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Industry News
CMS must strengthen enrollment controls and manage fraud risk on its insurance exchanges, according to a new Government Accountability Office report. The administration has taken a "passive" approach to identifying potential fraud, it argues. The federal HIX approved subsidized coverage for 11 of 12 fictitious GAO applicants for 2014; they obtained about $30,000 in annual advance premium tax credits, plus eligibility for lower costs at time of service. The fictitious enrollees maintained subsidized coverage throughout 2014, even though GAO sent fictitious documents, or no documents, to resolve application inconsistencies. 

The Office of the National Coordinator for Health IT is calling on nurses to use a common language in EHRs, Modern Healthcare reports. Sharing a common language is essential to achieving interoperability, says ONC Chief Nursing Officer Rebecca Freeman. Even if every EHR system could send and receive data seamlessly there would still be a communication problem with nursing data, because nurses use different terminology that would need to be normalized to be understood by the different systems and their users, Freeman explains. (Modern Healthcare) 

In its new report, A Framework for Educating Health Professionals to Address the Social Determinants of Health, the Institute of Medicine has developed a framework for educating health professionals on social determinants of health. "Educating health professionals about the social determinants of health generates awareness among those professionals about the potential root causes of ill health and the importance of addressing them in and with communities, contributing to more effective strategies...," according to the accompanying study brief. (FierceHealthcare; report)

According to research published in BMJ, only 29 percent of completed clinical trials conducted by major academic centers were published within two years of completion; only 13 percent were reported on ClinicalTrials.gov. "We found noticeable variation and poor performance across leading academic medical centers in the dissemination of clinical trial results. The lack of timely reporting and publication fundamentally impairs the research enterprise, violates the commitment made by investigators to patients and funders, squanders precious time and resources, and threatens to compromise evidence-based clinical decision making." (BMJ)
Innovation & Transformation 
The Army is testing a telemedicine platform that connects non-urgent ER patients at Kentucky's Blanchfield Army Community Hospital (BACH) with Eisenhower Army Medical Center (EAMC) Telehealth Center doctors at a Georgia hospital 445 miles away. BACH ER visitors are screened on arrival; those with non-urgent issues are directed to an area where they can have a video exam with EAMC clinicians. The encounter is logged into the EMR so care management is transferred back to the primary care physician after the telemedicine visit. (Military.com)
Increased recognition of the link between psychiatric and physical illnesses--and federal funding--is moving providers to integrate primary care into mental health clinics, Kaiser Health News reports. People with severe mental illnesses are more likely to die prematurely than those without; one reason is that many don't receive regular medical care. Even when they have appointments, their doctors rarely communicate with their mental health providers. This lack of coordination can lead to medication problems, higher health costs and gaps in care. But now, providers are beginning to form partnerships aimed at improving patients' physical and mental health, and simultaneously reducing costs. (Kaiser Health News)

Mathematica's Center on Health Care Effectiveness and the Milbank Memorial Fund will host a health policy forum and webcast, Harnessing Evidence to Redesign Primary Care, March 24 at 3 p.m. Eastern. Panelists who represent perspectives of providers and state and federal governments will present practical strategies from a new report about improving the strength of evidence from ongoing evaluations. They will also discuss the kind of evidence needed to understand the implications of primary care transformation for both the general population and people with chronic care needs. Admission is free. (event details and registration)

Consumers & Providers
Health care leaders routinely talk about the importance of patient engagement, but it's evident provider organizations don't always share all the information they have with consumers to enable them to make informed decisions, HealthLeaders Magazine reports. This leaves patients to make decisions burdened by "avoidable ignorance." One reason is shared decision-making for elective procedures could negatively affect volumes. But according to experts HLM interviewed, the best interests of the patient should trump other concerns. Ensuring shared decision-making occurs across an organization often requires clinical champions to advance patient engagement. (HealthLeaders Magazine)

Overall net savings to Medicare are relatively modest, with large variations among medical homes, ACOs and bundled payments, according to a new Kaiser Family Foundation report. It's a primer that describes the framework, concepts and early results of those three alternative payment models, and reviews their goals, financial incentives, sizes (number of participating providers and beneficiaries affected), and potential beneficiary implications. It also summarizes early results with respect to Medicare savings and quality. (Kaiser Family Foundation)
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New & Noted   
Stop blaming the consumer? Analysis from the Health Care Cost Institute finds that consumer choices have limited impact on health care spending in the U.S. Less than half of health care costs are for "shoppable" services, and out-of-pocket spending on those services accounts for just 7 percent of all spending. (Kaiser Health News)

ECP list updated: CMS released a final updated list of more than 19,000 essential community providers (ECPs) to assist insurers in complying with the ECP requirements that apply to qualified health plans. ECPs serve predominantly low-income, medically underserved individuals, Timothy Jost explains on the Health Affairs Blog.Health Affairs Blog; the list)
Newcomer Oscar loses millions: Startup Oscar Health Insurance Corp. lost $105.2 million in its New York and New Jersey businesses last year. Some losses stem from the cost of starting a new health insurer. Others are related to the same challenges facing older and larger health plans. (Bloomberg)

NPR recently explored the popularity of urgent care centers and their role as a bridge between the emergency department and the primary care office. In a survey conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, most people reported going to urgent care because they believe it is more convenient and takes less time than going to their regular doctor. Twenty percent said that at least once in the past two years, they were unable to see their regular doctor when they needed medical care. (NPR; poll)
MarketVoices...quotes worth reading
"There has been a sea change in attitudes. If we are going to bend the cost curve, the integration of behavioral health care and physical health care is essential."  -- Garrett Moran, who directs an academy on the integration of behavioral health and primary care for AHRQ, quoted in Kaiser Health News

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Editorial Team
Roxanna Guilford-Blake
Sandy Mau




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Wednesday, March 9, 2016