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This week, CMS announced Comprehensive Primary Care Plus (CPC+), a five-year model that will begin January 2017. CMS says it's the largest-ever initiative to transform primary care delivery and payment in the U.S. CPC+ will roll out in up to 20 regions; it could include 5,000 practices and more than 20,000 providers. The agency will accept payer participation proposals from April 15 through June 1 and practice applications in selected regions from July 15 through September 1. (Healthcare Dive; details from CMS) 
Medicare is often overbilled for hospice care, according to a new report from the Office of the Inspector General. These errors cost Medicare $268 million in 2012. The investigators found Medicare was paying hospices almost four times as much as it should have for some patients. The patients were receiving inpatient care when all they needed was less-expensive routine care in their homes, according to the report. Medicare sometimes paid twice for drugs: They were paid under Part D when they should have been provided by the hospice. And sometimes, the care provided was poor. (The New York Times; report)

Urgent care quality varies widely among commercial providers of virtual doctor visits, according to a study published in JAMA Internal Medicine. One in four patients received an incorrect or no diagnosis from the virtual visits. "One of the more surprising findings... was the universally low rate of [needed] testing," said lead researcher Adam Schoenfeld, MD. "[I]t may reflect the challenges of ordering or following up on tests performed near where the patient lives but far from where the doctor is, or concern about the costs." Mode of communication--Web chat or videoconference--didn't appear to make a difference. (Reuters; JAMA Internal Medicine)
It's time to standardize quality measures, AHIP CEO Marilyn Tavenner and National Coordinator for Health IT Karen DeSalvo said at a recent AHIP conference, FierceHealthPayer reports. DeSalvo noted there's been considerable progress in developing metrics, but this has led to variability, burdening providers and confusing consumers. "Letting a thousand flowers bloom is something that we started with, but we really have to start narrowing that down." Tavenner noted many current metrics were created for a fee-for-service system. "We will need new frameworks to measure quality under alternative payment systems rather than trying to retrofit existing measures into these models." (FierceHealthPayer)
Innovation & Transformation 
The care management team at Madison's St. Mary's Hospital is trying to make transitions a bit more dignified for patients--especially the poorest. That means having decent clothes to wear home or to the next facility. Social worker Debra Noell's team sorted through bags of donated clothing. They washed what was salvageable, found storage space, and the hospital's communications team ran an article in the staff newsletter about the clothes closet, asking for donations. "Once that article went out, the whole hospital embraced it," Noell says. "We haven't gone a day without somebody donating something." Most who benefit are homeless. (Hospitals and Health Networks)
UnitedHealth, the nation's largest health insurer, quietly launched Harken Health this year in Atlanta and Chicago. The independent subsidiary offers unlimited free primary care visits and 24/7 phone access. Each member has a personal health coach. This "boutique" is available only in Chicago and Atlanta, where it covers 35,000 members who joined via HIX. Harken's strategy is to get its members to seek care early to avoid costly problems down the road. (USA Today)

Research published in the Journal of Patient Experience finds an association between positive patient experience and favorable clinical outcomes in U.S. hospitals. Various theories could explain the association, says Stephen Trzeciak, MD, MPH, of Cooper Medical School of Rowan University, the lead author. "One theory is that health care providers who are diligent about providing an excellent patient experience may be similarly diligent about excellence in all aspects of patient care. Another theory is that an excellent patient experience may inspire patient confidence and adherence to a treatment plan both in the hospital and following discharge." (Journal of Patient Experience; announcement)
Consumers & Providers
Health IT falls short in improving patient medication adherence, according to a report in JMIR Medical Informatics. Health IT can help with tools such as electronic prescribing, clinical decision support, linkages between diagnosis and treatment plans and the use of patient portals. However, health IT has four "gaps" impede improvement efforts: Lack of interoperability, connectedness and reciprocity; inconsistencies in data definitions; inability to effectively use the National Drug Codes, because they aren't standardized in EHRs; and poor capture of medication management therapy in EHRs, which is often not available beyond the pharmacy. (FierceEMR; JMIR Medical Informatics)
More than half of U.S. physicians are now experiencing professional burnout, according to research published in Mayo Clinic Proceedings. Unlike other workers, more physicians are more burned out than they were three years earlier--resulting in a widening gap between physicians and U.S. workers in other fields. The level of burnout appears to predict whether physicians will decrease their hours over the next two years. (Becker's ASC Review; Mayo Clinic Proceedings)
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New & Noted   
UnitedHealth leaves Georgia, Arkansas HIXs: UnitedHealth Group has pulled out of the ACA exchanges in Georgia and Arkansas, two small and particularly unprofitable markets. Last year, the insurer had threatened to pull out of all the ACA exchanges. (The Fiscal Times)

Building transparency tools: Transparency still has a long way to go, Suzanne Delbanco and Lea Tessitore of Catalyst for Payment Reform explain in a Health Affairs Blog  post. They discuss where health policy needs to move to incorporate better transparency tools for consumers in the marketplace, and they share their specifications for such tools.(Health Affairs)
Spelling it out: CMS has changed the summary of benefits and coverage template to help consumers better navigate HIX choices. The template will include, among other thing, coverage examples that demonstrate the cost-sharing amounts in three common medical situations. (Healthcare Payer News)

A new webinar from the Patient-Centered Primary Care Collaborative, "Assessing the Practice with Patients and Families--Opportunities to Improve Patient and Family-Centered Care," is now available.  (PCPCC)
MarketVoices...quotes worth reading
"There is a societal imperative to provide physicians a better option than choosing between reducing clinical work or burning out." -- Tait Shanafelt, MD, of Mayo Clinic, quoted in Becker's ASC Review
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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, April 13, 2016