Research Roundup - November 2017

Alaska

Alaska Joins the Collective Medical Network for Real-Time Care Coordination

By Collective Medical Technologies | State of Reform | Nov. 9, 2017

The State of Alaska, Alaska State Hospital and Nursing Home Association and the Alaska Chapter of the American College of Emergency Physicians will join forces with Collective Medical Technologies to allow providers and plans to access data on every patient through an integrated electronic medical records system, reports State of Reform. The platform will make it easier for providers and care teams to treat the full spectrum of patient needs—physical, behavioral and social—through a coordinated and integrated approach. In Washington, Collective Medical saw a 24 percent reduction in narcotic prescriptions from the ER. Oregon saw nearly a 40 percent decrease in visits by high utilizers in the 90 days after an initial care guideline was created in their system.

California

How ‘Killer King’ Became the Hospital of the Future

By Nancy Pastor | Politico | Nov. 8, 2017

Martin Luther King Jr./Drew Medical Center closed its doors in 2007 amidst reports of patients being given the wrong drugs, preventable deaths and other incidents of mismanagement or incompetence. In its place, community leaders and elected officials created a new type of hospital, designed to serve as the hub of a wide network of neighborhood clinics that provide the day-to-day care residents need. But the new Martin Luther King Jr. Community Hospital is just one part of a larger system to improve the lives and protect the health of the community’s residents – the county is creating new senior housing, and is working with the hospital to bring healthier food options and increase jobs. Meanwhile, the hospital is working to provide more outpatient services outside its walls to support the county in revitalizing the community.

Kentucky

WellCare Targets Opioid Prescribing in Kentucky Medicaid Program

By Maria Castellucci | Modern Healthcare | Nov. 11, 2017 

Kentucky has been hugely affected by the opioid abuse epidemic. Last year, 623 state residents died from the opioid fentanyl, up 6 percent from 2015. In 2015, the state experienced the third-highest rate of drug overdose deaths in the country, according to an article in Modern Healthcare. WellCare, one of the state's Medicaid insurers, has created a program that monitors members who are prescribed opioids. Program participants are connected to one physician, one pharmacy and then a social worker who can help with addiction treatment and support services. The hope is to tackle pharmacy shopping, which is when patients use multiple pharmacies and prescriptions to obtain the same opioids.

Minnesota

Farmer Cooperative Health Plans May Rattle Individual Market in Minnesota

By Christopher Snowbeck | Star Tribune | Nov. 14, 2017 

Minnesota farmers are sizing up a new crop of health plans after struggling for years with skyrocketing premiums and diminished insurance options, according to the Star Tribune. Lawmakers approved the new coverage available from agricultural co-ops earlier this year in legislation addressing the troubled individual insurance market under the federal Affordable Care Act.

Missouri

A Hospital Without Patients: The Cutting Edge of Healthcare is Tucked Off a St. Louis Highway Exit. And it's Eerily Quiet.

By Jasu Hu | Politico | Nov. 8, 2017 

The St. Louis-based Mercy Virtual Care Center, a virtual hospital where specialists care for patients remotely, may provide a glimpse into the future of healthcare delivery, reports Politico. Using advanced technology, Mercy Virtual is able to detect irregularities in hospitalized patients even before the bedside nurses notice the symptoms. The technology has decreased physician burnout, hospital infections and readmissions, in addition to reducing the number of days that patients spend on ventilators.

South Dakota

Home Healthcare Costs Increased in South Dakota; Overall Costs are Up

Markets Insider | Nov. 14, 2017

The cost to receive long term care services at home with a home healthcare aide has increased both nationally and in South Dakota, according to Market Insider describing findings from the Genworth Cost of Care Survey. Home is where most Americans receive long term care. Overall, the annual median cost of long term care services in South Dakota increased an average of 1.95 percent from 2016 to 2017. Although home healthcare is far less expensive than care in a facility, in South Dakota, home healthcare costs can add up to as much as $57,200 per year.  

Texas

Redesigning Hospitals with Patient Experience in Mind

By Rachel Arndt | Modern Healthcare | Nov. 11, 2017

UT Health Austin clinics have atriums, cafes and libraries with outdoor decks. Their main concourses are dotted with furnished alcoves. One thing they don't have: designated waiting rooms, according to a report in Modern Healthcare. That's because patients can either go straight to their rooms, if available, or if they arrive early, to any of those decidedly non-institutional spaces, where in the future they'll be buzzed via a smartphone app. The clinics' design may be among the more futuristic in the country, but it points to a practice sweeping all sorts of healthcare systems: using technology to facilitate a better patient experience, rather than emphasizing cosmetic changes such as waterfalls and chandeliers. Whether it's better heating, ventilation and air conditioning, large screens in patient rooms, or comfortable places to wait for an appointment, design and technology are playing a big role in patient care—and not just in the strictly medical aspects of it but in the environmental and emotional aspects as well.

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Recent Reports

Price Transparency and Physician Quality Report Card 2017

By Francois de Brantes, Suzanne Delbanco, et al. | Altarum and Catalyst for Payment Reform | November 2017

There is no overlap among states that have high scores in price transparency tools and quality transparency tools according to a report produced jointly by Altarum’s Center for Payment Innovation and Catalyst for Payment Reform. For the first time, authors combine price and quality report cards, to emphasize the importance of making available both price and quality information.  Most states continue to fail, receiving an “F” for both price and quality.  

Expensive Specialty Drugs are Forcing Seniors to Make Hard Choices

By Carolyn Johnson | Chicago Tribune | Nov. 13, 2017

There is a growing problem with Medicare prescription drug coverage for seniors who take high-priced specialty drugs: there is no cap on how much they pay. Each prescription drug plan is structured a little differently, but people with very high drug costs almost inevitably enter what's called the "catastrophic" phase of coverage, according to an article in the Chicago Tribune. The number of seniors who reach the catastrophic phase has almost doubled over a four-year period, to more than 1 million people in 2015. That trend was driven in part by a new generation of high-priced hepatitis C drugs, but includes high out-of-pocket costs for people taking drugs for cancer, multiple sclerosis, schizophrenia and HIV.

Five States Make Dramatic Strides in Patient Safety

By The Leapfrog Group | Oct. 31, 2017 

The Leapfrog Group announced the release of its Fall 2017 Hospital Safety Grades, assigning letter grades to general acute-care hospitals in the U.S. The bi-annual analysis, which ranks states according to their percentage of “A” hospitals, found significant improvements in five states since the inception of the Safety Grades in 2012. Oregon, Rhode Island, Hawaii, Wisconsin and Idaho showed the most improvement over the five-year period. The most dramatic improvement was seen in Rhode Island, which was ranked 50th in 2012 and ranked first today. Hospitals with “F” grades are located in California, Washington D.C., Florida, Illinois, Maryland, Mississippi and New York.

Price and Intensity Identified as the Major Drivers of Rising Healthcare Spending

By Joseph L. Dieleman, et al. | JAMA | Nov. 7, 2017

A new study published in JAMA reveals that healthcare spending rose by nearly $1 trillion between 1996 and 2013. The research, funded by the Peterson Center on Healthcare and conducted by the University of Washington’s Institute for Health Metrics and Evaluation, explored five drivers of this growth in spending: a growing population; an aging population; changes in disease prevalence and incidence; increases in how often people receive healthcare; and increases in the price and intensity of services. The study found that healthcare spending increased 80 percent ($934 billion) from 1996-2013, and changes in both the price and intensity of care were the biggest contributors to spending growth.   

Global Lessons in Frugal Innovation to Improve Healthcare Delivery

By Yasser Bhatti, et al. | Health Affairs | November 2017 

A 2015 global study of low-cost innovations identified five leading innovations that may improve healthcare delivery in the United States, according to Health Affairs. This report describes common themes among these diverse innovations, critical factors for their translation to the United States to improve the efficiency and quality of care, and promising trends in the United States that support the adaptation of these innovations.

Choosing Wisely: How to Fulfill the Promise in the Next 5 Years

By Eve A. Kerr, Jeffrey T. Kullgren and Sameer D. Saini | Health Affairs | Oct. 24, 2017

In 2012 the ABIM Foundation and Consumer Reports launched the Choosing Wisely campaign, inspired by the idea that professional societies and healthcare providers should take the lead in defining and motivating efforts to reduce the use of low-value care. This Health Affairs report discusses the campaign’s significant accomplishments in the past five years and summarizes the work that is needed to fulfill the promise of Choosing Wisely focusing on three main areas: identifying high-priority clinical targets, developing theory-based interventions and evaluating interventions in ways that are clinically meaningful. 

Access to Obstetric Services in Rural Counties Still Declining, with 9 Percent Losing Services, 2004-14

By Peiyin Hung, et al. | Health Affairs | September 2017

There are 28 million women of reproductive age living in rural America and there has been a 9 percent reduction in obstetric services available in these rural areas, according this Health Affairs article by researchers at the University of Minnesota Rural Health Research Center. Findings show that more than half of all rural U.S. counties are without a hospital that has obstetric services. These counties were also found to have a higher percentage of non-Hispanic black women of reproductive age, lower median household incomes, and more restrictive Medicaid eligibility thresholds.

Prison Healthcare Costs and Quality: How and Why States Strive for High-Performing Systems

By Pew Charitable Trusts | Oct. 18, 2017

In a first-of-its-kind report, data outlining spending trends in prison healthcare, operational characteristics of states’ prison healthcare systems, if and how states monitor quality of care, cost, and continuity of care for people leaving prison, according to The Pew Charitable Trusts and Vera Institute of Justice. This information will allow policymakers, administrators and other stakeholders to compare how states administer healthcare in their prisons and provide practical information that can help optimize policies and programs to bring value to healthcare in prisons.

State-Level Trends in Employer-Sponsored Health Insurance, 2012-2016: Chartbook and State Fact Sheets

By SHADAC | September 2017

Using data from the Medical Expenditure Panel Survey-Insurance Component, the State Health Access Data Assistance Center (SHADAC) chartbook and fact sheet highlights the experience of employer-sponsored insurance in the private sector between 2012 and 2016 at both the national and state levels. Infographics of key characteristics at a state-level are also available. 

Comparing Healthcare Financial Burden with an Alternative Measure of Unaffordability

By Edward S. Kielb, Corwin N. Rhyan, and James A. Lee | Inquiry | Oct. 4, 2017

Delaying or not getting needed medical care is strongly correlated to insurance coverage under a high-deductible health plan, depression, poor perceived health as well as poverty, according to a study in Inquiry. Findings also suggest that delaying or avoiding medical care is relatively independent from the percent of income spent on out-of-pocket costs. Suggesting that the percent of income spent on out-of-pocket healthcare costs may not be a good measure of healthcare affordability, and encouraging the expansion of the definition of financial barrier to factors beyond expenditures.
 
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Commentary/News

Uwe Reinhardt

By Lynn Quincy | Healthcare Value Hub | Nov. 27, 2017

The Hub staff joins the chorus of those shaken and saddened by the passing of Uwe Reinhardt. As so many have already noted, he was a sought-after speaker because he made economics about people not just numbers and dollars. He was unwavering in his devotion to the idea that access to healthcare should be the right of all citizens yet firmly grounded in the evidence at all times. To borrow from one commentator: “He didn’t hesitate to tell truth to power, and had a talent for doing so in a way that didn’t alienate the powerful.”  Who will fill his shoes?

What Level of Health Spending is “Affordable”?

By Uwe Reinhardt | JAMA | Nov. 21, 2017

In this JAMA editorial economist Uwe Reinhardt discusses the difficulty and confusion of determining personal healthcare affordability, the percentage of the gross domestic product the U.S. can afford to spend on healthcare, or the level of spending on Medicare that is sustainable. Reinhardt reviews articles by Emanuel, et al., that proposes a new affordability index that is “compact and easy to calculate,” according to Reinhardt.

Most States Have Their Own Value-Based Payment Programs, Report Says

By Les Masterson | HealthcareDIVE | Nov. 13, 2017 

A report from Change Healthcare found that more than 40 states have a plan or strategy that involves value-based payments, half of which include multiple payers and only seven states have little or no value-based payment structure, according to an article in HealthcareDIVE. Most of these initiatives started in within the last five years and some are still in the rollout stages.  

CMS Cancels Planned Home Health Payment Model

By Virgil Dickinson | Modern Healthcare | Nov. 1, 2017 

CMS is canceling plans for a pay model it hoped would overhaul Medicare home health payment. According to an article in Modern Healthcare, under the nixed home health groupings model, Medicare payments would have been based on patient characteristics rather than the number of visits for various forms of therapy. The new system would boost payment for skilled-nursing and home health aide visits for medically complex patients. Providers argued the model would shrink beneficiary access to all types of needed services and lead to many home health agencies shutting down.  

Trump Health Agency Challenges Consensus on Reducing Costs

By Abby Goodnough and Kate Zernike | New York Times | Nov. 12, 2017 

Chipping away at mandatory payment programs have the potential to affect cost and quality for many more people than repealing the Affordable Care Act, because private insurers tend to follow Medicare, according to an article in The New York Times. While the Trump administration has slowed the impact of provider payment reforms in Medicare, it has yet to replace the payment model with any substantial change.

Building Blocks for Addressing Social Determinants of Health

By Stuart Butler | JAMA Forum | Oct. 5, 2017

Evidence shows that the U.S. remains an outlier among industrialized countries in dollars spent on medical care relative to social services. In an article in JAMA Forum, Stuart Butler makes the argument that a few basic steps are needed to create an environment that will allow for the focus to switch from medicine to health. First, make the case with more research, then develop better techniques to show how increases in social services leads to better health, next develop new business models that incentivize health, and finally improve agency coordination and budget flexibility at all levels of government.

Is Healthcare a Right?

By Atul Gawande | The New Yorker | Oct. 2, 2017

Atul Gawande explores the question whether healthcare is a right in the United States in this New Yorker article. He talks of how opinions on repealing, replacing or repairing the Affordable Care Act continues to produce divisions in a small Ohio town but finds some common ground that could be a path forward.