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Over four years, Pioneer ACOs and the Medicare Shared Savings Program have improved patient outcomes while saving taxpayers $1.29 billion, CMS announced last week. Significantly, nine of the 12 Pioneer ACOs achieved 90 percent of their quality goals in 2015, with the mean quality score at 92.26 percent, up from 87.2 percent a year earlier. All 12 improved their quality scores, by an average of 21 percentage points over the four years they participated. Together, ACOs in the two programs cared for 7.7 million Medicare patients last year. (MedCityNews)

CMS issued proposed rules this week to modify the Affordable Care Act. One of the biggest changes involves risk adjustment. Starting in 2018, risk adjustment would factor in prescription drug data in addition to all the normal conditions and illnesses that are factored into someone's risk score. This move appears to be a response to insurers who have argued their members look healthier than they actually are because the program doesn't account for the medications they may be taking. Critics warn that this move could lead doctors to write unnecessary prescriptions, Modern Healthcare reports. (Modern Healthcare)

By the end of 2016, consumers will be able to self-enroll in the CommonWell network, link their health care records from wherever they receive care, and browse the data via a variety of online methods. Eight CommonWell members have announced they will support the initiative; two will make it a reality this year. Two more member organizations, providers of patient portal and personal health record technology, said they will also support the patient access initiative. MediPortal and Integrated Data Services intend to provide patient access to CommonWell health data by the end of 2016. (HealthLeaders Media)
Innovation & Transformation  
Patients receiving primary care from an integrated team of mental and physical health clinicians received better quality care than those who didn't, according to research published in JAMA. Use of integrated care teams was also associated with lower care utilization. "Integrated [care] is clearly superior ... for patients with complex mental illness and chronic medical disease," Thomas Schwenk, MD, from the University of Nevada, wrote in an accompanying editorial. But he noted this approach can be challenging in a fee-for-service world. (Becker's Hospital ReviewJAMA; editorial)

Testing bundled payments for obstetric care
Bundled payment programs for maternity care hold promise but "are in their infancy,"
Modern Healthcare reports. Such an approach could improve maternity care quality and reduce cost disparities, but payers and providers are still working out the details. The model has gained popularity in Medicare in recent years but, so far, only a handful of pilot programs exist across the U.S. Even advocates of bundled payments for maternity care warn that developing the best model is a complicated process that will require much more time before it can be implemented widely.(Modern Healthcare)
According to the National Business Group on Health, nine in 10 large employers, in states where telemedicine is legal, will make telehealth services available to their employees next year, up from seven in 10 this year. NBGH predicts that by 2019, 97 percent of large employers will offer telehealth services. (MobiHealthNewsreport announcement)
Consumers & Providers
When medical errors happen, hospitals should consider the mental health of not only the patients and their families but also the clinicians involved, Alexa Ortiz--a health scientist and a nurse--argues in a Medical Care Blog. The patient is the first priority, she says. "However, when the dust finally settles, healthcare organizations and the medical profession as a whole have to consider the mental health of healthcare employees and how what they experience at work affects their daily lives." (Medical Care Blog)
Sociodemographic factors play a bigger role than portal use in controlling hypertension among newly diagnosed patients, according to findings published in the
Journal of the American Board of Family Medicine. The study tracked follow-up care for 1,571 patients newly diagnosed with high blood pressure, using patients' EHR data compared with their use of a patient portal. Initially, researchers found portal users were more likely than nonusers to achieve blood pressure control. But once they adjusted for sociodemographic factors, including race, sex and socioeconomic status, the association vanished. (FierceHealthcare; Journal of the American Board of Family Medicine)
Newborns are supposed to get a shot of Vitamin K to prevent potentially dangerous bleeds. Most do, but a few new parents decline the shots for their babies, and their numbers seem to be rising--and that's troubling health care professionals. Perhaps unsurprisingly, researchers have identified a link between refusal of Vitamin K and refusal of childhood vaccinations. WBUR interviews physicians and discusses the various factors at play. (WBUR)
As part of MACRA, CMS plans to create patient relationship codes to help determine incentive payments. In a letter to CMS, the American Academy of Family Physicians expressed "grave concerns," and pointed out that because family physicians often handle multiple conditions in a single patient, selecting one choice in the patient relationship category is difficult. "The proposed patient relationship categories have the potential to capture care relationships in a variety of settings," the letter stated, adding AAFP was unconvinced that "the proposed categories are sufficiently clear and distinct to ensure that they will be validly and reliably used by physicians." (AAFP News)
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New & Noted   
What is value-based insurance design? CMS announced plans to expand its value-based insurance design program to more states and more patients. Healthcare Economist offers an overview of VBID and the proposed changes. (Healthcare Economist)

Tribute: A friend's tribute to patient advocate Jess Jacobs, who died this month, has been making the rounds on social media. "Jess' response to all the awfulness she endured was unflaggingly positive. The woman was truly magical in her ability to find humor and light amidst the darkness." (Medium)
When people are dying and you can only save some, how do you choose? What happens, and who chooses what should happen, when humans are forced to play God? That's the question Radiolab  pursues. In this episode, it follows The New York Times reporter Sheri Fink as she explores the question in a war zone, in the wake of a hurricane and earthquake, and in a church basement. (Radiolab)
MarketVoices...quotes worth reading
"I'm struck by how truly funny she was, even as she was facing injustice and indignity that would have enraged Mother Theresa. Her way of screaming about the horrors she faced was to be snarky as hell. And we listened."--Mandi Bishop, in a tribute to patient advocate Jess Jacobs who died earlier this month, in Medium

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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, August 31, 2016

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