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New Commonwealth Fund-sponsored research dramatically illustrates Medicare is not a proxy for health spending overall. For one thing, the drivers are different. Private insurance spending is driven by provider prices, rather than the volume of health care services (Medicare's primary driver). Specifically, the level of hospital prices within regions is the primary driver of variation in health care spending for the privately insured. The research reveals prices at hospitals in monopoly markets are 15 percent higher than those in markets with four or more hospitals. The researchers have a website devoted to their findings: www.healthcarepricingproject.org. (Commonwealth Fund blog post; the study)

Kaiser Permanente plans to establish a medical school in Southern California. Classes will begin in 2019. Kaiser Chief Executive Bernard Tyson strongly believes Kaiser's technology-driven, evidence-based model of coordinated care is the answer for what ails the U.S. medical system; he said teaching that approach to young doctors could accelerate change across the country, according to the LA Times. Christine K. Cassel, MD, will be joining the team responsible for designing what Kaiser Permanente is calling an "innovative new approach" to training the physicians. (LA Timesannouncement)

California now allows physicians to prescribe lethal medications to certain patients who ask for them. Dr. Carin van Zyl, head of palliative care medicine at Los Angeles County-USC Medical Center, says although she understands the desire for an "escape hatch" she is not sure she will be able to "pull the trigger." She says there should be more advocacy for palliative care rather than assisted suicide. According to Kaiser Health News, palliative care doctors say the law underscores the need to raise awareness among doctors and patients about what they do. "I don't think a lot of people even know palliative care exists," she says. (Kaiser Health News 
This is the last issue before the new year;
H2R Minutes
is taking a hiatus for the holidays.
Look for your next one on Jan. 6, 2016.

Happy Holidays!
Innovation & Transformation 
Rivals Baylor Scott & White Health System and Texas Health Resources, the biggest hospital chains in north Texas, want to keep people out of the hospital, and they are focusing on population health. By Jan. 1, more than 400,000 of Baylor's 2.2 million patients are expected to be part of a new care system in which coordinators contact them to ensure they are taking their medicines and getting preventive care, Dallas Morning News reports. Texas Health Resources is part of the Blue Zones campaign to address lifestyle diseases by getting residents to eat less, exercise more and find spiritual fulfillment. (Dallas Morning News)
Alameda County, Calif., tackles mental health by empowering faith communities and other groups. It has provided $1 million to faith-based organizations to bring mental health services to underserved communities. Among them: New Revelation Community Church, where Rev. Donna Allen is working on strengthening the community response among the African-American population, which is 20 percent more likely to experience serious mental health problems. "I think it helps, especially if I don't have the stigmas and I don't have issues with someone having a mental health condition... The next step is connecting them with resources and following up with them, encouraging them," Allen said. (Kaiser Health News

Children with access to long-term primary care stay healthier and their cost of care is lower, according to a study published in JAMA Pediatrics. Patients with access to primary care for two years--provided within a Medicaid ACO--led to children spending nearly 41 percent fewer days in inpatient care than those who didn't. Researchers found continuous access to primary care translated to a 16 percent reduction in costs. "Our findings suggest significant and durable inpatient health care resource use and cost reductions associated with longer attribution to the ACO, where attribution is a proxy for exposure to consistent primary care within the ACO." (FiercePracticeManagement; JAMA Pediatrics)
Some scientists are addressing the challenges posed by an aging population through robotics. The University of Illinois' Dr. Naira Hovakimyan is experimenting with drones to adapt them for household chores. Former Microsoft software designer Tandy Trower is working on a four-foot-tall rolling robot, Roby, which is designed to monitor the health of its human companion, assisting with tasks such as keeping track of medicines. However, some seniors are not thrilled about the idea. A 91-year-old woman at the M.I.T. Media Lab presentation of Jibo, an internet-connected tabletop robot, said "If Jibo were my last friend, I would be very depressed." (The New York Times)
Consumers & Providers
The number of Americans who say their usual source of health care is a facility rather than a specific clinician has increased, "a worrying sign that fewer people are reaping the benefits of a continuous relationship with a personal physician," according to research from the Robert Graham Center and published in American Family Physician. Just what the findings mean isn't certain, says researcher Anuradha Jetty. "The advent of patient-centered medical homes, broader primary care teams, and increased virtual contact may help to explain these findings and represent opportunities for improved outcomes." (Forbes; American Family Physician; announcement)
Most opioids are prescribed by family doctors and general practitioners, according to a research letter published in JAMA Internal Medicine. Researchers studied prescriptions written by 808,020 physicians reimbursed by Medicare in 2013. Family physicians wrote 15 million; internal medicine physicians wrote nearly 13 million. These add up to more than half of all opioid prescriptions written that year. Individually, pain management specialists wrote around 900 to 1,100 prescriptions; family physicians each wrote about 160 prescriptions during the same timeframe, but there are far more of them. "Efforts to curtail national opioid overprescribing must address a broad swath of prescribers to be effective," the researchers conclude. (Fierce Practice ManagementJAMA Internal Medicine)
A new study published in JAMA Internal Medicine found patients are dissatisfied with the care received when their doctor spends time looking at a computer screen. In 2013, 78 percent of physicians used them; 29 percent did in 2006. However, opinions on their usefulness vary. Margaret Wheeler, an internal medicine doctor at San Francisco General Hospital, says, "I have a love-hate relationship with the computer, with the hate maybe being stronger than the love. I use YouTube to show how to use an inhaler or I can show them what their labs are and how they've changed." (Wall Street Journal; JAMA Internal Medicine)
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New & Noted   
Good news for grumpy elves: It won't kill you to be unhappy. New research finds that unhappiness itself has no direct effect on whether people will die before their time. Researchers in the U.K. found poor health raised the risk of being unhappy, but unhappiness itself did not increase the overall risk of early death. (HealthDay; Lancet announcement)

Access improves: In March 2015, 73.9 percent of nonelderly adults reported having a usual source of care--up 3.4 percentage points from September 2013. The share of nonelderly adults who had a routine checkup in the past 12 months increased 3.4 percentage points to 64 percent during that period. Nevertheless, the researchers say gaps remain in access and affordability. (Health Affairs)
The Center for Medicare & Medicaid Innovation just released the Comprehensive Primary Care Mid-Year 2015 Snapshot. In an infographic format, it summarizes CPC initiative practices' work on the five comprehensive primary care functions: risk-stratified care management; access and continuity; planned care for chronic conditions and preventive care; patient and caregiver engagement; and coordination of care across the medical neighborhood, through July 2015. One nugget from the infographic: All 474 practices focus on at least one advanced primary care strategy to support high risk patients; of those, 124 provide integration of behavioral health services. (infographic)
MarketVoices...quotes worth reading
"It's kind of counterintuitive for a hospital CEO to say I'm trying to keep people out of the hospital and keep them well, but I truly believe that the future is moving away from the inpatient to the outpatient, to the physician's office and, ultimately, the patient's home."
-- Joel Allison, CEO of Baylor Scott & White Health, the largest nonprofit health system in Texas, quoted in
Dallas Morning News 
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Wednesday, December 23, 2015