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Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions
Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a yearlong randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a \"remote\" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members. [PUBLICATION ABSTRACT]
Journal Article
Outpatient Total Joint Arthroplasty
Purpose of ReviewOutpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program.Recent FindingsSeveral studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA.SummaryThis article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.
Journal Article
An urgent call to raise the bar in oncology
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
Journal Article
Defining the concept of fair pricing for medicines
Suerie Moon and colleagues consider what makes a fair price for both buyers and sellers
Journal Article
Cost management of construction projects
\"The cost manager/quantity surveyor plays a pivotal role in the financial and contract management of construction projects, although the exact nature of the service they provide depends on the project employer's terms of engagement. This can mean acting as consultant in a range of roles including cost and advisory services for budget setting to initiate a project, cost management through the design and construction phases, contract administration and acting as the client side project manager to oversee the entire building process.Cost Management of Construction Projects focusses on the cost manager/quantity surveyor engaged by the project client, and discusses key elements that help drive project success including measurement (based on the New Rules of Measurement published by RICS), procurement, cost planning, contract administration and project cost management. With examples, it provides a thorough guide to the role in the workplace and in the field, directly addressing the day to day situations faced by the cost manager/quantity surveyor\"-- Provided by publisher.
Book
Intelligent system in the cost control of commercial complex projects: Data-driven optimization method
Commercial complex development is featured by large scale, complex operational procedures, and prominent challenges in cost management. This study proposes a data-driven intelligent approach for optimizing cost management of commercial complex projects. First,it emphasizes the necessity of applying value engineering (VE) principles-specifically integrating the Function Analysis System Technique (FAST)-in cost control. Subsequently,a model framework is constructed and workflow procedures for construction cost management are formulated,with the core methodology being the integration of VE with a Fuzzy Analytic Hierarchy Process (FAHP) model. The pre-analysis phase involves defining VE study objectives via FAST,using FAHP to determine functional coefficients,and leveraging systematic cost analysis tools.By calculating cost and value coefficients, the model realizes real-time monitoring, thus avoiding irrational construction behaviors and supporting post-implementation reviews for continuous optimization. To validate the model's effectiveness,an existing commercial complex project was selected for optimization. Comparative analysis shows that traditional methods resulted in a total cost of 74,886,333.3 yuan across civil engineering,building construction,HVAC,and electrical engineering,while the optimized approach reduced costs to 72,740,121.5 yuan,achieving a 2.87% cost reduction.
Journal Article