Cooperating for better care.

Uncategorized

Category Archives

An ACA architect skeptical of tech’s ability to improve U.S. healthcare

 

Ezekiel Emanuel, an architect of the  Affordable Care Act,  is “wildly optimistic” about the direction of the American healthcare system, reports FierceHealthcare. But he’s not particularly optimistic about technology’s ability to improve things a lot.

“Virtual medicine can’t change behavior by itself and our big problem is patient behavior change and physician behavior change,” he said at the AHIP Institute and Expo in San Diego.

He cited lower uninsured rates among adults and children and slower healthcare cost increases as critical good-news metrics since ACA’s implementation.

But, Fierce reported, he also acknowledged that the U.S. still lags behind every other developed country when it comes to cost control  and life expectancy, which he blamed on inefficiencies across the system. Fierce paraphrased him as saying that “Patients still get as many as 10 radiation treatments for a cancerous bone marrow lesion despite evidence that one is just as effective. For breast cancer patients, three weeks of intense radiation is just as effective as seven weeks, yet only one-third get the shorter duration.” He didn’t mention that ordering more and longer treatments make providers richer….

Fierce reported: “Perverse financial incentives, he argued, can be eliminated with a greater reliance in bundled payments and capitated—or risk-based—payments for primary-care providers.

“Providers that have successfully lowered costs and improved quality have done so using low-tech solutions, including care coordinators embedded alongside providers to help manage chronic care and an increased focus on behavioral health.”

To read the whole Fierce article, please hit this link.

 


Benefits of doctors discussing outcomes with patients

UPMC’s flagship facility, UPMC Presbyterian.

From NEJM Catalyst:

The University of Pittsburgh Medical Center orthopedic service line “began routine collection of patient-reported outcomes (PROs) from all patients seeking orthopedic care in 2017. In a survey of patients who had seen a foot and ankle specialist, greater shares of patients who report that their physician discussed their PROs with them reported top-box scores for physician communication and shared decision-making from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey.

“There is a correlation between PROs and patient satisfaction; patients who reported that physicians were discussing their PRO responses during office visits reported significantly better ratings of physician communication and shared decision-making.”

Among the takeaways from the survey, reports NEJM:

  1. “Patient-reported outcomes can be routinely collected and reported in the electronic health record.
  2. “Simply collecting patient-reported outcomes is not sufficient — clinicians must also discuss the responses during visits.
  3. “On average, patients who report that their patient-reported outcome responses were discussed during a visit provide higher ratings for doctor communication and shared decision-making.
  4. “Physicians may need training to discuss patient-reported outcome results with patients.”

To read the NEJM article, please hit this link.

 


Applying self-perceived ’employee capability’ concept to give physician leaders what they need to thrive

 

An athenahealth report says:

“In the late 1990s, a team of management scholars led by Harvard Business School professor Len Schlesinger came up with an important insight: Across a range of service industries, a single measurement of employees’ perceptions of their jobs can predict their performance. Called ’employee capability,’ the measurement gauges whether service workers feel they have the latitude, resources and support they need to effectively serve their customers. Since Schlesinger’s research was first published, boosting employees’ self-perceived capability has become a focus of leading service organizations and has been linked to greater customer loyalty, lower employee turnover, and higher shareholder returns.

“Healthcare is one of the nation’s largest service industries, but the concept of capability has not yet been applied to physicians in a healthcare setting. Evidence drawn from athenahealth data, however, suggest capability might be as influential in explaining physician performance as it is in other service industries.”

To read the report, please hit this link.


PwC cites consolidation, convenience care in predicting 6% rise in healthcare costs in 2019

 

FierceHealthcare reports:

“Healthcare costs will continue to rise next year, and a major culprit is the industry’s ‘merger-mania.'”

“Costs are projected to rise by about 6 percent in 2019—in line with recent years and a big improvement from a time not too long ago when prices were rising annually by double digits, according to the annual Behind the Numbers report from the PricewaterhouseCoopers Health Research Institute.

“But trends such as healthcare industry’s consolidation has stymied further progress in lowering costs, said Barbara Gniewek, health and welfare practice leader at PwC, in an interview with FierceHealthcare. At the same time, consumers are demanding more convenient access to care, and the focus on new sites of care—such as retail clinics and virtual visits—are also increasing costs as utilization rates increase.”

To read the entire article, please hit this link.

 


More states test ACO-based Medicaid payment system aimed at cutting costs

 

By PHIL GALEWITZ

For Kaiser Health News

MINNEAPOLIS — Sandy Dowland has been to the emergency room 10 times in the past year and was hospitalized during four of those visits. She has had a toe amputated and suffers from uncontrolled diabetes, high blood pressure, major depression, obesity and back pain.

But her health is not high on the 41-year-old woman’s priority list.

“I have a lot going on,” said the unemployed mother of five who lives in a homeless shelter. She said it’s a struggle just to get herself and children through each day.

Her health bills are covered by Medicaid, the state-federal health insurance program for the poor. That’s a relief for her, she said. But state officials say Medicaid is busting Minnesota’s budget, particularly with patients like Dowland and its system of paying hospitals for each admission, ER visit and outpatient test.

To ease that financial strain, Minnesota is at the forefront of a growing number of states testing a Medicaid payment system. It rewards hospitals and physician groups holding down costs by keeping enrollees healthy.

Under this arrangement, those health care providers are asked to do more than just treat medical issues such as diabetes and heart disease. They are called on to address the underlying social issues — such as homelessness, lack of transportation and poor nutrition — that can cause and exacerbate health problems.

It’s why North Memorial arranged for a community health worker and paramedic to meet Dowland on a recent weekday at a day care center for homeless families. They advised her on how to take her insulin, prodded her to use a patch to quit smoking and helped her apply for Social Security disability payments and food stamps.

“This is nice to have someone who I can talk to about everything in my life and give me access to the community resources I need,” said Dowland, who added that she puts off her own health needs in order to care for her children and look for housing and a job. “I appreciate the help because, at the clinic, the doctor doesn’t have time for this.”

North Memorial is among 21 health systems in Minnesota participating in this new model of care, called Accountable Care Organizations. ACOs get to share in money they save Medicaid by keeping spending under a budget and by reaching quality targets, such as averting hospital-acquired infections and controlling patients’ blood pressure and asthma.

The shift toward ACOs is occurring with Medicare and employer-sponsored insurance, too. But for Medicaid programs, it presents unique challenges. Medicaid enrollees, by definition, are low-income. Many have little experience navigating health systems and large numbers are homeless or dealing with mental health problems, conditions that can lead to difficulties in encouraging healthy behaviors.

“The goal [of ACOs] is really exciting to make health systems more responsive to what people need to be healthy,” said Ann Hwang, director of the center for consumer engagement and health innovation at Community Catalyst, a Boston-based consumer advocacy group. “But the jury is still out as to whether they are really moving the needle in addressing social services such as transportation, housing and food insecurity — the things we know affect people’s ability to be healthy.”

Nationwide, a dozen states are experimenting with Medicaid ACOs and 10 more are making plans for them.

About half of Minnesota’s 1 million Medicaid recipients are in ACOs, which officials said saved the state $213 million since 2013. Hospitals and doctors received $70 million of that.

In addition to North Memorial, other participating health systems include the Mayo Clinic and Hennepin Healthcare, the state’s largest safety-net provider and based in Minneapolis.

‘Going To Where The Patient Is’

For giant health systems that for years have competed by adding the latest technology or building sleek facilities, the ACOs are a huge shift. In effect, the ACOs push hospitals to address patients’ problems before they end up in the ER or operating rooms.

“We are learning to have to do a better job of going to where the patient is … as we now realize we are responsible for the patient when they are engaged with us and when they are not here,” said Robert Stroebel, who helps leads the ACO effort at Mayo Clinic.

So far, the model isn’t proving to be a panacea.

In six states using ACOs, a March federal study in found, Medicaid enrollees received more primary care services — such as doctor visits — but the program did not reduce hospital visits in most states or lower costs.

“Changing provider and beneficiary behavior may take more time than the few years this report covers,” concluded the study.

Minnesota’s experience demonstrates the challenges of changing to a new Medicaid payment system. In 2016, the latest year for which data are available, only six of the 16 ACOs were eligible to share in cost savings.

But Marie Zimmerman, Minnesota’s Medicaid director, noted the state’s program has seen a 7 percent cut in ER visits and a 14 percent reduction in hospital stays in areas where health providers participate in an ACO.

“Medicaid is 20 percent of Minnesota’s population, and we have to care about getting the best deal and the long-term fiscal ability of the program and not cutting eligibility and provider rates and benefits to show sustainability,” she said.

At Hennepin Healthcare in Minneapolis, Dr. Allison Wert examines Medicaid enrollee Rachel Rowell, who participates in the ACO.(PHIL GALEWITZ/KHN)

Struggle To Change Behaviors

The switch to ACOs accelerated efforts by hospitals and physician groups to attack so-called social determinants of health, such as the lack of stable housing and poor nutrition. But providers still struggle to change patients’ behaviors, particularly helping those with addiction and mental health problems, according to interviews with officials at several ACOs.

Doctors, nurses and social workers at Hennepin dealt with that head-on during a recent routine review of their patients. When they came to a 58-year old man suffering from alcoholism, anxiety and heart problems and living in a homeless shelter, they noted how they couldn’t get him into a primary care clinic and saw him only during frequent hospital admissions.

“Best we can hope for him is if we can facilitate a safe ending,” said Dr. Rachel Silva, a Hennepin internist, acknowledging that despite their best intentions, health providers likely would not be able to prevent his early death.

Even with teams of nurses, social workers and community health workers, Hennepin officials say they struggle to keep up with many Medicaid enrollees who have addiction problems, and many patients still go to the ER out of habit or convenience rather than the organization’s primary care clinics, which are as close as across the street.

Yet, there are success stories, too. The Mayo Clinic has started a community health worker program to help at-risk patients connect to social services such as housing and transportation.

Nancy Zein, 47, a Medicaid recipient who uses the Mayo Clinic, said having weekly meetings with community health worker Tara Nelson has been life-changing for her and her mother, who is also on Medicaid.

“She’s been a godsend,” said Zein, who noted how Nelson helped her get Social Security disability payments and her mom find affordable housing for disabled adults, as well as get both enrolled for food stamps.

“It’s made such an impact on our health,” Zein said. “My mom has depression issues, and with Tara helping us with housing, it helped her depression.”

With the opportunity to share in financial savings, North Memorial has hired additional community paramedics to visit high-risk patients. Mayo Clinic has added community health workers to help patients find housing and transportation and nurses to make home visits to patients after leaving the hospital. Hennepin set up special clinics for the most challenging Medicaid patients and sends doctors to care for patients in homeless centers, jails and the county’s mental health center — to reach people who may need help even before they are likely to end up in their ER and on Medicaid.

Nearly 20 percent of Hennepin’s adult Medicaid ACO members are homeless. In the past four years, social workers and other staff have helped more than 500 of their Medicaid patients — including in the ACO — get into public housing.

Cuts For Managed-Care Companies

The ACO model has raised concerns among managed-care companies that Minnesota and other states have used for decades to control Medicaid spending. Those companies get a monthly fee from Medicaid for each enrollee and often require those patients to seek care with doctors and hospitals that have contracts with the managed-care firm. The companies profit if they spend less on care than they receive in the state allotment.

“We are aligned with the goals … to explore innovation and provide better delivery of care,” said Scott Keefer, vice president of Minnesota Blue Cross and Blue Shield of Minnesota, which has 300,000 Medicaid members. But, he added, much of the ACO savings cited by state officials are dollars taken from managed-care company profits.

His health plan lost more than $200 million from Medicaid operations during the past two years, partly because it had to pay part of its state funding to ACOs.

“We are not magically saving money. … We are moving the financial deck chairs around,” he said.


How to benefit from design thinking

In NEJM Catalyst, Amy Compton-Phillips, M.D., and Namita Seth Mohta, M.D., look at how healthcare organizations can best benefit from design thinking. Among their observations:

“NEJM Catalyst Insights Council members say the top organizational issues that would benefit most from design thinking are workflow, for staff and patients alike, and patient-facing activities such as scheduling appointments. In written responses, survey respondents single out scheduling as a poorly designed aspect of care delivery, citing issues with skills of centralized schedulers, the need for provider input on scheduling, and an abundance of inefficiency. More executives (41%) and clinicians (39%) than clinical leaders (29%) rank patient adherence/compliance with therapy among the issues that would benefit most from design thinking approaches.”

To read their whole piece, please hit this link.

.


Study: Mandatory bundled-payment plans have little edge over voluntary ones

 

A study in Health Affairs suggests that mandatory bundled-payment programs have few advantages over voluntary one.  Fierce Healthcare, in its summary of the study, reported:

“Hospitals in voluntary and mandatory bundled-payment models vary by size and volume, but quality and ability to curb spending is largely the same, according to a new study.”

 

 


The latest on Trump efforts to kill the ACA

Please hit this link for an update from FierceHealthcare on the potential implications  for consumers and providers of the Trump administration’s latest attempts to kill the Affordable Care Act.

 


Agency cites drop in hospital-patient-safety risks

The Agency for Healthcare Research and Quality reports that efforts to reduce such hospital- patient-safety risks  as adverse drug events or falls saved 8,000 lives and $2.9 billion  in 2014-2016. The numbers came in the federal agency’s   National Scorecard on Hospital-Acquired Conditions.

The study said that the AHRQ estimated that 350,000 hospital-acquired conditions were avoided in that period, cutting the rate of such adverse events by 8 percent.

To read the piece, please hit this link.


Developing physician leaders in the new healthcare world

 

Caryn Lerman, Ph.D.,  and J. Larry Jameson, M.D., both of the University of Pennsylvania, write in NEJM Catalyst about leadership development in the new world of medicine.

Among their remarks:

“We believe it is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders….”

“Physician leaders were traditionally selected on the basis of their national prominence and excellence as master clinicians, star researchers, and revered educators. These credentials remain important, but they aren’t sufficient in the current health care climate. Given the high rate of turnover among physician leaders such as department chairs and deans, we can no longer afford to neglect the skills that are essential for leaders to succeed. We believe there is a need for a new generation of leaders who can promote strategic and cultural alignment in the face of rapid change. … We suggest that health systems focus on three key strategies for promoting the effective development of physician leaders.”

“First, such systems could build a diverse pipeline of future physician leaders from within the organization. This approach would expand the pool of potential leaders, allow emerging leaders to take on progressively increasing responsibility, and ensure that leadership strategies are aligned with the organization’s culture and priorities. …”

“Second, health systems could implement a deliberate process for rigorously mining talent pools, whether internal or external. The most promising leaders are those who not only have experience and a compelling vision but also exemplify the core values of the institution and can engage and inspire others to rally around a shared vision. Physicians are understandably passionate about their own clinical specialties and research areas, but leaders need to understand, respect, and support the diverse interests of their teams and the institution in a balanced way. Physician leaders also need to partner effectively with nonphysician colleagues, including business leaders, administrators and nurses.”

“Third, health systems could implement structured processes for ‘onboarding’ and methods for gathering feedback. For example, listening tours that allow newly appointed leaders to solicit viewpoints from current leaders, faculty, and staff are invaluable for learning cultural norms and strategic priorities for the new role. This process also serves to establish new collaborative partnerships and build credibility for the new leader.”

To read the article, please hit this link.


Page 3 of 357First...234...Last

Contact Info

info@cmg625.com

(617) 230-4965

Wellesley, Mass