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A Cochrane review supports the use of high-dose vitamin B 12 (1 mg and 2 mg daily) in elevating serum vitamin B 12 level and achieving haematological and neurological responses, even in patients with PA or with ileal resection.58 The recommendation for oral replacement is 1 mg daily for a month, and then 125 to 250 g daily as maintenance dose for patients with dietary insufficiency and food-cobalamin malabsorption, while for PA the maintenance dose is 1 mg daily.29 Vitamin B 12 does not have side-effects even when prescribed in large doses.59 However, hypokalaemia, resulting from uptake of circulating potassium by newly growing and dividing haematopoietic cells, can be severe or sometimes life-threatening

The design of the original HHVBP Model leveraged the successes and lessons learned from other CMS value-based purchasing programs and demonstrations to shift from volume-based payments to a model designed to promote the delivery of higher quality care to Medicare beneficiaries

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