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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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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Commonwealth Fund reports Colorado medical home pilot reduced ED use and costs

According to a Commonwealth Fund study, a multipayer medical home program piloted in Colorado led to a sustained reduction in emergency department use and costs over three years, although there were no overall cost savings for practices or patients. Primary care visits also decreased. The impact on quality was mixed: cervical cancer screening rates improved, yet colon cancer screenings and hemoglobin testing for diabetes patients decreased.

The goal of Patient Centered Medical Homes (PCMH) are to deliver primary care services in a proactive, coordinated manner and improve quality of care, including patient health outcomes– particularly those with multiple or complex care needs.  In addition, the PCMH goal is to lower by reducing the need for expensive hospital stays and emergency department visits.

The Commonwealth Fund research evaluated a pilot program involving 15 PCMH practices in Colorado serving approximately 98,000 patients both prior to the program’s launch and then again at two and three years.

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US spending largely driven by technology and high prices, according to a new Commonwealth Fund report

According to a new report by the Commonwealth Fund, health care spending in the U.S. far exceed that of other high-income countries, although spending growth has slowed in the U.S. and in most other countries in recent years.

The U.S. spends more public dollars on health care than all but two of the other countries.  Americans have relatively few hospital admissions and physician visits, but are greater users of expensive technologies like magnetic resonance imaging (MRI) machines.  Despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions. Mortality rates from cancer are low and have fallen more quickly in the U.S. than in other countries, but the reverse is true for mortality from ischemic heart disease. 

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Half of nation's primary care physicians have negative view of quality metrics

A new survey from The Commonwealth Fund and The Kaiser Family Foundation asked primary care providers—physicians, nurse practitioners, and physician assistants—about their experiences with and reactions to recent changes in health care delivery and payment.

  • While doctors' views are generally positive regarding the impact of health information technology on quality of care, physicians are more divided on the use of medical homes and accountable care organizations.
  • Overall, providers are more negative about the increased reliance on quality metrics to assess their performance and about financial penalties.

  • Many physicians expressed frustration with the speed and administrative burden of Medicaid and Medicare payments.
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New Commonwealth Fund scorecard notes states made little progress before ACA

According to a recent Commonwealth Fund report on State Health System Performance, in the five years preceding implementation of the Affordable Care Act’s major coverage provisions, the majority of states declined or failed to improve on two-thirds of the measures that could be tracked over time.

Commonwealth Fund researchers ranked the health systems of every state and the District of Columbia on a variety of health care measures. Of the 34 measures that could be tracked between 2007 and 2011–12, all states saw meaningful improvement on at least seven. But more than half of states lost ground on at least nine measures. 

The Commonwealth Fund scorecard covers areas such as Access and Affordability, Prevention and Treatment, Potentially Avoidable Hospital Use and Cost, and Health Lives (public health measures). 

Healthcare associated infections and diabetes complications dropping

In recent Commonwealth Fund blog post, David Blumenthal noted that a recent Center for Disease Control and Prevention report showed healthcare-acquired infections (HAIs) decreasing at the nation's hospitals, with central line associated bloodstream infections dropping 44% from 2008-2012 and some surgical site infections dropping as much as 20%. 

In a separate post, Blumenthal noted that in a separate CDC report published in the New England Journal of Medicine found that between 1990 and 2010 complication rates among US diabetic patients fell sharply.

Three US regions rank high on Commonwealth Fund scorecard

Case studies of three U.S. regions that ranked relatively high on the Commonwealth Fund’s Scorecard on Local Health System Performance, 2012, despite greater poverty compared with peers, revealed several common themes. In these communities, multistakeholder collaboration, mutually reinforcing efforts by health care providers and health plans to improve the quality and efficiency of care, a shared commitment to improve accessibility of care for underserved populations, and state policy and national and local funding programs all played a role in expanding access to care and providing resources for innovation.

Medical home plus health insurance can reduce health inequities for low income adults

Low income adults who were part of a medical home and had health insurance had fewer cost-related access problems, were more likely to be up-to-date with preventive screenings, and reported greater satisfaction with the quality of their care, according to a report by the Commonwealth Fund.
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Commonwealth Fund calls for government to develop a vision for improving population health

A Commonwealth Fund report calls for the federal government to develop a comprehensive, disciplined implementation plan that takes full advantage of the new opportunities provided by the Affordable Care Act, the American Recovery and Reinvestment Act, and the Health Information Technology for Economic and Clinical Health (HITECH) Act.
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