The health of the American public and the affordability of U.S. healthcare are both threatened by inefficiency in the U.S. healthcare system. A broad array of public and private sector payment and delivery system reforms is underway, the aim of which is to improve care, improve health and slow spending growth. The success of these reforms, however, requires reliable approaches to measuring health quality and costs while accounting for potential differences in patient risk. And while consensus has emerged that current approaches to risk adjustment and performance monitoring have serious limitations, the impending broadscale adoption of electronic health records is expected to enable the routine collection of extensive individual biomarker and patient-reported measures of risk, symptoms and functional status. The current proposal is intended to advance the science of health risk, health outcome and health system performance measurement while helping to address pressing policy needs. The project will draw on important data assembled in Core C: detailed individual risk and health status data from the Health and Retirement Survey (HRS), newly collected patient-level data from three diverse health systems, and comprehensive Medicare claims data. Under the first aim, which focuses on risk adjustment, we will develop two new risk-adjusters: (a) one based on the detailed biometric and patient-reported data collected through the HRS, and (b) a second based on integrating ZIP code and county level measures of health status, mortality and disease incidence. These will be compared to the claims-based measures currently used by Medicare for program payment, with the aim of informing both long-term and interim approaches to improving risk adjustment. Under the second aim, we will use the patient risk and biometric data collected in routine clinical practice to explore potential limitations to using these data for risk adjustment and performance measurement, including assessing the degree to which non-response bias is likely to be problematic, how their routine use in primary care practices is perceived by clinicians, and whether their use contributes to improved care for Medicare patients.
Medicare, Medicaid and private health plans are all moving toward payment systems intended to reward value: better care and lower costs. Many are concerned, however, that current approaches to risk adjustment arid outcome assessment may not be sufficiently reliable to protect patients from stinting on care or to discourage providers from avoiding sick patients. This project is intended to advance the science of performance measurement in order to inform both short- and long-term approaches to these challenges.
|Bekelis, Kimon; Gottlieb, Dan; Labropoulos, Nicos et al. (2017) The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms. J Neurosurg 126:29-35|
|Nyweide, David J; Bynum, Julie P W (2017) Relationship Between Continuity of Ambulatory Care and Risk of Emergency Department Episodes Among Older Adults. Ann Emerg Med 69:407-415.e3|
|Chandra, Amitabh; Frakes, Michael; Malani, Anup (2017) Challenges To Reducing Discrimination And Health Inequity Through Existing Civil Rights Laws. Health Aff (Millwood) 36:1041-1047|
|Bekelis, Kimon; Skinner, Jonathan; Gottlieb, Daniel et al. (2017) De-adoption and exnovation in the use of carotid revascularization: retrospective cohort study. BMJ 359:j4695|
|Bekelis, Kimon; Gottlieb, Daniel J; Su, Yin et al. (2017) Comparison of clipping and coiling in elderly patients with unruptured cerebral aneurysms. J Neurosurg 126:811-818|
|Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A et al. (2017) Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State? World Neurosurg 103:852-858.e1|
|Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2017) Association of Hospital Teaching Status with Neurosurgical Outcomes: An Instrumental Variable Analysis. World Neurosurg :|
|Norton, Edward C; Li, Jun; Das, Anup et al. (2017) Moneyball in Medicare. J Health Econ :|
|Regenbogen, Scott E; Cain-Nielsen, Anne H; Norton, Edward C et al. (2017) Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults. JAMA Surg 152:e170123|
|Missios, Symeon; Bekelis, Kimon (2017) Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay. Neurosurgery :|
Showing the most recent 10 out of 239 publications