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Pay for Performance and Red Blood Cell Transfusion Appropriateness

IHCDirectors — Tue, 13 Sep 2011 12:03:53 +0000

P4P is a concept that was originally developed in the business world to help improve efficiency and productivity. In health care, P4P refers to a payment model that offers financial incentives to physicians and hospitals for meeting pre-established clinical performance measures. The goal is to link financial incentives, in part, to the quality and efficiency of health care provided, as opposed to current payment systems that pay providers based only on the volume of services. The following case takes a glimpse into the a P4P measure at the hospital level, specifically red blood cell transfusion appropriateness.

RBC Transfusion Case

Value Based Insurance Design

IHCDirectors — Mon, 10 Jan 2011 14:10:59 +0000

Value Based Insurance Design (VBID) represents a strategy of using attractive pricing to steer patients towards better health and, in the long term, lower overall health care costs. It focuses on pricing as a mechanism to encourage patients to use medicines beneficial to their health instead of solely attempting to dissuade them from using expensive medications. This case follows the University of Michigan’s efforts to introduce VBID to its employees.

Value Based Insurance Design

Rural Health Care

IHCDirectors — Mon, 10 Jan 2011 14:08:38 +0000

Rural communities represent nearly 20 percent of the population and are incredibly heterogeneous in their culture, population density, economic and geographic characteristics. This case aims to illustrate the challenges faced by rural populations with respect to their health care and the problems involved in the provision of such care. This case is centered on the Indian Health Service, a federal health care system responsible for the health care of nearly 2 million American Indian and Alaskan Natives across the United States.

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Patient Protection and Affordable Care Act of 2010

IHCDirectors — Mon, 10 Jan 2011 14:04:26 +0000

The Patient Protection and Affordable Care Act (PPACA) of March 2010 represents the most significant government overhaul of the U.S. healthcare system since the passage of Medicare in 1965. It includes a wide range of provisions, including expanded insurance coverage, regulation of the private insurance market, and longer-term changes to care delivery aimed at improving quality of care and containing the nation’s high and growing healthcare costs. This case examines the effects of the legislation on decisions made by individuals and their families while pursuing insurance coverage.

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Mental Health Parity

IHCDirectors — Mon, 10 Jan 2011 14:02:59 +0000

Approximately one in four adults in the United States experience a mental health disorder in a given year, and mental illness costs society over 100 billion dollars in lost productivity per year, yet mental services have historically struggled to achieve insurance coverage on par with general medical and surgical care. This case explores access to mental health care among lower-income people, and changing policies on coverage.

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Massachusetts Health Care Reform

IHCDirectors — Mon, 10 Jan 2011 14:01:25 +0000

As national health reform took center stage in the Obama administration in 2008, policymakers turned the spotlight onto Massachusetts, where a model that virtually achieved universal coverage had been pioneered two years earlier. The path that Massachusetts took resulted in near-universal coverage of its citizens. This case outlines the strengths and weaknesses of the MA health care system and its influence on the reform debate.

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High deductible health plans

IHCDirectors — Mon, 10 Jan 2011 14:00:01 +0000

A deductible is an amount of money that an individual must pay out-of-pocket before a health plan begins to cover expenses. High deductible health plans (HDHPs) are fee-for-service insurance plans with higher than normal deductibles, defined by the federal government as greater than $1200 per year for a single person or more than $2400 for a family. Proponents of these plans assert that these plans will motivate individuals to use less unnecessary care and therefore lower their overall health spending. This case explores this relatively new addition to the health insurance market.

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End of Life Care

IHCDirectors — Mon, 10 Jan 2011 13:56:03 +0000

In recent years, assisting patients with advanced care planning has become an important aspect of caring for seriously ill patients. This case provides a brief overview of prominent legislation related to the end-of-life and its introduction into the clinical setting. It also describes several topics relating to the care of patients with serious illnesses – advance directives, health care proxies, palliative care, and hospice care—and broader issues relating to end-of-life decisions, such as cost and government policy.

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Drug Development and Regulation

IHCDirectors — Mon, 10 Jan 2011 13:52:42 +0000

The FDA is charged with ensuring the efficacy and safety of a drug before allowing its distribution to the American public. This case investigates the development of Provenge, immunotherapy for prostate cancer, and the challenges it faced in passing FDA approval, choosing an appropriate price and meeting demand.

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Complementary and Alternative Medicines

IHCDirectors — Mon, 10 Jan 2011 13:51:52 +0000

Complementary and alternative medicines (CAM) are widely used. A National Health Interview Survey in 2007 revealed that 38% of American adults and 12% of children used some type of CAM in the prior 12 months. Despite high demand, rates of insurance coverage for CAM remain low. This case discusses common perspectives of CAM within the medical community and decisions made by the insurance companies when deciding whether or not to provide reimbursement for a particular medical service.

Download Complementary and Alternative Medicine in the U.S.