Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief [Care Innovation Research Synthesis]
The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and ...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Sinaiko, A. D., Landrum, M. B., Meyers, D. J., Alidina, S., Maeng, D. D., Friedberg, M. W., Kern, L. M., Edwards, A. M., Flieger, S. P., Houck, P. R., Peele, P., Reid, R. J., McGraves-Lloyd, K., Finison, K., Rosenthal, M. B. Tags: Care Innovation Research Synthesis Source Type: research
Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists [Access To Specialty Care]
Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider’s question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of e...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Barnett, M. L., Yee, H. F., Mehrotra, A., Giboney, P. Tags: Access To Care, Minority Health, Safety-Net Systems Access To Specialty Care Source Type: research
Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending [Commercial Insurer Innovation]
The use of direct-to-consumer telehealth, in which a patient has access to a physician via telephone or videoconferencing, is growing rapidly. A key attraction of this type of telehealth for health plans and employers is the potential savings involved in replacing physician office and emergency department visits with less expensive virtual visits. However, increased convenience may tap into unmet demand for health care, and new utilization may increase overall health care spending. We used commercial claims data on over 300,000 patients from three years (2011–13) to explore patterns of utilization and spending for ac...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Ashwood, J. S., Mehrotra, A., Cowling, D., Uscher-Pines, L. Tags: Access To Care, Health Spending Commercial Insurer Innovation Source Type: research
Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge [Commercial Insurer Innovation]
We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians). Using four years of data on commercially insured, high-needs patients in Michigan primary care practices, we found lower spending and utilization among practices with a higher proportion of high-needs patients (more than 10 percent of the practice’s panel) compared to practices with smaller proportions. Small practices (those with one or two physicians) had lower overall spending, ...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Cross, D. A., Cohen, G. R., Lemak, C. H., Adler-Milstein, J. Tags: Commercial Insurer Innovation Source Type: research
Early Impact Of CareFirsts Patient-Centered Medical Home With Strong Financial Incentives [Commercial Insurer Innovation]
In 2011 CareFirst BlueCross BlueShield, a large mid-Atlantic health insurance plan, implemented a payment and delivery system reform program. The model, called the Total Care and Cost Improvement Program, includes enhanced payments for primary care, significant financial incentives for primary care physicians to control spending, and care coordination tools to support progress toward the goal of higher-quality and lower-cost patient care. We conducted a mixed-methods evaluation of the initiative’s first three years. Our quantitative analyses used spending and utilization data for 2010–13 to compare enrollees wh...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Afendulis, C. C., Hatfield, L. A., Landon, B. E., Gruber, J., Landrum, M. B., Mechanic, R. E., Zinner, D. E., Chernew, M. E. Tags: Physicians, Health Spending Commercial Insurer Innovation Source Type: research
Texas Medicaid Payment Reform: Fewer Early Elective Deliveries And Increased Gestational Age And Birthweight [Medicaid Innovation]
We examined the impact of this policy on clinical care practice and perinatal outcomes by comparing the changes in Texas relative to comparison states. We found that early elective delivery rates fell by as much as 14 percent in Texas after this payment policy change, which led to gains of almost five days in gestational age and six ounces in birthweight among births affected by the policy. The impact on early elective delivery was larger in magnitude for minority patients. Other states may look to this Medicaid payment reform as a model for reducing early elective deliveries and disparities in infant health. (Source: Health Affairs)
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Dahlen, H. M., McCullough, J. M., Fertig, A. R., Dowd, B. E., Riley, W. J. Tags: Maternal And Child Health, Medicaid Medicaid Innovation Source Type: research
Oregons Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures [Medicaid Innovation]
In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of t...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: McConnell, K. J., Renfro, S., Lindrooth, R. C., Cohen, D. J., Wallace, N. T., Chernew, M. E. Tags: Health Care Finance, Health Reform, Medicaid Medicaid Innovation Source Type: research
Initiative To Reduce Avoidable Hospitalizations Among Nursing Facility Residents Shows Promising Results [Medicare Innovation]
Nursing facility residents are frequently admitted to the hospital, and these hospital stays are often potentially avoidable. Such hospitalizations are detrimental to patients and costly to Medicare and Medicaid. In 2012 the Centers for Medicare and Medicaid Services launched the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, using evidence-based clinical and educational interventions among long-stay residents in 143 facilities in seven states. In state-specific analyses, we estimated net reductions in 2015 of 2.2–9.3 percentage points in the probability of an all-cause hospita...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Ingber, M. J., Feng, Z., Khatutsky, G., Wang, J. M., Bercaw, L. E., Zheng, N. T., Vadnais, A., Coomer, N. M., Segelman, M. Tags: Long-Term Care, Health Spending, Evidence-Based Medicine, Elderly Medicare Innovation Source Type: research
Innovative Oncology Care Models Improve End-Of-Life Quality, Reduce Utilization And Spending [Medicare Innovation]
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) an...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Colligan, E. M., Ewald, E., Ruiz, S., Spafford, M., Cross-Barnet, C., Parashuram, S. Tags: Access To Care, Quality Of Care, Health Spending, Elderly Medicare Innovation Source Type: research
Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use [Medicare Innovation]
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams—that is, teams led by registered nurses or lay health workers—provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; ...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Ruiz, S., Snyder, L. P., Rotondo, C., Cross-Barnet, C., Colligan, E. M., Giuriceo, K. Tags: Home Care, Medicare, Chronic Care, Health Spending Medicare Innovation Source Type: research
Impact Of The YMCA Of The USA Diabetes Prevention Program On Medicare Spending And Utilization [Medicare Innovation]
The YMCA of the USA received a Health Care Innovation Award from the Centers for Medicare and Medicaid Services to provide a diabetes prevention program to Medicare beneficiaries with prediabetes in seventeen regional networks of participating YMCAs nationwide. The goal of the program is to help participants lose weight and increase physical activity. We tested whether the program reduced medical spending and utilization in the Medicare population. Using claims data to compute total medical costs for fee-for-service Medicare participants and a matched comparison group of nonparticipants, we found that the overall weighted ...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Alva, M. L., Hoerger, T. J., Jeyaraman, R., Amico, P., Rojas-Smith, L. Tags: Medicare, Health Spending, Evidence-Based Medicine Medicare Innovation Source Type: research
Strategies For Assessing Delivery System Innovations [Promoting Innovation]
Driven by evidence of continuing gaps in health care quality and efficiency and inspired by the emergence of new value-based payment models, both large and small health care organizations are developing and deploying a wide range of care delivery innovations. But how can decision makers in these organizations determine if the innovations really improve service delivery, patient experience, clinical outcomes, or costs? Organization leaders need appropriate, timely evidence to inform their decision making. In this article we describe a range of approaches to evaluating innovations and pose key questions about the validity of...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: McGlynn, E. A., McClellan, M. Tags: Health Reform, Evidence-Based Medicine Promoting Innovation Source Type: research
Innovative Environments In Health Care: Where And How New Approaches To Care Are Succeeding [Promoting Innovation]
Organizations seeking to create innovative environments in health care need to pay attention to a number of factors. These include making available sufficient resources, notably money and physical space, but also coordination and consultation regarding intellectual property and licensing; enabling access to engineers, software developers, and behavioral scientists; making providers and patients available to innovators; having a sufficiently long-term view; and insulating the innovation group from operational demands. If there is a single essential key to success, it is making innovation a strategic priority. Academic healt...
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Bates, D. W., Sheikh, A., Asch, D. A. Tags: Health Reform, Health Spending Promoting Innovation Source Type: research
First Steps Of Repeal, Replace, And Repair [Web First]
The United States has never experienced a sea change in national health policy like that which occurred in early 2017. (Source: Health Affairs)
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Jost, T. S. Tags: Health Reform, Affordable Care Act Web First Source Type: research
For Super-Utilizers, Integrated Care Offers A New Path [Entry Point]
Many health systems continue to experiment with the best way to care for those patients who end up in the hospital most frequently. (Source: Health Affairs)
Source: Health Affairs - March 5, 2017 Category: Global & Universal Authors: Vaida, B. Tags: Access To Care, Chronic Care, Health Spending, Determinants Of Health Entry Point Source Type: research
