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Documented: Fragmentation impairs outcomes, increases cost

Lack of coordination leads to poor health outcomes and higher costs, according to research published in The American Journal of Managed Care. Researchers have, for what they say is the first time, quantified and confirmed this long-held hypothesis. Patients of primary care physicians with the most-fragmented practice styles were most likely to receive care that departed from clinical best practices and had higher rates of preventable hospitalizations than those in the most-coordinated practices. "The effects were sizable, and suggest that policy makers and clinical leaders may need to pay greater attention to reducing fragmentation in order to improve care and reduce healthcare spending," researchers conclude. (The American Journal of Managed Care)



PWC report takes on outdated payment system

"The nation's healthcare payment system is an artifact of an earlier age, focusing for decades on perfecting business-to-business functions," concludes a new study from PwC's Health Research Institute. The health care industry's billing and payments system remains mired in paper and telephone calls while the rest of US business moves to seamless, mobile, digital payment. Health consumers would prefer a contemporary, retail payment structure after receiving services from hospitals and doctors, (PwC's Health Research Institute; HEALTHPopuli) 

Despite growth, telehealth reimbursement still a low priority
Medicare reimbursement for telehealth services has been on the rise since 2008, totaling $14 million in 2014 according to new CMS data. More than $12.4 million of the total reimbursements can be attributed to provider fees and more than $1.4 million to originating site fees. While the increase in reimbursement for telehealth has steadily increased for nearly a decade, concerns persist about its low position on the federal priority list. (iHealthBeat)


Innovation & Transformation

Study: Comprehensive primary care reduces costs, hospitalizations

Comprehensive primary care is associated with lower costs and fewer hospitalizations, according to research published in the Annals of Family Medicine. Doctors who are more comprehensive in their approach have Medicare patients who were less likely to be hospitalized and who had better care-seeking behavior. "Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help 'bend the cost curve,'" researchers conclude. (Annals of Family Medicine)



Chesley: It's time to heal primary care

Primary care services have been carved up, carved out and fractured for so long that some may think primary care is mortally wounded. Not Yonnie Chesley, CEO of Health to You. In a new issue brief, she offers a vision for affordable, integrated primary care services. She goes back to the drawing board, rethinking pricing structures, access to primary care and consumer-centric delivery models. "There's a growing understanding that we must fundamentally change how healthcare is paid for and delivered. If we are to achieve the Institute of Health Care Improvement's Triple Aim--better patient care and improved health for populations at a lower cost--we need something more enduring, something more effective," she says. (Carved Out, Carved Up and Broken Down: It's time to heal primary care)  



Feds pushing better consumer tools

Administration officials plan to require insurers to update provider directories at least once a month, with penalties for those who don't. In addition, insurers will be required to provide physician information in a format that software developers can use to create tools to help consumers find health plans which include their doctors. Officials also plan to create an out-of-pocket cost calculator to help consumers estimate their total annual plan costs. (New York Times


Consumers & Providers

Patients aren't adequately informed of risks 

Patients are often ill-informed about the risks of being admitted to a hospital. "Risks are not being adequately discussed by physicians with their patients," says David Magnus, director of the Stanford Center of Biomedical Ethics. A survey of 425 physician-patient pairs evaluated perceptions when patients had been admitted to the hospital for possible acute coronary syndromes. The research found these vital exchanges were marked by poor communication, overstated risk of heart attack and inflated potential benefits of hospital admission for the patient. Doctors also very rarely talked about the possible harms of hospital admissions, such as hospital-acquired infections. (US News and World Report)

Commonwealth Fund says 31 million Americans underinsured 

Thirty-one million working-age adults in the U.S. who had health insurance coverage all year were estimated to be underinsured in 2014, according to a Commonwealth Fund report released Tuesday. People are considered underinsured if they have had health insurance for a full year, but have high deductibles or out-of-pocket expenses relative to their income. Those who are underinsured struggle to pay medical bills, skip needed health care and can face serious financial consequences from unpaid medical bills such as lower credit ratings and bankruptcy, according to the report. (The Hill) 
According to a new GAO report, in each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. The least expensive 50 percent of Medicaid-only enrollees accounted for less than 8 percent of such expenditures. (GAO reportA&B Healthcare Week in Review)
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New & Noted   

All fixed? Optum, tapped to rescue HealthCare.gov in the fall of 2013, announced Thursday that its work is done. "Having achieved the goal of making HealthCare.gov a stable and reliable platform for people seeking coverage, Optum will not rebid to continue the role of senior adviser," says spokesman Matt Stearns. (Wall Street Journal)



Avoiding the Cadillac tax: About 62 percent of companies facing the "Cadillac tax" say they are changing their coverage to avoid the extra levy, according to a survey of about 600 members of the International Foundation of Employee Benefit Plans. Only about 2.5 percent of companies that would be hit by the tax said they plan to pay it. (The Hill)



Pass it on: Insurers are passing on the Health Insurance Providers Fee. The logic of the fee was simple: Because insurers would gain so many new customers, they should help pay for the expansion. But according to the Associated Press, insurers say they have raised prices for individual and small business customers, and now they're raising their prices to state Medicaid programs. (Associated Press)



AHRQ's interactive Care Coordination Measures Database, based on its Care Coordination Measures Atlas, is now live. It's intended to assist evaluators and researchers interested in care coordination measurement. Users of the database can compare more than 60 validated care coordination measurement tools found in the Database, many of which are intended for ambulatory care settings, to identify those that are most appropriate for their needs. (AHRQ)


MarketVoices...quotes worth reading


"A horse-and-buggy in a world contemplating driverless cars, the healthcare industry's consumer billing and payment system is an inefficient antique." -- PwC Health Research Institute report, Money matters: Billing and payment for a New Health Economy 


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Editorial Team
Roxanna Guilford-Blake
Sandy Mau




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Wednesday, May 20, 2015































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