A solution set of care redesign for all sizes of health care organizations

In a January 2018 post in NEJM Catalyst by Onil Bhattacharyya, MD, PhD, David Blumenthal, MD, MPP & Eric C. Schneider, MD, MSc, authors note that innovating in clinical care redesign involves creating new products, services, or processes which is fraught with uncertainty.

The authors make the point that given the choice, most organizations are more comfortable with the predictability of quality improvement, labeling it innovation in some cases, but shunning the risk-taking that characterizes true innovation work. 

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The Cost of Patient-Reported Outcomes

In a January 25, 2018 post in NEJM Catalyst, authors Judith F. Baumhauer, MD, MPH, Christopher Dasilva, BS, David Mitten, MD, Paul Rubery, MD & Michael Rotondo, MD outline the several options and costs of implementing patient-reported outcomes in a clinical practice.  The authors outline the costs of a custom-built, an EHR solution, and standalone commercial product, citing the costs, advantages and disadvantages of each.

 

Amazon, Berkshire Hathaway and JP Morgan Chase announce health care company

The New York Times reports that Amazon, Berkshire Hathaway and JPMorgan Chase just announced they would form an independent health care company to serve their employees.

The three companies noted the new entity would initially focus on technology to provide simplified, high-quality health care for their employees and their families, and at a reasonable cost. 

The partnership brings together three of the country’s most influential companies to try to improve a system that other companies have tried and failed to change: Amazon, the largest online retailer in the world; Berkshire Hathaway, the holding company led by the billionaire investor Warren E. Buffett; and JPMorgan Chase, the largest bank in the United States by assets.

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Drop in life expectancy in the U.S. a Reflection of the American health system

According to David Blumenthal of the Commonwealth Fund, Americans are dying younger which is a reflection of the failure of the American health system. 

Blumenthal notes that while it is easy to blame the nation’s opioid epidemic, the abysmal new life expectancy data from the Centers for Disease Control and Prevention show the data for what they are — an indictment of the American health care system.

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

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National Adolescent Drug Trends in 2017: Findings Released

In the annual Monitoring the Future study by the University of Michigan, now in its 43rd year, about 45,000 students in some 380 public and private secondary schools have been surveyed each year in this U.S. national study, designed and conducted by research scientists at the University of Michigan’s Institute for Social Research and funded by the National Institute on Drug Abuse. Students in grades 8, 10 and 12 are surveyed.

 

Highlights:

This increase in marijuana drove trends in any illicit drug use in the past year. Marijuana use among adolescents edged upward in 2017, the first significant increase in seven years. Overall, past-year use of marijuana significantly increased by 1.3% to 24% in 2017 for 8th, 10th, and 12th graders combined.

The 2017 survey also reports first-ever national, standard estimates of nicotine vaping, marijuana vaping, flavoring-only vaping, and any vaping. Previously, no national study has published estimates for vaping of specific substances for the standard time periods of past 30 days, past year, and lifetime.

Cigarette smoking by teens continued to decline in 2017. For the three grades combined, all measures (lifetime, 30-day, daily, and half-pack/day) are at historic lows since first measured in all three grades in 1991. Since the peak levels reached in the mid-1990s, lifetime prevalence has fallen by 71%, 30-day prevalence by 81%, daily prevalence by 86%, and current half-pack-a-day prevalence by 91%.

Smokeless tobacco also showed a continuing decline this year with 30-day prevalence reaching a low point for the three grades individually and combined.

In general, alcohol use by adolescents has been in a long-term decline that actually first began in the 1980s and was interrupted for a few years during the relapse phase in the substance use epidemic in the 1990s.

In 2017, however, lifetime prevalence, annual prevalence, 30-day prevalence, and daily prevalence all showed little or no change with no significant changes for any grade or for the three grades combined. This is the first time this has happened in many years and may herald the end of the long-term decline in adolescent alcohol use.

Use of inhalants significantly increased among 8th grade students in 2017. Inhalant use includes sniffing glue, gases, or sprays, and is an unusual type of substance use because it is more common among younger than older adolescents.

The opioid epidemic among adults has received much attention in recent months, and MTF offers the opportunity to see what is happening with opioid use among adolescents. Heroin use by adolescents has always been low, and did not significantly change in the 8th, 10th, or 12th grades in 2017, with annual use levels at 0.4% or lower in all three grades.

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United Health Foundation releases annual America's Health Rankings reports

United Health Foundation's America’s Health Rankings annual report is out, one of the longest-running assessment of the nation’s health on a state-by-state basis.

According to the 2017 report, the analysis looks at 35 measures covering behaviors, community and environment, policy, clinical care and outcomes data. The report also serves as a benchmark for states – and the nation – to measure progress, identify emerging trends and drive action for improving public health.

The nation is facing public health challenges, including rising rates of premature death and an uneven concentration of key health care providers.

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Are hospital readmission penalties a good idea?

According to a report in StatNews, the Medicare Hospital Readmission Reduction Program has achieved its primary goal: It has reduced readmissions. A wide body of evidence shows that readmissions began to fall in 2012, when financial penalties took full effect. They have since declined several percentage points in each of the three conditions originally included in the program, according to a Kaiser Family Foundation analysis of Medicare data.

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Leapfrog releases its 2017 top hospitals list

The Leapfrog Group on Thursday released its 2017 Top Hospitals list, recognizing 109 hospitals for excellence in hospital quality, patient safety, and efficiency.

Leapfrog President and CEO Leah Binder in a release said, "The Top Hospital award highlights American hospitals that are providing the highest quality of care to their patients." She added, "We're encouraged to see hospitals across the country and within diverse communities earn this distinction."

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America's Largest Safety-Net Health System Built A High-Performing Medicare ACO

In a recent article in the Health Affairs blog,  the NYC Health + Hospitals ACO (NYCHH ACO) reduced costs by 4–12 percent annually compared to benchmark, while continually improving quality in its first four years.  It is the only ACO in New York State to achieve shared savings in all four Medicare SSP performance years. Overall costs to Medicare have been reduced by more than $31 million, generating shared savings incentive payments of nearly $14 million.

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What a Trump election might mean for the ACA

In an article published November 9th on the Health Affairs BlogTimothy Jost, Emeritus Professor at the Washington and Lee University School of Law and a member of the Institute of Medicine, cataloged the potential ramifications of what a Trump Presidency might mean for the Affordable Care Act.  A summary of Jost's arguments are included below:

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Medicare publishes final rule on the Quality Payment Program

The Department of Health & Human Services (HHS) finalized a new payment system for Medicare clinicians that will continue to reform how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the Sustainable Growth Rate (SGR), is designed to consolidate the SGR, Meaningful Use, and the Value Modifier into a single alternative payment system.  According to the HHS press release, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

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GAO recommends priority setting to reduce quality measurement burden

The US Government Accounting Office said in a report that the Department of Health and Human Services (HHS) should comprehensively plan and set timelines in developing more meaningful quality measures, and prioritize development of electronic quality measures.  The Medicare Access and CHIP Reauthorization Act of 2015 called for GAO to examine the use of quality measures across HHS programs and private payers, with a focus on reducing burden. In the report, HHS concurs with the GAO recommendations.

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Community Health Centers, Medicaid, and payment reform

Payment reform has become a dominant issue in Medicaid policy, reflecting a broader effort among all payers to reduce spending while improving outcomes. But Medicaid faces unique challenges, including a low-income population with disproportionately high health care needs, as well as surging enrollment in states that have implemented the Affordable Care Act’s Medicaid expansion. One of the goals of payment reform in Medicaid therefore is to use payment to stimulate health care innovation for medically underserved populations who depend on safety-net providers. To meet this challenge, several Medicaid expansion states are now beginning to adapt the special federal payment policies that apply to the nation’s nearly 1,400 community health centers. 

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Obama administration issues most sweeping rules in a decade for Medicaid enrollees

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors.

For consumers the most visible change may be quality ratings intended to reflect Medicaid plans’ health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years.

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Doctors having hard time engaging with patients on end of life discussions

According to a national poll released Thursday survey by The John A. Hartford Foundation, the California Health Care Foundation and Cambia Health Foundation, doctors are having a difficult time starting end of life discussions and, when they do, aren't sure what to say.

Such discussions are becoming more important as baby boomers reach their golden years. By 2030, an estimated 72 million Americans will be 65 or over, nearly one-fifth of the U.S. population.

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CMS announces new Primary Care delivery model

Public and private payers can apply through June 1 to participate in a new medical home model that will build on the Comprehensive Primary Care model to help practices support patients with serious or chronic diseases, the Centers for Medicare & Medicaid Services announced today. 

Under the CPC+ model, CMS will partner with insurers and Medicaid agencies in up to 20 regions and up to 5,000 practices to provide monthly care management fees based on beneficiary risk tiers.  The model can accommodate up to 5,000 practices, 20,000 doctors and the 25 million people they serve.

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Medicare starts new method to pay for hip, knee replacement surgeries

Medicare on Friday launches an experiment changing how it pays for hip and knee replacements in an effort to raise quality and lower costs.  The idea is to follow patients more closely to smooth their recovery and head off unwanted complications that increase costs.

Hip and knee replacements are the most common inpatient surgery for beneficiaries, and Medicare will be using financial rewards and penalties to foster coordination among hospitals, doctors, and rehab centers. Traditional payment for such surgeries has been by tying payment to the volume of procedures.  Medicare says that Comprehensive Care for Joint Replacement Model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.

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What CMS is trying to accomplish with a new drug pricing model

The Obama administration is trying to duplicate efforts by insurance companies to manage drug prices.  The results could lead to a change in how the Centers for Medicare & Medicaid Services (CMS) spends $20 billion a year for drugs under Part B, which are those given in doctors’ offices and hospital outpatient centers. 

According to Kaiser Health News, CMS is following recent efforts by insurers such as Aetna and Cigna to only pay for drugs that work--in the long run.

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CMS announces final round of application for Next Generation ACO model

The Centers for Medicare & Medicaid Services’ (CMS) Innovation Center is accepting the second and final round of applications for its Next Generation Accountable Care Organization (ACO) model, which will begin its second performance year on Jan. 1, 2017.

The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients and allows doctors and hospitals to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.

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