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A study published in the Southern Medical Journal undermines a few common assumptions about who frequents emergency departments. For instance, self-paying patients were only 7 percent more likely than commercially insured individuals to be "frequent flyers." "Although it is commonly suspected that uninsured minorities make up the bulk of the patients who frequently use the ED, analysis of our data showed that this was not the case; in fact, the greatest predictor, outside of specific medical complaints, of a patient being a frequent ED user was having a dual Medicare and Medicaid payer classification," the authors wrote. (Southern Medical Journal; MedPage Today)


Spurred by losses, insurers are accelerating their move toward plans offering limited choices of doctors and hospitals, The Wall Street Journal reports. A McKinsey & Co. analysis found about 75 percent of the offerings on exchanges in 2017 will likely be HMOs or exclusive provider organizations. Both typically require consumers to use an often-narrow provider network. Only a quarter will be PPOs, which generally offer larger selections of doctors and hospitals and include out-of-network coverage. (The Wall Street Journal)

"Significant spikes in premiums, insurer dropouts and persistently low enrollment numbers are combining to make this fall's sign-up period a crossroads" for the Affordable Care Act, according to The Wall Street Journal. Of particular importance is persuading a greater number of healthy people to sign up this fall. And all of this is happening before a backdrop of elections that will shape the law's future. But bigger changes will likely require hefty political wrangling among lawmakers from both parties in the new Congress and administration--next year's biggest unknown variable. (The Wall Street Journal)
 

During the office day, a time-motion study, funded by the AMA and published in the Annals of Internal Medicine, found physicians spent 27 percent of their total time on direct clinical face time with patients and 49.2 percent on EHR and deskwork activities. In other words, for each hour of clinical face time with patients, physicians spend nearly two hours on EHR and administrative activities. Physicians also spend personal time on those activities. (FierceHealthcare; Annals of Internal Medicine; AMA statement)
 
Innovation & Transformation  
Increasingly, community health workers are being deployed to better understand patients' socioeconomic circumstances and steer them away from the emergency department and toward cost-efficient, proactive care, HealthLeaders Magazine reports. High-risk patients often face obstacles in their lives clinicians are unaware of that keep them from engaging with the health system. It's here CHWs shine, and it's why they are becoming a critical part of the integrated care team. (HealthLeaders Magazine)

EHR utilization data can be mined to identify ad hoc collaborative care teams and patterns within large medical centers, according to research published in the Journal of the American Medical Informatics Association. Vanderbilt researchers designed a data-mining framework to "infer patterns of collaborative teams." They determined the health care system was "highly collaborative" and the utilization data could be translated into knowledge relevant to collaborative networks. But identification is just the first step. "Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices," they conclude. (FierceHealthcare; Journal of the American Medical Informatics Association)
 
Consumers & Providers
Physician reimbursement alone will not change attitudes surrounding advance care planning (ACP), according to a Health Affairs Blog post. Community members and leaders must also be engaged. The authors draw on the experience of the Washtenaw (Mich.) Health Initiative: Through a series of focus groups and interviews, they learned "ACP is not an accepted, understood part of the normal aging process." They discuss their findings in the blog post and in a white paper. (Health Affairs Blog; white paper)
 
 
Today, 80 percent of the public says their doctor or other provider usually enters their health information into a computer while they are present, according to the latest Kaiser Health Tracking Poll. That's up from 46 percent in 2009. Fifty-two percent now say it is "very important" for their providers to use electronic medical records, up from 42 percent in 2009. While 78 percent of Americans report that at least some of their medical information is available online, less than half of Americans report having accessed any type of medical information online. (Kaiser Family Foundation)
Bring primary care clerks on board as skilled health care team members who can "use administrative tasks as conduits for investing in long-term personalized relationships with patients that foster trust in the [patient-centered medical home] and the broader health care organization," counsel the authors of an Annals of Family Medicine paper. "Integration and support of clerks will make it possible for such team-based initiatives as medical homes to optimize their true potential of transforming how patient care is delivered." This approach not only reduces workload for clinically trained staff; it represents an investment in the "clerks' unique contributions to care," co-author Samantha Solimeo, PhD, MPH, tells AAFP News. (Annals of Family Medicine; AAFP News)
 
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New & Noted   
Precision medicine support: After reading a short description of the Precision Medicine Initiative Cohort Program, 79 percent of the respondents expressed support, and 54 percent said they would definitely or probably participate if asked. This level of support was fairly constant across demographic categories. (PLOS; announcement)
Gray

Practice acquisition spikes: Hospital ownership of physician practices increased by 86 percent from 2012 to 2015, according to analysis by Avalere Health and the Physicians Advocacy Institute. During that period, hospitals acquired 31,000 physician practices. (Becker's Hospital Review)

Interoperability and value: CHIME's Russell Branzell and KLAS' Bob Cash address the role of health IT interoperability in value-based care. To advance value-based care and move closer to the Triple Aim, "we must tackle, once and for all, the problem that providers face in exchanging patient information. Setting data standards and finally addressing the problem of patient identification are two critical starting points." (Health System CIO)
 
Multi-media 
A Center for Medicare & Medicaid Innovation program that includes visits from occupational therapists, nurses and handymen improved low-income seniors' ability to care for themselves in their own homes. The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program has the potential to help seniors age in place and reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment, according to researchers. (AP video)
 
MarketVoices...quotes worth reading
     
"Care is not isolated to the clinical encounter--it begins with the first contact between a patient and the team. Clerks are patients' first introduction to the quality of care they will receive from their PCMH." Samantha Solimeo, PhD, MPH, in AAFP News

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Wednesday, September 14, 2016