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Twelve million U.S. adults have three or more chronic illnesses plus a functional limitation, and the health system is not meeting the needs of these highest-need patients, according to research from the Commonwealth Fund. Despite having coverage, they spend more out-of-pocket than other adults, but they were more likely to have delayed or done without treatment or a prescription, and they're more likely to say that their doctors were disrespectful, didn't spend enough time with them or didn't listen or explain things carefully. The findings are discussed in two reports. (The Fiscal Times; High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care?; Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences)

A new report from the Department of Health and Human Services highlights telemedicine's potential in providing care in rural or underserved communities, delivering mental health or specialist services, managing chronic illnesses and preventing unnecessary hospitalizations. It finds that problems such as lacking broadband connectivity in rural areas and uncertainties--in reimbursement, licensure, credentialing and privileging--hamper implementation. (MobiHealthNews; report)
Innovation & Transformation  
More health centers are opening in schools across the country, serving students and their families. For example there's been a rapid expansion in Georgia. "School-based health centers eliminate every barrier to healthcare that you can think of," says Veda Johnson, MD, who has led Emory University's work to expand the clinics in Georgia schools. Elsewhere, the Mayo Clinic Health System partnered with a Minnesota school system; this approach uses telemedicine. The system, which combines cloud-based software and walk-in kiosks, allows school staff to connect with providers. (FierceHealthcare; The Atlanta Journal-Constitution)

A combination of a visit to the doctor and multiple home nursing visits in the week following discharge cut the probability of readmission for heart failure patients from about 20 percent to about 12 percent, according to research published in
Health Services Research. "Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge," researchers conclude. That's easier said than done, according to the lead researcher, because hospitals generally don't provide home care agencies with "rapid, timely complete clinical information" about patients. (HealthLeaders MediaHealth Services Research)
Minnesota-based Fairview Health Services has launched a mobile health tool, developed by Zipnosis, to help providers identify--and recommend treatment for--people at risk of diabetes or heart disease. Now available to employees, Fairview plans to expand the program to patients and then to all Minnesota residents. Officials also hope to expand the telehealth service to cover more chronic conditions. "We expect this service will make it possible for our providers to diagnose chronic conditions sooner and to recommend immediate interventions if a problem is found," says Fairview's Dang Tran, MD. (mHealth Intelligenceannouncement)
A new paper by the Health Care Transformation Task Force, a "consensus framework," outlines six principles to guide health care professionals in developing patient-centered care models. The Task Force is a consortium of patients, payers, providers and purchasers working to accelerate the pace of U.S. health care delivery system transformation. It has previously committed to having 75 percent of its members' businesses operating under value-based payment arrangements by 2020. (FierceHealthcare; whitepaper/framework)
Consumers & Providers
Some hospitals, including Mount Sinai in New York, are creating separate emergency rooms for the elderly. The rationale: Overcrowding and chaos in traditional emergency rooms can harm seniors' health. "It's like a war zone," physician assistant Emmy Cassagnol tells Kaiser Health News. "When it gets packed, it's overwhelming. Our sickest patients are often our geriatric patients, and they get lost in the shuffle." (Kaiser Health News)
Don't rely on hospital staff to ensure things go smoothly, warns the latest column in Kaiser Health News' Navigating Aging series. "Medical centers' interests (efficiency, opening up needed beds, maximizing payments, avoiding penalties) are not necessarily your interests (recovering as well as possible, remaining independent and easing the burden on caregivers)." To avoid readmission and other adverse outcomes, patients and/or their caregivers need to be aggressive about asking questions and insisting on answers. The column features advice for patients from health policy experts, geriatric care managers, older adults and caregivers. (Kaiser Health News)
CMS hasn't provided physicians enough risk information about Comprehensive Primary Care Plus (CPC+), according to Modern Healthcare. CPC+ is designed to improve primary care by placing physician practices in risk-based payment agreements, but physician organizations say CMS is not being transparent on just how much doctors may lose if they aren't successful meeting goals; that could affect participation. CMS has promised to release information on how it would calculate payments, but nothing's been issued and the deadline is Sept. 15. A spokesman told Modern Healthcare CMS has received significant interest from physicians and physician organizations. (Modern Healthcare)
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New & Noted   
Aging population may strain Medicaid: Many older Americans can't afford long-term care, and this could put an even bigger strain on Medicaid, Kaiser Health News reports. Roughly half of those turning 65 today will need daily help as they age, either at home or in nursing homes. The cost: an average of about $91,000 for men and twice that for women, because they live longer. (Kaiser Health News)

Cancer docs, patients, must communicate: Cancer patients' attitudes and emotions about treatment-related side effects differ from those of oncologists, according to a recent Harris survey. That means oncologists and patients need to communicate more openly about their expectations and coping strategies. (Clinical Oncology)

DOD delivery: The Defense Department is delaying its $4.3 billion EHR modernization project with Cerner by at least a few months. Implementation had been slated to begin Dec. 6. (Healthcare IT News)
In Iran, people can buy and sell kidneys--and there's not a long waiting list as there is in the United States. Some Western doctors see this approach as a way to cut time for lifesaving transplants. Ethicists have questions--about the potential for taking advantage of the poor, for example. (AP, via Science Daily)
MarketVoices...quotes worth reading
"We are asking the sickest people to pay the most, when they have the lowest incomes."--Dr. Gerard Anderson of Johns Hopkins Bloomberg School of Public Health, in a Commonwealth Fund announcement

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Roxanna Guilford-Blake
Sandy Mau




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Wednesday, September 7, 2016