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Industry News

Employer-sponsored plan enrollment rates hold steady

Rates of consumers enrolled in employer-sponsored health plans have remained steady over the last two years, according to a report from the U.S. Bureau of Labor Statistics. Approximately 72 percent of workers had access to employer-sponsored coverage; about 74 percent of those employees actually enrolled. While enrollment rates have remained steady since the ACA took effect, health care experts disagree on the extent to which it will affect future employer-sponsored coverage. A study by Rand Corp suggests employer-based plans saw large gains, while a Mercer study suggests otherwise. (FierceHealthPayer; Rand studyMercer Study)



Disappointing results for PCMH FQHC demonstration

A $57 million experiment to deliver better, more efficient care at federally funded health centers failed to meet its goals and is unlikely to save money, according to a new RAND Corp report commissioned by CMS. Only 69 percent of the clinics that did not drop out received medical home recognition; the goal was 90 percent. Moreover, admissions, expenses and emergency-room care rose in centers that were part of the experiment compared with those that weren't. Some experts note that the program did not provide enough funding, Kaiser Health News reports. (Kaiser Health News; RAND report)



Six states meet re-enrollment success

A recent Robert Wood Johnson Foundation report indicates six states successfully re-enrolled large numbers of residents during the second year of open enrollment on health insurance exchanges. California, Colorado, Kentucky, Maine, Rhode Island and Washington all operate their own exchanges. They faced challenges including technology glitches and disputes about the best strategy to inform consumers about enrollment options. Despite the hurdles, the states all retained at least two-thirds of 2014 enrollees. (FierceHealthPayer; RWJF study)

Innovation & Transformation 

Medicare scores a hat trick: reduced hospitalizations, deaths and costs

A recent JAMA paper shows remarkably lower rates of hospitalizations, mortality and costs among Medicare patients since 1999. Hospitalization rates have dropped by 24 percent with more than 3 million fewer hospitalizations in 2013 than in 1999. Mortality rates are 16 percent lower, equaling more than 300,000 fewer deaths per year, and costs for hospitalized patients fell by 15 percent for fee-for-service patients. Public health improvements and a focus on improving safety in health care have played key roles in reducing death rates and costs, researchers conclude. (USA Today; JAMA)



CareFirst program reports strong results

A program launched in 2011 by CareFirst BlueCross BlueShield in Maryland to better coordinate patient care has slowed its overall pace of spending, avoiding millions in costs for the company and those it insures, CareFirst BlueCross BlueShield reported Thursday. "The medical cost trends we are seeing are remarkable and energizing," said Chet Burrell, CareFirst's president and CEO, during a conference call with reporters. "Even with slowing national medical cost trends in the last few years, to see sustained overall increases as low as we are now seeing is dramatic." (Baltimore Sun)



Tailored mobile tools can promote safe medication use

Research published in the Clinical Journal of the American Society of Nephrology finds that tailored mobile health technologies can help individuals with complex chronic diseases take medications appropriately. The researchers evaluated the home-based usability of a mobile health medication inquiry system (MIS) that they designed as a patient-centered medication safeguard. The MIS application responds to study medications with three potential responses: "not safe in chronic kidney disease," "use with caution, speak with your healthcare provider" and "safe in chronic kidney disease." (announcement; Clinical Journal of the American Society of Nephrology)


Consumers & Providers

Waiting for referrals erodes confidence in physicians, study finds

If patients need more than three trips to the general practitioner to get referred for cancer tests, patients are more likely to be dissatisfied with their overall care, eroding confidence in the doctors and nurses who go on to treat and monitor them, according to an article in the European Journal of Cancer Care. "We have provided large scale evidence from a real-world setting suggesting that less prompt referral for specialist assessment after symptomatic presentation negatively affect the experience of subsequent cancer care. These realizations support efforts to increase the proportion of cancer patients who experience a prompt referral." (European Journal of Cancer Care; Science Daily)


IOM offers recommendations to improve wait times, access

A new report from the Institute of Medicine (IOM), Transforming Health Care Scheduling and Access: Getting to Now, finds tremendous variability in wait times for health care appointments. These delays can have negative effects on health outcomes, patient satisfaction, health care utilization and organizational reputation. To improve access, continuous assessment, monitoring and realigning of supply and demand are required. In addition, alternatives to in-office physician visits, including the use of non-physician clinicians and telephone consults, can often meet patients' needs. (reportannouncement)



PBGH's Kramer: Medicare can learn a lot from large employers

William Kramer of the Pacific Business Group on Health thinks Medicare could learn a lot from large employers, who are, after all, the second-largest purchaser of U.S. health care services. Large employers have introduced innovations, he writes in a Modern Healthcare commentary, but lack the market clout to drive systemwide changes. If Medicare were to adopt them, it could lead to improvement in cost and quality. The key elements are paying for value, not volume; encouraging beneficiaries to seek and use high-value providers and services; and creating and using meaningful performance measures to support consumer choice and provider quality improvement. (Modern Healthcare)

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New & Noted   

Congress ready to address behavioral health: Bills addressing behavioral health are piling up in Congress, Modern Healthcare reports, including bills to integrate behavioral health and primary-care services. (Modern Healthcare)


Is the team huddle disappearing? Fred N. Pelzman, MD, thinks it is, and it makes him sad. He writes about it in his MedPage Today column, "Building the Patient-centered Medical Home." (MedPage Today) 



Support for observation status reform: Providers are voicing support for legislation, overwhelmingly approved by Congress, requiring hospitals to notify Medicare patients when they are receiving observation care but have not been admitted. (Modern Healthcare)


Assessing value: A $5.2 million grant from the Laura and John Arnold Foundation will help the nonprofit Institute for Clinical and Economic Review expand its research evaluating whether new drugs are worth their price tags. (Wall Street Journal)


Briefing explains the CARE Act

AARP has focused its 2015 advocacy efforts on legislation entitled Caregiver Advise, Record and Enable (CARE) Act. The CARE Act outlines a process by which a family can choose a designated caregiver for a loved one, where a hospital then has the responsibility to instruct and demonstrate how to perform different medical tasks and give proper care. Elaine Ryan, AARP's vice president of state advocacy & strategic integration, discussed the bill during a recent Patient-Centered Primary Care Collaborative briefing. (PCPCC video)


MarketVoices...quotes worth reading


"Everyone would like to hear the words, 'How can we help you today?' when reaching out for health care assistance." -- Gary Kaplan, chairman and chief executive officer of Virginia Mason Health System and chair of the IOM study committee that wrote Transforming Health Care Scheduling and Access: Getting to Now, in a prepared statement


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Wednesday, August 5, 2015




































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