5.5 References & Attributions


Agency for Healthcare Research and Quality. (2011). Principles for the National Quality Strategy. Rockville, MD. https://www.ahrq.gov/workingforquality/index.html

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost. Health Affairs27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

Biles, B., Guterman, S., & Arnold, G. (2011). Medicare Advantage in the era of health reform: Progress in leveling the playing field. New York (NY): Commonwealth Fund. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2011_mar_1491_biles_medicare_advantage_era_hlt_reform_ib.pdf

Center on Budget and Policy Priorities. (2020). The far-reaching benefits of the Affordable Care Act’s Medicaid expansion. https://www.cbpp.org/research/health/chart-book-the-far-reaching-benefits-of-the-affordable-care-acts-edicaid-expansion#:~:text=Increased%20health%20coverage,and%20opportunities%20for%20economic%20mobility

Centers for Medicare & Medicaid Services. (n.d.-a). Know your rights: Emergency Medical Treament and Labor Act (EMTALA). https://www.cms.gov/files/document/emtala-know-your-rights.pdf

Centers for Medicare & Medicaid Services. (n.d.-b). Medicare FFS physician feedback program/value-based payment modifier. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram

Centers for Medicare & Medicaid Services. (n.d.-c). Deadlines and key dates: HIPAA administrative simplification compliance. https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/Downloads/Timeline-of-Key-Statutes-and-Regulations-20181116.pdf

Centers for Medicare & Medicaid Services. (n.d.-d). Capitation and pre-payment. https://innovation.cms.gov/key-concept/capitation-and-pre-payment#:~:text=Defining%20key%20terms%3A,a%20certain%20period%20of%20time.

Centers for Medicare & Medicaid Services. (2019). Accountable care organizations (ACOs). https://www.cms.gov/medicare/medicare-fee-for-service-payment/aco

Centers for Medicare & Medicaid Services. (2020). Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model. https://innovation.cms.gov/data-and-reports/2021/bpci-yr2-annual-report-findings-aag

Centers for Medicare and Medicaid Services. (2022a). Bundled payments for care improvement (BPCI) initiative: General information. https://innovation.cms.gov/innovation-models/bundled-payments

Centers for Medicare and Medicaid Services. (2022b). What are the value-based programs? https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs

Centers for Medicare and Medicaid Services. (2023). BPCI Advanced. https://innovation.cms.gov/innovation-models/bpci-advanced

Colla, C., & Skinner, J. (2020). The Affordable Care Act made healthcare (slightly) more affordable. Health Affairs. https://doi.org/10.1377/forefront.20200313.368916

Commonwealth Fund. (2010a). What will happen under health reform – and what’s next? https://www.commonwealthfund.org/publications/newsletter-article/what-will-happen-under-health-reform-and-whats-next

Commonwealth Fund. (2010b). Timeline for health care reform implementation; system and delivery reform provisions. http://www.healthedpartners.org/ceu/hr2/commonwealthhealthreformsummary.pdf

Commonwealth Fund. (2019). Health Iinsurance coverage eight years after the ACA: Fewer uninsured Americans and shorter coverage gaps, but more underinsured. Survey Brief. https://www.commonwealthfund.org/sites/default/files/2019-08/Collins_hlt_ins_coverage_8_years_after_ACA_2018_biennial_survey_sb_v2.pdf

Congressional Budget Office. (2010a). Letter to Speaker of the House, Honorable Nancy Pelosi, 20 January 2010. https://www.cbo.gov/sites/default/files/hr4872 _0.pdf

Congressional Budget Office. (2010b). H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation), 20 March 2010. https://w w w.cbo.gov/  publication/21351

Congressional Budget Office. (2012a). The health care system for veterans: An interim report. https://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/88xx/doc8892/maintext.3.1.shtml

Congressional Budget Office. (2012b). Estimates for the insurance coverage provisions of the Affordable Care Act updated for the recent Supreme Court Decision, 24 July 2012. https://www.cbo.gov/publication/43472

Cutler, D. M., Davis, K., & Stremikis, K. (2009). Why health reform will bend the cost curve. Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2009/dec/why-health-reform-will-bend-cost-curve

Duncan, I. (2014). Managing and evaluating healthcare intervention programs. Actex Publications.

Duncan, I. (2022). Value-based contracting in health care. Health Insurance. https://doi.org/10.5772/intechopen.103021

Garfield, R., Orgera, K., & Damico, A. (2019). The uninsured and the ACA: a primer-key facts about health insurance and the uninsured amidst changes to the affordable care act. Kaiser Family Foundation. https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

Graham, C., Ross, L., Bueno, E. B., & Harrington, C. (2018). Assessing the quality of nursing homes in managed care organizations: Integrating ltss for dually eligible beneficiaries. INQUIRY: The Journal of Health Care Organization, Provision, and Financing55, 0046958018800090. https://doi.org/10.1177/0046958018800090

Hardin, L., Kilian, A., & Murphy, E. (2017). Bundled payments for care improvement: Preparing for the medical diagnosis-related groups. The Journal of Nursing Administration47(6), 313-319. https://doi.org/10.1097/nna.0000000000000492

Harrington, C., Mukamel, D., & Rosenau, P. (2012). Exploring the concept of medical loss ratios (MLRs) for nursing homes. Kaiser Family Foundation. https://www.kff.org/wp-content/uploads/2013/06/8455-improving-the-financial-accountability-of-nursing-facilities.pdf

Hinton E., & Musumeci, M. (2020). Medicaid nanaged care rates andflexibilities: State options to respond to COVID-19 pandemic. Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/medicaid-managed-care-rates-and-flexibilities-state-options-to-respond-to-covid-19-pandemic/

Internal Revenue Service. (2023). Topic No. 502 medical and dental expenses. https://www.irs.gov/taxtopics/tc502

Jacobs, L., & Skocpol, T. (2010). Health care reform and American politics: What everyone needs to know. Oxford University Press.

Kaiser Family Foundation. (2011). Summary of the Affordable Care Act. https://www.kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/

Kaiser Family Foundation. (2019a). Medicaid waiver tracker: Approved and pending section 1115 waivers by state. https://www.kff.org/medicaid/issue-brief/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

Kaiser Family Foundation. (2019b). Marketplace average benchmark premiums. www.kff.org/health-reform/state-indicator/marketplace-average-benchmark-premiums/currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Magill, M. K. (2016). Time to do the right thing: end fee-for-service for primary care. Annals of Family Medicine14(5), 400-401. https://doi.org/10.1370/afm.1977

Matthews, M. L. (2016). Managed care 101: Utilization management. California Association of Physician Groups Symposium. https://www.apg.org/wp-content/uploads/2018/10/Managed-Care-101-Melanie-Lite-Matthews.pdf

McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine348(26), 2635-2645. https://doi.org/10.1056/nejmsa022615

Mercer, M. (2013). The Affordable Care Act’s insurance marketplace opens for business. AARP Bulletin. https://www.aarp.org/health/health-insurance/info-10-2013/health-insurance-marketplace.html

Muhlestein, D., Saunders, R., & McClellan, M. (2017). Growth of ACOs and alternative payment models in 2017. Health Affairs Blog28. https://www.healthaffairs.org/do/10.1377/forefront.20170628.060719/

Muhlestein, D., Saunders, R., Richards, R., & McClellan, M. (2018). Recent progress in the value journey: growth of ACOs and value-based payment models in 2018. Health Affairs Blog10. https://www.healthaffairs.org/do/10.1377/ hblog20180810.481968/full/

National Institutes of Health. (2012). Greek medicine. https://www.nlm.nih.gov/hmd/greek/greek_oath.html

Nelson, L. (2012). Lessons from Medicare’s demonstration projects on disease management and care coordination. Washington DC: Congressional Budget Office.

Peikes, D., Brown, R., Chen, A., & Schore, J. (2008). Third report to Congress on the evaluation of the Medicare coordinated care demonstration. In Final Report to Congress. Princeton, NJ: Mathematica Policy Research, Inc. www. mathematica-mpr. com/publications/PDFs/Health/MCCD_rptcongress08. pdf

Peikes, D., Chen, A., Schore, J., & Brown, R. (2009). Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA301(6), 603-618. https://doi.org/10.1001/jama.2009.126

Tolbert, J. (2010). Health reform: an overview. Kaiser Family Foundation. https://www.kff.org/archived-kaiseredu-org-tutorials/

Tolbert, J. (2015). The coverage provisions in the Affordable Care Act: An update. Kaiser Family Foundation. https://www.kff.org/report-section/the-coverage-provisions-in-the-affordable-care-act-an-update-health-insurance-market-reforms/

U.S. Department of Health and Human Services. (2011). Bundled payments for care improvement (BPCI) initiative: General information. https://innovation.cms.gov/innovation-models/bundled-payments

U.S. Department of Health and Human Services. (2022). About the Affordable Care Act. https://www.hhs.gov/healthcare/about-the-aca/index.html#:~:text=The%20Patient%20Protection%20and%20Affordable,insurance%20available%20to%20more%20people.

United Nations. (n.d.). Universal Declaration of Human Rights. https://www.un.org/en/about-us/universal-declaration-of-human-rights

United States Congress. (2010). Patient Protection and Affordable Care Act. Washington D.C. https://www.congress.gov/bill/111th-congress/house-bill/3590

Werner, R. M., Emanuel, E. J., Pham, H. H., & Navathe, A. S. (2021). The future of value-based payment: A Road Map to 2030. In: LDI-HTI Next Decade of Payment Innovation Working Group. Philadelphia, PA: Leonard Davis Institute for Health Economics University of Pennsylvania. https://ldi.upenn.edu/our-work/research-updates/the-future-of-value-based-payment-a-road-map-to-2030/

World Intellectual Property Organization. (n.d.). Patents. https://www.wipo.int/patents/en/#:~:text=In%20principle%2C%20the%20patent%20owner,without%20the%20patent%20owner’s%20consent.

Zezza, M., Abrams, M., & Guterman, S. (2011). The Innovation Center at one year: much progress, more to be done. The Commonwealth Fund Blog. https://www.commonwealthfund.org/blog/2011/innovation-center-one-year-much-progress-more-be-done


Selected content from:

  1. “Introduction to the U.S. Healthcare System” by Thomas A. Clobes is licensed under CC BY-NC-SA 4.0 by-nc-sa. Chapter 12 . https://scholarworks.calstate.edu/concern/educational_resources/nk322m064?locale=en
  2. Reprinted from United States: Health System Review 2020 , Vol 22(4), Ewout van Ginneken (ed.), Health Systems in Transition / Chapter 6 (pgs. 310-317) / Copyright 2020. Accessed January 30, 2023. https://eurohealthobservatory.who.int/publications/i/united-states-health-system-review-2020
  3. Economics – Theory Through Applicationsby Saylor Academy is licensed under CC BY-NC-SA 3.0. by-nc-sa. Chapter 16.4. https://socialsci.libretexts.org/Bookshelves/Economics/Book%3A_Economics_-_Theory_Through_Applications/16%3A_A_Healthy_Economy/16.02%3A_Supply_and_Demand_in_Health-Care_Markets.
  4. Chapter 9, Value-Based Contracting in Health Care” by Ian Duncan, found in the book “Health Insurance” (Isabel Tavares, A. Ed.), is licensed under CC BY 3.0

Click here to move on to Chapter 6: Technology in Healthcare.


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