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Healthcare Utilization and the Progress of the Choosing Wisely Campaign
The right payment system will align the patient’s incentives with the provider’s incentives, said Margaret E. O’Kane, MHA. For instance, it’s no good for Medicare to use patient-centered medical homes and accountable care organizations, if patients, particularly high-need patients, do not have an incentive to use those delivery models.
On the topic of utilization, the panelists moved on to discuss the Choosing Wisely campaign. While the campaign is admirable, and some of the lists provided by specialty societies are helpful, that’s not the case across the board, O’Kane said.
Leah Binder was actually surprised that the societies were willing to put the lists together, and that they’re pushing the lists to be used in their community. But she would like to see the campaign go further.
“I mean what they focused on were tests and preventive kinds of procedures that are not the big money,” she said. For example, she was thinking about spinal surgeries and caesarean sections in mind. Binder added, “There’s a long list of very significant procedures that they did not address and so I think that’s the next step.”
Finally, the campaign isn’t measurable, so it’s difficult to tell how much progress has been made, she said. Unfortunately, O’Kane added, there are so many exceptions with Choosing Wisely that trying to measure it just is not practical.
ACOs’ Focus on Rooting Out Fraud Aligns With CMS Vision Under Oz
April 23rd 2025Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix
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April 23rd 2025For patients with complex needs and social challenges like unstable housing, the hospital has become their de facto medical home—yet each visit is a fragmented restart, without continuity, context, or a clear path forward.
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Personalized Care Key as Tirzepatide Use Expands Rapidly
April 15th 2025Using commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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