Vertical Integration Has Negative Impacts on Patient Outcomes
Although many health systems are moving toward vertical integration by acquiring private practices, the strategy may be hurting the bottom line and patients. A newly published study examined how vertical integration impacts patients undergoing colonoscopies and their subsequent healthcare costs using data from over 2.6 million visits.
Children with Asthma Don’t Get Enough GP Visits
A set of studies published in the Archives of Disease in Childhood and the Journal of Asthma found that patients with childhood asthma benefit from regular general practitioner (GP) visits but unfortunately do not get enough of them. Only 20% saw their GP for a majority of their visits, with less than 40% seeing their GP in the week following a hospital discharge for asthma-related reasons.
US Nursing Homes are Facing a Profitability Crisis
The American Healthcare Association (AHCA) has announced that over half of nursing homes in the US are unprofitable, leaving the future of long-term care in question. The report found that key contributors include increasing prices for drugs and medical supplies, Medicaid payments that are lower than the cost of care, and a decreased patient population.
In Search of a Better Specialty Pharmacy Experience for People with Chronic Illness
People living with chronic illness often have to jump through hoops to get the specialty medicines they need, with many expected to justify their prescriptions to payers and pharmacy benefit managers (PBMs) on a monthly basis. A new Med City News article covers how medically integrated dispensing (MID) can help patients and providers.
Six Steps to Target Social Determinants of Health and Advance Health Equity
Social determinants of health (SDoH) like socioeconomic status, race, transportation, geographic location, and educational status all factor into health outcomes but are often not addressed in care settings. In a new Medical Economics article, learn 6 ways that providers can address SDoH and promote better health for marginalized groups. The first step is by asking questions in person.
NAHC President Tells Home Care Providers to Keep an Eye on Medicare Advantage
At a webinar this week, the president of the National Association for Home Care & Hospice (NAHC) Bill Dombi said that Medicare Advantage plans are on the rise and that home care providers should pay attention. Dombi noted that there is a huge marketing force driving the boom, with big celebrity names behind it.
Inflation Might Have a Good Side? – Managed Healthcare Executive State of the Industry Survey
In its latest annual State of the Industry survey, Managed Healthcare Executive found that many respondents saw there could be a good side to inflation for the healthcare sector, despite its many negative effects. Many predict layoffs, decreases in care, increased spending, and costs being shifted to patients and their employers.
Involving Doctors in Hospital Governance Reduces Burnout and Improves Patient Outcomes
The Australian Medical Association (AMA) has released a new position statement promoting the involvement of doctors in hospital governance. The organization notes that doing so will help improve workplace cultures and thereby improve patient care and subsequent health outcomes. Moreover, their direct interactions with patients provides know-how for things like resource allocation and space planning.
Bettering Health Outcomes for Older People Through Real-World Data
Older adults account for a sizeable portion of Medicare Advantage (MA) beneficiaries, but healthcare is only one determinant of health. Non-medical benefits could help address other lifestyle and social determinants of health (SDoH). However, more data is needed to identify and address these factors. Real-world data (RWD) may be an avenue to do just that.
AJMC Staffs 2022 Favorite American Journal of Accountable Care Papers
The AJMC staff have just published their top 5 favorite articles published in The Journal of Accountable Care (AJMC) this past year. These papers covered the cost-effectiveness of virtual healthcare, how employers can get the most from high-deductible health plans, value-based care at the end of life, and more.
NHS Launches Digital Home Health Check-Up Trial
The UK’s National Health Service (NHS) is launching a trial to test its new Digital Health Check service for patients with underlying health conditions. The 2,000+ participant trial would provide patients with at-home blood test kits and have them get their blood pressure checked at a nearby pharmacy, reporting that data online to their provider. In doing so, the NHS hopes lower the pressure on clinics while expanding access to preventative care to more patients.
New CMS Rule Proposal to Improve Access to Health Information and Streamline Prior Authorization
The US Centers for Medicare & Medicaid Services (CMS) has announced a rule proposal to streamline the prior authorization process and increase access to health information for patients and providers. The rule would require payers to share data with other payers when patients change plans. In addition, it would mandate that payers establish systems and policies that would expedite the prior authorization process.
More Providers Looking to Bill for Patient Messaging
After a recent health system implemented a plan to bill patients for patient-provider messaging, what was before a free service, some providers and care systems are eyeing similar moves. The Cleveland Clinic started charging patients $50 dollars for messages that require medical expertise. Many patient groups worry that more care providers will adopt the practice, as several already have.
Community Care Hubs as an Avenue to Improve Health Outcomes
The US Department of Health and Human Services (HHS) has prioritized the need to address social determinants of health to improve health outcomes for marginalized people. In this month’s issue of Health Affairs¸ authors discuss the use of community care hubs to help improve community health outcomes.
Potential Effects of the Inflation Reduction Act on US Healthcare
The recent passage of the Inflation Reduction Act in the US signals a change on the horizon in healthcare. Certain drugs will have their Medicare prices negotiated, while some older patients will have their out-of-pocket prescription drug spending capped. These changes are part of a long-fought battle between patient advocates and pharma.
Edifecs Teams Up with Empowered Health to Streamline Prior Authorization
Prior authorization is rated as a top annoyance for providers and patients. Yesterday, November 16th, Edifecs, Inc. and Empowered-Home announced they will team up to provide a streamlined, automated approach to prior authorization through the former’s existing healthcare ecosystem consisting of payers and providers. The tool uses artificial intelligence (AI) and machine learning to make instant prior authorizations.
Major US Healthcare Organizations Recommend Several Changes to Value-Based Care Programs
A group of US healthcare organizations has asked Congress for several changes to help boost engagement in value-based care payment models as laid out in the the Medicare Access and CHIP Reauthorization Act (MACRA). The groups included the National Association of ACOs (NAACOS), the American Medical Group Association (MGMA), and the American College of Rheumatology (ACR). The program thresholds in the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) lay at the center of the organizations’ concerns.
San Diego Non-Profit and Managed Care Company Brings Free Healthcare to Unhoused People
A non-profit team of clinicians is providing comprehensive care to San Diego’s unhoused population in a partnership with Medi-Cal, a medical provider for low-income people in California, and Molina Healthcare of California, a managed care company. The team, called Healthcare in Action, is comprised of five clinicians who work five days a week to give unhoused people care for chronic conditions and, critically, mental illnesses.
Group Practices Rate Prior Authorization as Worst Regulatory Burden
The 2022 Annual Regulatory Burden Report by MGMA found that prior authorizations were the largest source of regulatory headaches for executives of group practices. Almost 82% of respondents stated that prior authorizations exacted a high burden on their practices and 89% said that their regulatory burden increased from the previous year. However, this is not the only pressing issue on respondents’ minds.
Report Identifies PCPs Driving Value-Based Care
While nearly 70% of primary care physicians have worked with some form of value-based care, a report by the Chartis Group has zeroed in on characteristics of PCPs that are driving the transition to this payment model. These “Leaders” in value-based care, who are involved in a partial- or full-risk capitation agreement, account for 21% of PCPs, according to the report.
Value-Based Care is Already Present at Community Health Centers
Federally qualified health centers (FQHCs) are key providers of healthcare to the under- and uninsured population. In a new article in Health Affairs Forefront, Amanda Pears Kelly explains how FQHCs are a model of value-based care (VBC) that may serve as a model for the Biden administration’s push for the payment model and health Equity.
Study Finds Involving Pharmacists in Hemophilia Care Results in Better Outcomes and Lower Costs
Hemophilia care often comes with a high price tag and requires a multidisciplinary care team. A newly published paper in The Permanente Journal finds that adding a pharmacist to the team can help improve outcomes and lower costs. The study examined 15 medical providers that actively involved pharmacists in hemophilia care, having them check in with patients between visits and ordering specialty lab tests.
US State of Georgia Reaches $3.3 Million Settlement with Teva in Price Fixing Lawsuit
Teva Pharmaceuticals has settled yet another lawsuit with the government of a US State, this time with Georgia. The company reached a settlement worth $3.3 million with the state, the third and most expensive settlement of its kind. The lawsuits faced by the company surrounded claims of price fixing
Getting the Best Outcomes from Value-Based Care
As the US moves towards value-based reimbursement for Medicare and Medicaid, uncertainty surrounds the logistics of such contracts. In a new article, Lavonna Bowman of Inovalon discusses the biggest questions surrounding value-based care. The first key step to improving health outcomes for patients is to clearly define the goals the care system is trying to reach.
AI-Driven Value-Based Care Must Contend with Bias
Many healthcare organizations are supporting their value-based care decision-making and research with data analytics powered by artificial intelligence (AI) and machine learning (ML). However, for these tools to help address issues of health equity, the bias in the datasets used by AI must be addressed.
