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Medicine Grand Rounds - ‘When one door closes…’ - The Challenge for Chronic Care Delivery in the Transition from Fee-for-Service to Value-Based Payment Policy

Dr. Vickrey reviews the complexities of developing a Value Based Care model, and how a dedicated Team Care approach improves patient outcomes and reduces cost, but is difficult to implement as a standard of practice for patients with chronic conditions. She discusses how a lack of coordination in clinical care leads to fragmented and crisis-oriented disease management for the family and patient. She describes incentives and key factors that can help lead organizations and clinical staff toward a sustainable health care delivery model.

Activity Details

Start Date:  July 26, 2019
End Date: July 26, 2021

You may claim CME credit for successful completion of this online course. In order to claim credit, you must follow these steps:

  1. Register for the learning activity by creating an account or logging in to your account.
  2. Click Continue to navigate to the Activity Material tab. Click View Presentation to view the recording. View the entire presentation.
  3. Return to this Activity page.
  4. Click Continue to navigate to the Evaluation tab; then click the Launch button to start the evaluation.
  5. Complete and Submit the evaluation and attestation form.

When the evaluation is submitted, you will be awarded credit. You may access your transcript for verification of participation at any time via Your Account. Need help? Visit the Support Page, send an Email, or call the Center for Learning and Professional Development at (603) 653-1234, Option 1.

  • Barbara Vickrey, MD, MPH
    Henry P. and Georgette Goldschmidt Professor and Chair of Neurology
    Icahn School of Medicine at Mount Sinai
    New York

    Dr. Vickrey received her MD from Duke University and completed her Internal Medicine internship and Neurology Residency at the University of Washington in Seattle.  After neurology residency, she earned an MPH from UCLA School of Public Health and completed post-doctoral research fellowships in the Robert Wood Johnson Clinical Scholars Program and the RAND/UCLA Center for Health Policy Study.
    The overarching goal of her research is to create and implement effective and sustainable, evidence-based interventions to improve access, quality, and outcomes for persons with neurological conditions.  For over two decades, her scholarship has focused on implementation research, translating evidence from clinical trials into routine medical practice and improved patient outcomes.
Learning Outcome

Participants will be able to explain the rationale, benefits and challenges for measuring the quality of care for chronic conditions, and describe opportunities to maximize health benefits by building, sustaining, and measuring clinical outcomes of effective care delivery models for diverse patient populations.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for ‘When one door closes…’ - The Challenge for Chronic Care Delivery in the Transition from Fee-for-Service to Value-Based Payment Policy (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Allurion. 

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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