Recent Research

• Experts Debate Payment Reform

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  Payment Reform: Bundled Episodes vs. Global Payments

  There is widespread agreement that the current fee-for-service approach to paying for health care is problematic, but there is a lack of consensus on what should replace it. Medicare is pursuing bundled episode payments, and proponents like Francois de Brantes of the Health Care Incentives Improvement Institute have been laying the groundwork for implementation. But other experts, such as the Urban Institute’s Robert Berenson, worry that the current interest in bundled payments will distract policy-makers from moving more decisively away from fee-for-service. In a new paper, de Brantes and Berenson debate the benefits and drawbacks of bundled payments and global capitation.

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• Legal Protection of Protocols for Care

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  Can Clinical Guidelines Serve as Malpractice Safe Harbors?

  When physicians practice defensive medicine by ordering extra tests and procedures that have little or no benefit solely to avoid malpractice lawsuits, it can impact the quality of the care they provide and increase health care costs. But the introduction of reliable clinical practice guidelines—recommendations for optimizing patient care based on scientific evidence—holds promise for helping to reduce overutilization of unnecessary procedures and set standards of good care.

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• The Future of Measuring Patient Satisfaction and Engagement

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  Will Health Reform Improve Patient-Centeredness?

  A Robert Wood Johnson Foundation-funded paper from the Urban Institute discusses how the Affordable Care Act (ACA) places new emphasis on measuring patients’ experiences of care and using that information to improve care. The paper traces the way in which listening to the patient’s voice has grown from an ethical demand of the patient rights movement into a series of specific, measurable behaviors characterized by use of patient experience surveys. The paper examines patient engagement, patient experience of care, and overall patient centeredness within the context of the ACA and its mandates. It outlines the growing evidence of benefits from better communication between providers and patients and involving patients more closely in their care, including greater adherence to medical advice, fewer complaints, fewer malpractice claims, and improvement in patient health.

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• The Center for Medicare and Medicaid Innovation

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  The Innovation Center: One Year Later

  In its first year of operation, the Center for Medicare and Medicaid Innovation has a long list of accomplishments, yet some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems. A Robert Wood Johnson Foundation-funded paper from the Urban Institute provides a status report of the Innovation Center’s activities to date—including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs. The paper concludes with descriptions of the Center’s major initiatives to date, including those that address primary care redesign, bundled payments, ACOs, dual-eligible beneficiaries, and the health care system’s capacity for spreading innovative ideas.

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