested in them. Notably, CMS has created a ton of quality measures but only implemented 34.8% of them. Additionally, there's evidence to suggest that coupling payment to quality measures leads to some unintended consequences. This is a really timely piece and gives another dimension to our talks on value.
CMS Quality Metrics
- Opt: Recent Insights into Bundled Payments
- The recent review looks back at various studies to ascertain the value impact made by three CMS bundled payments programs, Acute Care Episode Demonstration, the voluntary Bundled Payments for Care Improvement initiative, and the mandatory Comprehensive Care for Joint Replacement model. Their results suggest that bundled payments are helpful for mitigating cost/improving quality in joint conditions but not others. A few themes to think about:
- What are the ways these programs were evaluated for Quality?
- How was health care spending quantified?
- What were the limitations of this review? What's the impact of these limitations?
- What are the policy implications as listed in the discussion?
impact of bundled payments.pdf
Impact: Bundled Payments
- Final Project
- At UNC, students submitted their final projects to our online course program Sakai and then used the embedded commenting system to critique each other's work.
- Student feedback from the course requested that final projects be submitted earlier, with presentations integrated into the course itself.
- We encourage facilitators to make the decision that is best for their students and course objectives.