1. Home
  2. medicare

medicare

Quick Guide to Primary Care First

Author/s: 
Primary Care First

Primary Care First is a voluntary five-year payment model that rewards value and quality by offering an innovative payment structure to support advanced primary care delivery. Primary Care First aims to improve quality and access to care for all patients, particularly those with complex chronic conditions. The model also aims to reduce Medicare spending by preventing avoidable inpatient hospital admissions.

Keywords 
primary care medicare medicaid PCF primary care first Application

The Primary Cares Initiative: Value-Based Redesign of Primary Care

Author/s: 
Bliss, HE, George, P, Adashi, EY

On April 22, 2019, the Centers for Medicare and Medicaid Services (CMS) rolled out the Primary Cares Initiative, a collection of voluntary payment model options in support of high value primary care.1 The first element of the initiative, Primary Care First, is to engage advanced primary care practice sites via two performance-based payment model options.1 The second element of the initiative, Direct Contracting, aims to involve larger primary care entities via three risk-assuming payment model options.

Keywords 
primary care medicare medicaid primary care first payment model

Medicare’s Direct Provider Contracting: To Primary Care And Beyond

Author/s: 
Liao, J.M., Navathe, A.S.

Direct provider contracting (DPC) is coming to Medicare. 

Under a new announcement about reforming health care payment and delivery, the Centers for Medicare and Medicaid Services (CMS) has announced forthcoming DPC models as part of the effort to “deliver value-based transformation in primary care.” In particular, the agency seeks to implement models that enable it to directly contract with providers and suppliers and hold them accountable for the cost and quality of care of defined patient populations. Direct contracting shares and extends some features of existing primary care payment reforms, such as an emphasis on financial accountability over outcomes. However, DPC differs from existing primary care payment models primarily by allowing Medicare to contract with providers for a population of beneficiaries’ entire health care spending via global capitated payments. This incorporates approaches from Medicare Advantage (through which Medicare contracts with health plans for beneficiaries’ entire health care spending), while adding flexibility and emphasis on beneficiary choice.

Keywords 
medicare medicaid direct primary care

Legal Advocacy To Improve Care For Older Adults With Complex Needs

Author/s: 
Hooper, Sarah, Parekh, Ami, Fabiny, Anne, Teitelbaum, Joel

Legal advocacy is a recognized strategy to address social factors that influence the health of populations with complex care needs. Such advocacy can improve housing stability, increase access to public benefits that support a host of social needs, assure that medical and financial proxy decision makers are in place, and reduce psychosocial distress. 

Keywords 
Elderly care elder abuse social workers home care dementia medicare elderly aged

Lung Cancer Screening: A Clinician’s Checklist

This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below must be met for the screening to be covered as a preventive service benefit under Medicare.

Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality from lung cancer. There are also potential harms associated with lung cancer screening, including a high-false positive rate and the associated need for diagnostic followup, known and unknown risks of additional testing associated with incidental findings, cumulative radiation exposure, and overdiagnosis. Shared decisionmaking is a collaborative patient-centered process in which patients and clinicians make decisions together, within the context of the best evidence and recommendations and based on the patient’s values and preferences.

Keywords 
lung cancer medicare medicaid

Medical-Legal Partnership

Author/s: 
Legal Aid Services of Oklahoma, Inc.

In Oklahoma, 1 in 5 people live in poverty and also have at least one health-harming civil legal need. Creating a system to screen for these legal needs will allow us to address problems not otherwise attended to, reducing patient stressors and saving health care partner’s money in terms of reducing illness, increasing
adjustment rate payments and reimbursement potential. The Medical-Legal Partnership (MLP) model integrates civil legal aid attorneys in health care teams to address health-harming legal needs for low-income populations.

Keywords 
poverty medicare medicaid legal services

Short- and Long-Term Outcomes after Bariatric Surgery in the Medicare Population

Author/s: 
Orestis, A. Panagiotou, Markozannes, Georgios, Kowalski, Rishi, Di, Mengyang, Bond, Dale S., Ryder, Beth A., Adam, Gaelen P., Trikalinos, Thomas A.

Introduction. We conducted a technology assessment to summarize and appraise the current evidence regarding the effectiveness and safety of bariatric surgery in the Medicare-eligible population.

Data Sources. We searched six bibliographic databases and the reference lists of published clinical practice guidelines, relevant narrative and systematic reviews, and scientific information packages from manufacturers and other stakeholders on the outcomes and prediction models of different bariatric procedures studied in the Medicare-eligible population.

Results. Of 126 eligible studies, 83 described outcomes after bariatric therapy and 43 described predictors of body weight loss or absolute body weight after bariatric therapy. We did not identify any randomized clinical trials in the Medicare-eligible population. Studies examined surgical modalities. There were no studies on endoscopically-performed bariatric procedures. Only 15 studies had a design and/or analytical approach that allowed inferences for causal treatment effects on weight loss outcomes, adverse events/complications, or other non-weightloss outcomes. Bariatric surgery in the Medicare-eligible population leads to improvements in weight loss and non-weight-loss outcomes, particularly mortality, metabolic, cardiovascular, respiratory, and musculoskeletal outcomes, and polypharmacy but the strength of evidence is low to moderate. There is moderate evidence that Roux-en-Y gastric bypass performs better compared to sleeve gastrectomy or adjustable gastric banding for metabolic, cardiovascular, and renal function outcomes and for postoperative complications. Finally, no models to predict weight loss have undergone internal or external validation.

Conclusions. Relatively few nonrandomized studies examine the comparative effectiveness and safety of bariatric therapies in the Medicare population. Large gaps remain in regard to comparisons of individual bariatric surgical procedures to each other, and very limited evidence exists in regard to patient-centered outcomes such as quality of life after surgery.

Keywords 
medicare gastric bypass weight loss bariatric surgery
Subscribe to medicare